Nicotinic acid


Concise Prescribing Info
Indications/Uses
Listed in Dosage.
Dosage/Direction for Use
Adult : PO Nicotinic acid deficiency For treatment of pellagra: 300-500 mg/day in divided doses. For management of Hartnup disease: 50-200 mg/day. Hyperlipidaemias Initial: 250 mg once daily in the evening. Increase dose every 4-7 days until desired outcome is achieved or dose of 1.5-2 g/day is reached. If hyperlipidaemia is not controlled after 2 mth, it can be increased at 2- to 4-wk intervals to 1 g tid. Max: 6 g/day. As extended-release tab: Initial: 500 mg at night. Maintenance: 1-2 g at bedtime. Vasodilation 100-150 mg 3-5 times daily. As extended-release tab: 300-400 mg 12 hrly. Topical Mild to moderate inflammatory acne As 4% gel: Apply to affected area bid.
Dosage Details
Oral
Hyperlipidaemias
Adult: Initially, 250 mg once daily in the evening. Increase dose every 4-7 days until desired LDL cholesterol and/or triglyceride level is achieved or dose of 1.5-2 g/day is reached. If hyperlipidaemia is not adequately controlled after 2 mth w/ this dose, it can be increased at 2- to 4-wk intervals to 1 g tid. Max: 6 g daily. As extended-release tab: Initially, 500 mg at night, gradually increased according to response to a maintenance of 1-2 g at bedtime.

Oral
Vasodilation
Adult: 100-150 mg 3-5 times daily. As extended-release tab: 300-400 mg 12 hrly.

Oral
Treatment and prophylaxis of nicotinic acid deficiency
Adult: For treatment of pellagra: 300-500 mg daily in divided doses. For management of Hartnup disease: 50-200 mg daily.
Child: For treatment of pellagra: 100-300 mg daily in divided doses.

Topical/Cutaneous
Mild to moderate inflammatory acne
Adult: As 4% gel: Apply to affected area bid.
Administration
Should be taken with food. Take at bedtime after a low-fat snack.
Contraindications
Patient w/ active liver disease or unexplained persistent elevations of serum transaminases, active peptic ulcer disease, arterial bleeding.
Special Precautions
Patient w/ unstable angina, acute MI, CHD, DM, gout, history of peptic ulceration. Patient who consume large amount of alcohol. Patient undergoing surgery. Renal or hepatic impairment. Pregnancy and lactation.
Adverse Reactions
Flushing, sensation of heat, faintness, pounding in the head, tingling, itching, headache, dizziness, tachycardia, palpitations, dyspnoea, sweating, chills, oedema; dryness of skin, pruritus, hyperpigmentation, rash, cramps, cough, diarrhoea, nausea and vomiting, anorexia, activation of peptic ulcer, eye disorders including cystoid macular oedema and toxic amblyopia; decreased glucose tolerance, hyperglycaemia, hyperuricaemia; abnormal LFTs, jaundice; hypophosphataemia, reduced platelet counts, prolonged prothrombin time, arrhythmias, hypersensitivity reactions including angioedema; insomnia, myalgia and hypotension.
IM/IV/Parenteral/PO/SC: C
MonitoringParameters
Monitor LFTs and blood glucose frequently.
Drug Interactions
Increased risk of myopathy and rhabdomyolysis w/ concomitant HMG-CoA reductase inhibitors. Reduced bioavailability w/ colestyramine or colestipol. Decreased metabolic clearance w/ aspirin. May potentiate effects of ganglionic blocking agents and vasoactive drugs resulting in postural hypotension.
Food Interaction
Avoid alcohol or hot drinks and spicy foods as it may increase risk of flushing and pruritus.
Lab Interference
May produce false elevations in some fluorometric determinations of plasma or urinary catecholamines. May give false-positive results w/ cupric sulfate soln (Benedict's reagent) in urine glucose determination.
Action
Description: Nicotinic acid is a derivative of vitamin B3 and is incorporated into coenzymes nicotinamide adenine dinucleotide (NAD) and nicotinamide adenine dinucleotide phosphate (NADP), which are involved in multiple cellular metabolic pathways. Nicotinic acid also reduces total serum cholesterol, LDL, VLDL, apolipoprotein B and triglycerides, and increases HDL cholesterol.
Pharmacokinetics:
Absorption: Readily absorbed from the GI tract.
Distribution: Widely distributed in body tissues and appears in breast milk.
Metabolism: Converted to N-methylnicotinamide, 2-pyridone and 4-pyridone derivatives.
Excretion: Via urine in small amounts as unchanged drug. Plasma elimination half-life: 20-45 min.
Chemical Structure

Chemical Structure Image
Nicotinic acid

Source: National Center for Biotechnology Information. PubChem Database. Nicotinic acid, CID=938, https://pubchem.ncbi.nlm.nih.gov/compound/Nicotinic-acid (accessed on Jan. 22, 2020)

Storage
Store between 20-25°C.
ATC Classification
C10AD02 - nicotinic acid ; Belongs to the class of nicotinic acid and derivatives. Used in the treatment of hyperlipidemia.
C04AC01 - nicotinic acid ; Belongs to the class of nicotinic acid agents. Used as peripheral vasodilators.
References
Anon. Niacin. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 10/10/2014.

Buckingham R (ed). Nicotinic acid. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 10/10/2014.

Joint Formulary Committee. Nicotinic acid. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 10/10/2014.

McEvoy GK, Snow EK, Miller J et al (eds). Niacin, Niacinamide. AHFS Drug Information (AHFS DI) [online]. American Society of Health-System Pharmacists (ASHP). https://www.medicinescomplete.com. Accessed 10/10/2014.

McEvoy GK, Snow EK, Miller J et al (eds). Niacin. AHFS Drug Information (AHFS DI) [online]. American Society of Health-System Pharmacists (ASHP). https://www.medicinescomplete.com. Accessed 10/10/2014.

Niacor-Niacin Tablet (Upsher-Smith Laboratories Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 10/10/2014.

Niaspan-Niacin Tablet, Film Coated, Extended Release. DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 26/08/2015.

Disclaimer: This information is independently developed by MIMS based on Nicotinic acid from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to MIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, MIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2020 MIMS. All rights reserved. Powered by MIMS.com
Register or sign in to continue
Asia's one-stop resource for medical news, clinical reference and education
Sign up for free
Already a member? Sign in