Vitamin B3

Related Terms

2-pyridone, 3-pyridine carboxamide, acipimox (5-methylpyrazinecarboxylic acid 4-oxide), acipomox, Acipimox?, anti-blacktongue factor, antipellagra factor, B vitamin, B-complex vitamin, benicot, B-vitamin, chromium polynicotinate (niacin-bound chromium), coenzyme beta-nicotinamide adenine dinucleotide (NAD(+)), crystalline niacin, dihydropyridines, Efacin?, Endur-Acin? (sustained release niacin (nicotinic acid)), Enduramide?, ER niacin, esters of niacin, extended-release (ER) niacin, extended-release (ER) niacin monotherapy, extended-release (ER) niacin therapy, Hexopal?, immediate-release (crystalline) niacin, immediate-release niacin, inositol hexaniacinate, inositol hexanicotinate, inositol nicotinate, kynurenine (KYN), low-dose sustained-release nicotinic acid (Tri-B3), meso-inositol hexanicotinate, methyl niacinamide, Nature's Bounty? Flush Free Niacin Inositol Hexanicotinate 500mg Dietary Supplement, NIAC?, niacin, niacin (nicotinic acid), niacin equivalents, niacin ER, niacinamide, niacinamide adenine dinucleotide (NAD), niacinamide adenine dinucleotide phosphate (NADP), niacin/colestipol therapy, Niacor?, Niaspan? (prolonged-release nicotinic acid), Niaspan? (sustained-release nicotinic acid), Nicalex?, nicamid, Nicamin?, Nicangin?, Niceritrol, Nico-400?, Nicobid? (sustained-released niacin), Nicobid? (time-release niacin), Nicolar? (unmodified niacin), nicosedine, Nico-Span?, nicotinamide, nicotinamide (niacinamide), Nicotinamide cures, nicotinate, Nicotinex?, nicotinic acid, nicotinic acid adenine, nicotinic acid adenine dinucleotide phosphate (NAADP), nicotinic acid amide, nicotinic acid analog (low plasma free fatty acid trial, LFA), nicotinic acid analogue, nicotinic amide, nicotinuric acid, nicotylamidum, nutrient supplements, Papulex?, pellagra preventing factor, pentaerythritoltetranicotinate, perycit, prolonged-release (PR) nicotinic acid (niacine)[Niaspan?], pyridine-3-carboxylic acid, Slo-Niacin? (sustained-release niacin), sustained-release nicotinic acid (Nico-Span?), Tega-Span?, Tri-B3?, trigonelline, tryptophan, vitamin B-3, vitamin B3, vitamin B3 (nicotinamide), vitamin B3 derivative, vitamin-B complex (vit-B), Wampocap?, wax-matrix sustained release niacin, wax-matrix sustained-release niacin (Endur-Acin?).
Combination product examples: ADVICOR? (niacin extended-release/lovastatin tablets), CordaptiveTM (niacin/laropiprant).

Background

Vitamin B3 is made up of niacin and niacinamide, and can be found in many foods, including yeast, meat, fish, milk, eggs, green vegetables, and cereal grains. Vitamin B3 is often found in combination with other B vitamins, including thiamine, riboflavin, pantothenic acid, pyridoxine, cyanocobalamin, and folic acid.
The U.S. Food and Drug Administration (FDA) has approved niacin for use in treating vitamin B3 deficiency (pellagra), which includes symptoms of skin inflammation, dementia, and diarrhea.
Human research has shown that niacin is effective and relatively safe for treating high cholesterol levels. Limited evidence shows that niacin may help with clogged arteries and heart disease. Side effects commonly related to higher doses of niacin are itching, flushing, and stomach upset. Niacin may also cause liver problems, increased blood sugar, and hormone changes.

