Vitamin B3
Common name
Niacin
ID
HD0276
Scientific name of the plant
Anatomical part for use
Human use
Circulatory disorders
Summary
Niacin, also known as nicotinic acid, is an organic compound and a form of vitamin B3, an essential human nutrient. It can be manufactured by plants and animals from the amino acid tryptophan. Niacin is obtained in the diet from a variety of whole and processed foods, with highest contents in fortified packaged foods, meat, poultry, red fish such as tuna and salmon, lesser amounts in nuts, legumes and seeds. Niacin as a dietary supplement is used to treat pellagra, a disease caused by niacin deficiency. Signs and symptoms of pellagra include skin and mouth lesions, anemia, headaches, and tiredness. Many countries mandate its addition to wheat flour or other food grains, thereby reducing the risk of pellagra.The amide derivative nicotinamide (niacinamide) is a component of the coenzymes nicotinamide adenine dinucleotide (NAD) and nicotinamide adenine dinucleotide phosphate (NADP+). Although niacin and nicotinamide (niacinamide) are identical in their vitamin activity, nicotinamide does not have the same pharmacological, lipid-modifying effects or side effects as niacin, i.e., when niacin takes on the -amide group, it does not reduce cholesterol nor cause flushing. Nicotinamide is recommended as a treatment for niacin deficiency because it can be administered in remedial amounts without causing the flushing, considered an adverse effect.Niacin is also a prescription medication. Amounts far in excess of the recommended dietary intake for vitamin functions will lower blood triglycerides and low density lipoprotein cholesterol (LDL-C), and raise blood high density lipoprotein cholesterol (HDL-C, often referred to as "good" cholesterol). There are two forms: immediate-release and sustained-release niacin. Initial prescription amounts are 500 mg/day, increased over time until a therapeutic effect is achieved. Immediate-release doses can be as high as 3,000 mg/day; sustained-release as high as 2,000 mg/day. Despite the proven lipid changes, niacin has not been found useful for decreasing the risk of cardiovascular disease in those already on a statin. A 2010 review had concluded that niacin was effective as a mono-therapy, but a 2017 review incorporating twice as many trials concluded that prescription niacin, while affecting lipid levels, did not reduce all-cause mortality, cardiovascular mortality, myocardial infarctions, nor fatal or non-fatal strokes. Prescription niacin was shown to cause hepatotoxicity and increase risk of type 2 diabetes. Niacin prescriptions in the U.S. had peaked in 2009, at 9.4 million, declining to 1.3 million by 2017.Niacin has the formula C6H5NO2 and belongs to the group of the pyridinecarboxylic acids. As the precursor for nicotinamide adenine dinucleotide (NAD) and nicotinamide adenine dinucleotide phosphate (NADP), niacin is involved in DNA repair.
Evidence Level
Level 4 (Individual reports repeated observed over 5 years among different countries)
Hepatotoxicity reports in literature
- Ultrasonographic findings in niacin-induced hepatitis : (Source)
- Hepatotoxicity associated with sustained-release niacin : (Source)
- Fulminant hepatic failure following low-dose sustained-release niacin therapy in hospital : (Source)
- A case for immediate-release niacin : (Source)
- Niacin induced coagulopathy as a manifestation of occult liver injury : (Source)
- Acute hepatic failure associated with the use of low-dose sustained-release niacin : (Source)
- Rechallenge with crystalline niacin after drug-induced hepatitis from sustained-release niacin : (Source)
- Fulminant hepatic failure after ingestion of sustained-release nicotinic acid : (Source)
- Rare cause of acute hepatitis: a common energy drink : (Source)
- Hepatitis and hematemesis complicating nicotinic acid use : (Source)
- Nicotinic acid-induced fulminant hepatic failure : (Source)
- Jaundice following the administration of niacin : (Source)
- Hepatic fibrosis following long acting nicotinic acid therapy: a case report : (Source)
- Niacin hepatitis : (Source)
- Niacin-induced hepatitis and thrombocytopenia after 10 years of niacin use : (Source)
- Hepatitis caused by low-dose sustained-release niacin : (Source)
- Intrahepatic cholestasis during nicotinic acid therapy : (Source)
- Transient focal hepatic defects related to sustained-release niacin : (Source)
Hepatotoxicity Description
