niacin (vitamin B3)

Adult Dosing .

Dosage forms:  CAP: 500 mg, 1000 mg; ER CAP: 250 mg, 500 mg; TAB: 50 mg, 100 mg, 250 mg, 500 mg; ER TAB: 250 mg, 500 mg, 750 mg, 1000 mg

Special Note

[formulation clarification]

Info: two 500 mg ER tab interchangeable w/ one 1000 mg ER tab, while three 500 mg ER tab not interchangeable w/ two 750 mg ER tab; niacin ER products not interchangeable w/ other niacin ER products

dietary supplementation

[individualize dose]

Info: see Dietary Reference Intakes: Vitamin B3 (niacin) table

hypertriglyceridemia, severe

[immediate-release form (off-label)]

Dose: 1500-3000 mg/day PO divided bid-tid; Start: 250 mg PO qhs, then incr. 250 mg/day q4-7 days up to 2000 mg/day, then after 2mo, may incr. 250-500 mg/day q2-4wk; Max: 6000 mg/day; Info: 325 mg aspirin 30min before dose may reduce flushing; give w/ food

[extended-release form]

Dose: 1000-2000 mg ER PO qhs; Start: 500 mg ER PO qhs x4wk, then incr. 500 mg/day q4wk based on effect/tolerance; Max: 2000 mg/day ER; Info: use start regimen even when switching from other niacin products; aspirin 325 mg 30min before dose may reduce flushing; do not cut/crush/chew ER tab; give w/ low-fat food

primary hyperlipidemia

[immediate-release form (off-label)]

Dose: 1500-3000 mg/day PO divided bid-tid; Start: 250 mg PO qhs, then incr. 250 mg/day q4-7 days up to 2000 mg/day, then after 2mo, may incr. 250-500 mg/day q2-4wk; Max: 6000 mg/day; Info: not 1st-line tx; 325 mg aspirin 30min before dose may reduce flushing; give w/ food

[extended-release form]

Dose: 1000-2000 mg ER PO qhs; Start: 500 mg ER PO qhs x4wk, then incr. 500 mg/day q4wk based on effect/tolerance; Max: 2000 mg/day ER; Info: not 1st-line tx; use start regimen even when switching from other niacin products; aspirin 325 mg 30min before dose may reduce flushing; do not cut/crush/chew ER tab; give w/ low-fat food

cardiovascular event risk reduction

[1000-2000 mg ER PO qhs]

Start: 500 mg ER PO qhs x4wk, then incr. 500 mg/day q4wk based on effect/tolerance; Max: 2000 mg/day ER; Info: use start regimen even when switching from other niacin products; aspirin 325 mg 30min before dose may reduce flushing; do not cut/crush/chew ER tab; give w/ low-fat food

CAD

[1000-2000 mg ER PO qhs]

Start: 500 mg ER PO qhs x4wk, then incr. 500 mg/day q4wk based on effect/tolerance; Max: 2000 mg/day ER; Info: use start regimen even when switching from other niacin products; aspirin 325 mg 30min before dose may reduce flushing; do not cut/crush/chew ER tab; give w/ low-fat food

pellagra (off-label)

[25-300 mg/day PO divided qd-tid]

Start: 100-250 mg PO tid x5 days if symptomatic; Info: 325 mg aspirin 30min before dose may reduce flushing; give w/ food

renal dosing

[see below]

renal impairment: not defined, caution advised

HD/PD: not defined

hepatic dosing

[see below]

hepatic dz hx: not defined, caution advised; unexplained elev. LFTs/active hepatic dz: contraindicated

Peds Dosing .

Dosage forms:  TAB: 50 mg

dietary supplementation

[individualize dose]

Info: see Dietary Reference Intakes: Vitamin B3 (niacin) table

renal dosing

[see below]

renal impairment: not defined, caution advised

HD/PD: not defined

hepatic dosing

[see below]

hepatic dz hx: not defined, caution advised; unexplained elev. LFTs/active hepatic dz: contraindicated