Dosage of Niacin in details
Niacin Extended-Release Tablets should be taken at bedtime, after a low-fat snack, and doses should be individualized according to patient response. Therapy with Niacin Extended-Release Tablets must be initiated at 500 mg at bedtime in order to reduce the incidence and severity of side effects which may occur during early therapy. The recommended dose escalation is shown in Table 1 below.
| Week(s) | Daily Dose | Niacin Extended-Release Tablets Dosage | |
| INITIAL TITRATION | 1 to 4 | 500 mg | 1 Niacin Extended-Release 500 mg Tablet at bedtime |
| SCHEDULE | 5 to 8 | 1000 mg | 1 Niacin Extended-Release 1000 mg Tablet or 2 Niacin Extended-Release 500 mg Tablets at bedtime |
| * | 1500 mg | 2 Niacin Extended-Release 750 mg Tablets or 3 Niacin Extended-Release 500 mg Tablets at bedtime | |
| * | 2000 mg | 2 Niacin Extended-Release 1000 mg Tablets or 4 Niacin Extended-Release 500 mg Tablets at bedtime | |
| * After Week 8, titrate to patient response and tolerance. If response to 1000 mg daily is inadequate, increase dose to 1500 mg daily; may subsequently increase dose to 2000 mg daily. Daily dose should not be increased more than 500 mg in a 4-week period, and doses above 2000 mg daily are not recommended. Women may respond at lower doses than men. | |||
Maintenance Dose
The daily dosage of Niacin Extended-Release Tablets should not be increased by more than 500 mg in any 4-week period. The recommended maintenance dose is 1000 mg (two 500 mg tablets or one 1000 mg tablet) to 2000 mg (two 1000 mg tablets or four 500 mg tablets) once daily at bedtime. Doses greater than 2000 mg daily are not recommended. Women may respond at lower Niacin Extended-Release Tablet doses than men.
Single-dose bioavailability studies have demonstrated that two of the 500 mg and one of the 1000 mg tablet strengths are interchangeable but three of the 500 mg and two of the 750 mg tablet strengths are not interchangeable.
Flushing of the skin may be reduced in frequency or severity by pretreatment with aspirin (up to the recommended dose of 325 mg taken 30 minutes prior to Niacin Extended-Release Tablet dose). Tolerance to this flushing develops rapidly over the course of several weeks. Flushing, pruritus, and gastrointestinal distress are also greatly reduced by slowly increasing the dose of Niacin and avoiding administration on an empty stomach. Concomitant alcoholic, hot drinks or spicy foods may increase the side effects of flushing and pruritus and should be avoided around the time of Niacin Extended-Release Tablet ingestion.
Equivalent doses of Niacin Extended-Release Tablets should not be substituted for sustained-release (modified-release, timed-release) Niacin preparations or immediate-release (crystalline) Niacin. Patients previously receiving other Niacin products should be started with the recommended Niacin Extended-Release Tablet titration schedule, and the dose should subsequently be individualized based on patient response.
If Niacin Extended-Release Tablet therapy is discontinued for an extended period, reinstitution of therapy should include a titration phase.
Niacin Extended-Release Tablets should be taken whole and should not be broken, crushed or chewed before swallowing.
Dosage in Patients with Renal or Hepatic Impairment
Use of Niacin Extended-Release Tablets in patients with renal or hepatic impairment has not been studied. Niacin Extended-Release Tablets are contraindicated in patients with significant or unexplained hepatic dysfunction. Niacin Extended-Release Tablets should be used with caution in patients with renal impairment.
What other drugs will affect Niacin?
Tell your doctor about all other cholesterol-lowering drugs you are taking with Niacin, especially atorvastatin (Lipitor, Caduet), fluvastatin (Lescol), lovastatin (Mevacor, Altoprev, Advicor), pravastatin (Pravachol), or simvastatin (Zocor, Simcor, Vytorin, Juvisync).