N/A
Common name
Niacin
ID
HD0276
Scientific name of the plant
Anatomical part for use
Human use
Circulatory disorders
Summary
Niacin, also known as nicotinic acid, is an organic compound and a form of vitamin B3, an essential human nutrient. It can be manufactured by plants and animals from the amino acid tryptophan. Niacin is obtained in the diet from a variety of whole and processed foods, with highest contents in fortified packaged foods, meat, poultry, red fish such as tuna and salmon, lesser amounts in nuts, legumes and seeds. Niacin as a dietary supplement is used to treat pellagra, a disease caused by niacin deficiency. Signs and symptoms of pellagra include skin and mouth lesions, anemia, headaches, and tiredness. Many countries mandate its addition to wheat flour or other food grains, thereby reducing the risk of pellagra.The amide derivative nicotinamide (niacinamide) is a component of the coenzymes nicotinamide adenine dinucleotide (NAD) and nicotinamide adenine dinucleotide phosphate (NADP+). Although niacin and nicotinamide (niacinamide) are identical in their vitamin activity, nicotinamide does not have the same pharmacological, lipid-modifying effects or side effects as niacin, i.e., when niacin takes on the -amide group, it does not reduce cholesterol nor cause flushing. Nicotinamide is recommended as a treatment for niacin deficiency because it can be administered in remedial amounts without causing the flushing, considered an adverse effect.Niacin is also a prescription medication. Amounts far in excess of the recommended dietary intake for vitamin functions will lower blood triglycerides and low density lipoprotein cholesterol (LDL-C), and raise blood high density lipoprotein cholesterol (HDL-C, often referred to as "good" cholesterol). There are two forms: immediate-release and sustained-release niacin. Initial prescription amounts are 500 mg/day, increased over time until a therapeutic effect is achieved. Immediate-release doses can be as high as 3,000 mg/day; sustained-release as high as 2,000 mg/day. Despite the proven lipid changes, niacin has not been found useful for decreasing the risk of cardiovascular disease in those already on a statin. A 2010 review had concluded that niacin was effective as a mono-therapy, but a 2017 review incorporating twice as many trials concluded that prescription niacin, while affecting lipid levels, did not reduce all-cause mortality, cardiovascular mortality, myocardial infarctions, nor fatal or non-fatal strokes. Prescription niacin was shown to cause hepatotoxicity and increase risk of type 2 diabetes. Niacin prescriptions in the U.S. had peaked in 2009, at 9.4 million, declining to 1.3 million by 2017.Niacin has the formula C6H5NO2 and belongs to the group of the pyridinecarboxylic acids. As the precursor for nicotinamide adenine dinucleotide (NAD) and nicotinamide adenine dinucleotide phosphate (NADP), niacin is involved in DNA repair.
Evidence Level
Level 4 (Individual reports repeated observed over 5 years among different countries)
Hepatotoxicity reports in literature
- Ultrasonographic findings in niacin-induced hepatitis : (Source)
- Hepatotoxicity associated with sustained-release niacin : (Source)
- Fulminant hepatic failure following low-dose sustained-release niacin therapy in hospital : (Source)
- A case for immediate-release niacin : (Source)
- Niacin induced coagulopathy as a manifestation of occult liver injury : (Source)
- Acute hepatic failure associated with the use of low-dose sustained-release niacin : (Source)
- Rechallenge with crystalline niacin after drug-induced hepatitis from sustained-release niacin : (Source)
- Fulminant hepatic failure after ingestion of sustained-release nicotinic acid : (Source)
- Rare cause of acute hepatitis: a common energy drink : (Source)
- Hepatitis and hematemesis complicating nicotinic acid use : (Source)
- Nicotinic acid-induced fulminant hepatic failure : (Source)
- Jaundice following the administration of niacin : (Source)
- Hepatic fibrosis following long acting nicotinic acid therapy: a case report : (Source)
- Niacin hepatitis : (Source)
- Niacin-induced hepatitis and thrombocytopenia after 10 years of niacin use : (Source)
- Hepatitis caused by low-dose sustained-release niacin : (Source)
- Intrahepatic cholestasis during nicotinic acid therapy : (Source)
- Transient focal hepatic defects related to sustained-release niacin : (Source)
Hepatotoxicity Description
N/A