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1 Contraindications/Precautions
Contraindicated in: Hypersensitivity to niacin; Some products may contain tar- PDF Page #1
niacin trazine and should be avoided in patients with known hypersensitivity; Alcohol intol-
(nye-a-sin) erance (Nicotinex only).
Niacor, Niaspan, Nicobid, Nicolar, Nicotinex, nicotinic acid, Slo-Niacin, vitamin B3 Use Cautiously in: Liver disease; Arterial bleeding; History of peptic ulcer disease;
niacinamide Gout; Glaucoma; Diabetes mellitus.
(nye-a-sin-a-mide) Adverse Reactions/Side Effects
nicotinamide Adverse reactions and side effects refer to doses used to treat hyperlipidemia CNS:
Classification dizziness, nervousness, panic. EENT: blurred vision, loss of central vision, propto-
Therapeutic: lipid-lowering agents, vitamins sis, toxic amblyopia. CV: orthostatic hypotension. GI: HEPATOTOXICITY, GI upset,
Pharmacologic: water soluble vitamins bloating, diarrhea, dry mouth, flatulence, heartburn, hunger pains, nausea, peptic ul-
Pregnancy Category C ceration. Derm: flushing of the face and neck, pruritus, burning, dry skin, hyperpig-
mentation,qsebaceous gland activity, rashes, stinging or tingling of skin. Metab:
glycosuria, hyperglycemia, hyperuricemia. MS: myalgia.
Indications
Treatment and prevention of niacin deficiency (pellagra). Adjunctive therapy in cer- Interactions
tain hyperlipidemias (niacin only). Drug-Drug:qrisk of myopathy with concurrent use of HMG-CoA reductase in-
Action hibitors. Additive hypotension with antihypertensive agents. Large doses mayp
Required as coenzymes (for lipid metabolism, glycogenolysis, and tissue respira- uricosuric effects of probenecid.
tion). Large doses decrease lipoprotein and triglyceride synthesis by inhibiting the Route/Dosage
release of free fatty acids from adipose tissue and decreasing hepatic lipoprotein syn- PO (Adults and Children): Dietary supplement— 10– 20 mg/day. Dietary defi-
thesis (niacin only). Cause peripheral vasodilation in large doses (niacin only). ciency— Up to 500 mg/day in divided doses. Hyperlipidemias– Niacin only— Im-
Therapeutic Effects: Decreased blood lipids (niacin only). Supplementation in mediate-release: 250 mg once daily;qdose every 4– 7 days to desired response
deficiency states. (usual dose ⫽ 1.5– 2 g/day in 2– 3 divided doses); after 2– 3 mo, mayqat 2– 4 wk
Pharmacokinetics intervals to 1 g 3 times daily; Extended-release: 500 mg at bedtime for 4 wk, then 1 g
Absorption: Well absorbed following oral administration. at bedtime for 4 wk; may thenqdose every 4 wk by 500 mg/day to maximum of 2 g/
Distribution: Widely distributed following conversion to niacinamide. Enters day.
breast milk. PO (Children 7– 10 yr): Prevention of deficiency— 13 mg/day.
Metabolism and Excretion: Amounts required for metabolic processes are PO (Children 4– 6 yr): Prevention of deficiency— 12 mg/day.
converted to niacinamide. Large doses of niacin are excreted unchanged in the urine. PO (Children birth– 3 yr): Prevention of deficiency— 5– 9 mg/day.
Half-life: 45 min. NURSING IMPLICATIONS
TIME/ACTION PROFILE (effects on blood lipids)
Assessment
ROUTE ONSET PEAK DURATION ● Vitamin Deficiency: Assess patient for signs of niacin deficiency (pellagra—
PO (cholesterol) several days unknown unknown dermatitis, stomatitis, glossitis, anemia, nausea and vomiting, confusion, memory
PO (triglycerides) several hr unknown unknown loss, and delirium) prior to and periodically during therapy.
⫽ Canadian drug name. ⫽ Genetic Implication. CAPITALS indicate life-threatening, underlines indicate most frequent. Strikethrough ⫽ Discontinued.
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2 ● Foods high in niacin include meats, eggs, milk, and dairy products; little is lost
during ordinary cooking.
● Hyperlipidemia: Obtain a diet history, especially with regard to fat consumption. ● Patients self-medicating with vitamin supplements should be cautioned not to ex- PDF Page #2
● Lab Test Considerations: Monitor serum glucose and uric acid levels and he- ceed RDA. The effectiveness of megadoses for treatment of various medical condi-
patic function tests periodically during prolonged high-dose therapy. Notify health tions is unproved and may cause side effects.
care professional if AST, ALT, or LDH becomes elevated. Mayqprothrombin times ● Hyperlipidemia: Advise patient that this medication should be used in conjunc-
andpserum albumin. tion with dietary restrictions (fat, cholesterol, carbohydrates, alcohol), exercise,
● High-dose therapy may causeqserum glucose and uric acid levels. and cessation of smoking.
● When niacin is used as a lipid-lowering agent, serum cholesterol and triglyceride
levels should be monitored prior to and periodically during therapy. Evaluation/Desired Outcomes
● Prevention and treatment of niacin deficiency.
Potential Nursing Diagnoses ● Decrease in serum cholesterol and triglyceride levels.
Imbalanced nutrition: less than body requirements (Indications)
Noncompliance (Patient/Family Teaching) Why was this drug prescribed for your patient?
Implementation
● Because of infrequency of single B-vitamin deficiencies, combinations are com-
monly administered.
● PO: Administer with meals or milk to minimize GI irritation.
● Extended-release tablets and capsules should be swallowed whole, without break-
ing, crushing, or chewing. Use calibrated measuring device to ensure accurate
dose of solution.
Patient/Family Teaching
● Inform patient that cutaneous flushing and a sensation of warmth, especially in the
face, neck, and ears; itching or tingling; and headache may occur within the first 2
hr after taking the drug. These effects are usually transient and subside with con-
tinued therapy. If flushing is distressing or persistent, aspirin 300 mg given 30 min
before each dose or slow upward titration of dose may decrease flushing.
● Advise patient to change positions slowly to minimize orthostatic hypotension.
● Instruct patients taking long-term OTC extended-release niacin to re-
port signs of hepatotoxicity (darkening of urine, light gray– colored
stool, loss of appetite, severe stomach pain, yellow eyes or skin) to
health care professional.
● Emphasize the importance of follow-up examinations to evaluate progress.
● Vitamin Deficiency: Encourage patient to comply with dietary recommendations
of health care professional. Explain that the best source of vitamins is a well-bal-
anced diet with foods from the four basic food groups.
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