Ask a doctor or pharmacist if it is safe for you to use Niacin if you are also using any of the following drugs:
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a blood thinner such as warfarin (Coumadin, Jantoven);
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multivitamins or mineral supplements that contain Niacin;
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blood pressure or heart medications such as amlodipine (Norvasc, Caduet, Exforge, Lotrel, Tekamlo, Tribenzor, Twynsta, Amturnide), diltiazem (Cardizem, Cartia, Dilacor, Diltia, Diltzac, Taztia, Tiazac), felodipine (Plendil), nicardipine (Cardene), nifedipine (Procardia, Adalat), nimodipine (Nimotop), nisoldipine (Sular), or verapamil (Calan, Covera, Isoptin, Verelan); or
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heart medications such as doxazosin (Cardura), isosorbide (Dilatrate, Imdur, Isordil, Monoket, Sorbitrate), nitroglycerin (Nitro-Bid, Nitro-Dur, Nitrostat), prazosin (Minipress), or terazosin (Hytrin).
This list is not complete and other drugs may interact with Niacin. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.
Niacin interactions
Statins
Caution should be used when prescribing Niacin ( ≥ 1 gm/day) with statins as these drugs can increase risk of myopathy/rhabdomyolysis.
Bile Acid Sequestrants
An in vitro study results suggest that the bile acid-binding resins have high Niacin binding capacity. Therefore, 4 to 6 hours, or as great an interval as possible, should elapse between the ingestion of bile acid-binding resins and the administration of Niacin.
Aspirin
Concomitant aspirin may decrease the metabolic clearance of Niacin. The clinical relevance of this finding is unclear.
Antihypertensive Therapy
Niacin may potentiate the effects of ganglionic blocking agents and vasoactive drugs resulting in postural hypotension.
Other
Vitamins or other nutritional supplements containing large doses of Niacin or related compounds such as nicotinamide may potentiate the adverse effects of Niacin.
Laboratory Test Interactions
Niacin may produce false elevations in some fluorometric determinations of plasma or urinary catecholamines. Niacin may also give false-positive reactions with cupric sulfate solution (Benedict's reagent) in urine glucose tests.
References
- DailyMed. "NIACIN: DailyMed provides trustworthy information about marketed drugs in the United States. DailyMed is the official provider of FDA label information (package inserts).". https://dailymed.nlm.nih.gov/dailyme... (accessed September 17, 2018).
- FDA/SPL Indexing Data. "2679MF687A: The UNique Ingredient Identifier (UNII) is an alphanumeric substance identifier from the joint FDA/USP Substance Registration System (SRS).". https://www.fda.gov/ForIndustry/Data... (accessed September 17, 2018).
- MeSH. "Vitamin B Complex". https://www.ncbi.nlm.nih.gov/mesh/68... (accessed September 17, 2018).
Reviews
The results of a survey conducted on ndrugs.com for Niacin are given in detail below. The results of the survey conducted are based on the impressions and views of the website users and consumers taking Niacin. We implore you to kindly base your medical condition or therapeutic choices on the result or test conducted by a physician or licensed medical practitioners.User reports
Consumer reported frequency of use
No survey data has been collected yet3 consumers reported doses
What doses of Niacin drug you have used?The drug can be in various doses. Most anti-diabetic, anti-hypertensive drugs, pain killers, or antibiotics are in different low and high doses and prescribed by the doctors depending on the severity and demand of the condition suffered by the patient. In our reports, ndrugs.com website users used these doses of Niacin drug in following percentages. Very few drugs come in a fixed dose or a single dose. Common conditions, like fever, have almost the same doses, e.g., [acetaminophen, 500mg] of drug used by the patient, even though it is available in various doses.
| Users | % | ||
|---|---|---|---|
| 11-50mg | 1 | 33.3% | |
| 51-100mg | 1 | 33.3% | |
| 201-500mg | 1 | 33.3% | |
Consumer reviews
There are no reviews yet. Be the first to write one! |
Information checked by Dr. Sachin Kumar, MD Pharmacology