Evidence Table

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. GRADE *
These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. GRADE *


Niacin is a well-accepted treatment for high cholesterol. Multiple studies show that niacin (not niacinamide) has benefits on levels of high-density cholesterol (HDL or "good cholesterol"), with better results than drugs such as "statins" like atorvastatin (Lipitor?). There are also benefits on levels of low-density cholesterol (LDL or "bad cholesterol"), although these effects are less dramatic. Adding niacin to a second drug such as a statin may increase the effects on low-density lipoproteins. The use of niacin for the treatment of high cholesterol associated with type 2 diabetes has been controversial because of the possibility of worsening blood sugar control. People should check with a physician and pharmacist before starting niacin.

 A


Niacin is a well-accepted treatment for high cholesterol. Multiple studies show that niacin (not niacinamide) has benefits on levels of high-density cholesterol (HDL or "good cholesterol"), with better results than drugs such as "statins" like atorvastatin (Lipitor?). There are also benefits on levels of low-density cholesterol (LDL or "bad cholesterol"), although these effects are less dramatic. Adding niacin to a second drug such as a statin may increase the effects on low-density lipoproteins. The use of niacin for the treatment of high cholesterol associated with type 2 diabetes has been controversial because of the possibility of worsening blood sugar control. People should check with a physician and pharmacist before starting niacin.

 A


Niacin (vitamin B3) and niacinamide are U.S. Food and Drug Administration (FDA)-approved for the treatment of pellagra, or niacin deficiency. Pellagra is a nutritional disease that occurs due to insufficient dietary amounts of vitamin B3 or the chemical it is made from (tryptophan). Symptoms of pellagra include skin disease, diarrhea, dementia, and depression.

 A


Niacin (vitamin B3) and niacinamide are U.S. Food and Drug Administration (FDA)-approved for the treatment of pellagra, or niacin deficiency. Pellagra is a nutritional disease that occurs due to insufficient dietary amounts of vitamin B3 or the chemical it is made from (tryptophan). Symptoms of pellagra include skin disease, diarrhea, dementia, and depression.

 A


Niacin decreases blood levels of cholesterol, which may reduce the risk of clogged or hardened arteries. However, niacin also can increase homocysteine levels, which may have the opposite effect. Overall, the research supports the use of niacin in combination with other drugs to reduce the risk of clogged arteries. More research is needed in this area before a firm conclusion can be drawn.

 B


Niacin decreases blood levels of cholesterol, which may reduce the risk of clogged or hardened arteries. However, niacin also can increase homocysteine levels, which may have the opposite effect. Overall, the research supports the use of niacin in combination with other drugs to reduce the risk of clogged arteries. More research is needed in this area before a firm conclusion can be drawn.

 B


Niacin decreases levels of cholesterol, and other chemicals in the blood, which can reduce the risk of heart disease. However, niacin also increases homocysteine levels, which can increase this risk. Research has shown beneficial effects of niacin, especially in combination with other drugs, for preventing heart disease and fatal heart attacks. Further study is needed to draw conclusions.

 B


Niacin decreases levels of cholesterol, and other chemicals in the blood, which can reduce the risk of heart disease. However, niacin also increases homocysteine levels, which can increase this risk. Research has shown beneficial effects of niacin, especially in combination with other drugs, for preventing heart disease and fatal heart attacks. Further study is needed to draw conclusions.

 B


Early evidence suggests that niacin may have beneficial effects in age-related macular degeneration (AMD), a disease that often leads to vision loss. More well-designed studies are needed for conclusions to be reached.

 C


Early evidence suggests that niacin may have beneficial effects in age-related macular degeneration (AMD), a disease that often leads to vision loss. More well-designed studies are needed for conclusions to be reached.

 C


Dementia can be caused by a severe lack of niacin in the body. Early evidence suggests that taking more niacin in the diet may slow the onset of Alzheimer's disease and mental decline. Further research is needed before a conclusion can be drawn.

C


Dementia can be caused by a severe lack of niacin in the body. Early evidence suggests that taking more niacin in the diet may slow the onset of Alzheimer's disease and mental decline. Further research is needed before a conclusion can be drawn.

C


Early research suggests that niacin has a beneficial effect on erectile dysfunction. However, further well-controlled studies are needed to draw conclusions.

C


Early research suggests that niacin has a beneficial effect on erectile dysfunction. However, further well-controlled studies are needed to draw conclusions.

C


Early research shows that niacin may be beneficial in the treatment or prevention of headaches. More research is needed.

 C


Early research shows that niacin may be beneficial in the treatment or prevention of headaches. More research is needed.

 C


Early research suggests that niacin may decrease blood levels of hepatitis C, a virus that damages the liver. Notably, niacin has been also associated with liver damage. Further research is necessary for a conclusion to be made.

C


Early research suggests that niacin may decrease blood levels of hepatitis C, a virus that damages the liver. Notably, niacin has been also associated with liver damage. Further research is necessary for a conclusion to be made.

C


Early evidence shows that niacinamide had reduced high phosphate levels in the blood. However, more research is needed before a firm conclusion can be made.

 C


Early evidence shows that niacinamide had reduced high phosphate levels in the blood. However, more research is needed before a firm conclusion can be made.

 C


Early research suggests that niacinamide may be useful in the treatment of osteoarthritis. Further research is needed before a conclusion can be made.

 C


Early research suggests that niacinamide may be useful in the treatment of osteoarthritis. Further research is needed before a conclusion can be made.

 C


Niacinamide has been used in skin care products, including moisturizers, anti-aging products, and treatments for rosacea, a skin condition involving facial redness and pimples. The benefits of niacinamide in skin care needs to be further studied before conclusions can be made.

 C


Niacinamide has been used in skin care products, including moisturizers, anti-aging products, and treatments for rosacea, a skin condition involving facial redness and pimples. The benefits of niacinamide in skin care needs to be further studied before conclusions can be made.

 C


Non-human research shows that niacinamide delays the onset of insulin dependence in type 1 diabetes. However, human research assessing whether niacinamide slows progression of type 1 diabetes has yielded unclear results. Further study is needed for conclusions to be reached.

C


Non-human research shows that niacinamide delays the onset of insulin dependence in type 1 diabetes. However, human research assessing whether niacinamide slows progression of type 1 diabetes has yielded unclear results. Further study is needed for conclusions to be reached.

C


Limited research shows unclear effects of niacin on outcomes of type 2 diabetes. Human research has also shown that niacin increases blood sugar levels. People should seek medical advice before starting niacin. Further research is needed to draw conclusions.

 C


Limited research shows unclear effects of niacin on outcomes of type 2 diabetes. Human research has also shown that niacin increases blood sugar levels. People should seek medical advice before starting niacin. Further research is needed to draw conclusions.

 C


In human research, niacinamide lacked an effect on the development of diabetes (type 1). Evidence is mixed and more study is needed in this area.

D


In human research, niacinamide lacked an effect on the development of diabetes (type 1). Evidence is mixed and more study is needed in this area.

D
* Key to grades

A: Strong scientific evidence for this use
B: Good scientific evidence for this use
C: Unclear scientific evidence for this use
D: Fair scientific evidence for this use (it may not work)
F: Strong scientific evidence against this use (it likley does not work)
* Key to grades

A: Strong scientific evidence for this use
B: Good scientific evidence for this use
C: Unclear scientific evidence for this use
D: Fair scientific evidence for this use (it may not work)
F: Strong scientific evidence against this use (it likley does not work)

Tradition / Theory

The below uses are based on tradition, scientific theories, or limited research. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. There may be other proposed uses that are not listed below.

Dosing

Adults (over 18 years old)
The dietary reference intake established by the Food and Nutrition Board for niacin ranges from 14-18 milligrams niacin daily by mouth for adults, with an upper intake level of 35 milligrams daily by mouth. Niacinamide and niacin are used in cosmetics, as well as hair and skin products. The concentration of niacinamide varies from a low of 0.0001% in night preparations to a high of 3% in body and hand creams, lotions, powders, and sprays. Niacin concentrations range from 0.01% in body and hand creams, lotions, powders, and sprays to 0.1% in paste masks (mud packs).
For age-related macular disease (eye disease), 500 milligrams of immediate-release niacin has been taken by mouth.
For preventing clogged arteries, 3,000-4,000 milligrams of niacin has been taken by mouth daily alone or in combination with other cholesterol therapy for 0.5-6.2 years.
For heart disease, 0.125-12 grams of niacin has been taken by mouth daily for up to five years.
For erectile dysfunction, 500-1,500 milligrams of niacin (Niaspan?) has been taken by mouth for 12 weeks.
For high cholesterol, 300-1,2000 milligrams of niacin has been taken by mouth daily for 6-44 weeks as wax-matrix, immediate-release (crystalline); 2 grams of niacin has been injected into the vein over 11 hours. The maximum recommended daily dose is 3 grams.
For high cholesterol (in combination with statins or bile acid sequestrants) 500-4,000 milligrams of extended-release or regular niacin has been taken by mouth daily for eight weeks to 6.2 years. Extended-or sustained-release niacin may be started at a dose of 500 milligrams daily and titrated up to 3 grams daily.
For high cholesterol levels in HIV-infected patients 500-2,000 milligrams of extended-release niacin (Niaspan?) has been taken by mouth daily for 44 weeks to two years.
For high blood phosphorous levels, a single 375 milligram dose of extended-release nicotinic acid has been taken by mouth.
For osteoarthritis, 3 grams of niacinamide has been taken by mouth daily for 12 weeks.
For pellagra, or niacin deficiency, 50-1,000 milligrams of niacin has been taken by mouth daily.
For skin conditions, 2-5% of niacinamide cream has been applied to the skin for up to 12 weeks.
For type 1 diabetes mellitus prevention, 200-3,000 milligrams of niacinamide has been taken by mouth daily for up to one year; 20-40 milligrams per kilogram of niacinamide has been taken daily by mouth for up to one year and lacked evidence of benefit.
For type 2 diabetes, 0.5 grams of nicotinamide has been taken by mouth three times daily for six months.

Safety

The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

Interactions

Interactions with Drugs
Niacin may increase the risk of bleeding when taken with drugs that increase the risk of bleeding. Some examples include aspirin, anticoagulants ("blood thinners") such as warfarin (Coumadin?) or heparin, anti-platelet drugs such as clopidogrel (Plavix?), and non-steroidal anti-inflammatory drugs such as ibuprofen (Motrin?, Advil?) or naproxen (Naprosyn?, Aleve?).
Niacin may increase blood sugar levels. Caution is advised when using medications that may alter blood sugar. People taking drugs for diabetes by mouth or insulin should be monitored closely by a qualified healthcare professional, including a pharmacist. Medication adjustments may be necessary.
Niacin may cause low blood pressure. Caution is advised in people taking drugs that lower blood pressure.
Niacin may interfere with the way the body processes certain drugs using the liver's "cytochrome P450" enzyme system. As a result, the levels of these drugs may be altered in the blood, and may cause altered effects or potentially serious adverse reactions. People using any medications should check the package insert, and speak with a qualified healthcare professional, including a pharmacist, about possible interactions.
Niacin may also interact with agents for the heart, agents that widen blood vessels, agents used for the liver, agents used for seizures, alcohol, androgens, antibiotics, antigout agents, antihistamines, antithyroid agents, aspirin, benzodiazepines, birth control taken by mouth, calcium-channel blockers, cholesterol-lowering agents (bile acid sequestrants, fibrates, HMG-CoA reductase inhibitors), epinephrine, estrogens, ganglionic blocking drugs, griseofulvin, neomycin, nicotine, nonsteroidal anti-inflammatory drugs (NSAIDs), primidone, probucol, procetofene, progestins, pyrazinamide, theophylline, and thyroid hormones.

Attribution

This information is based on a systematic review of scientific literature edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography

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