Adult: For patients with very high triglyceride levels (>500 mg/dL) or in cases in which alternative treatments, diet restrictions and other nonpharmacologic measures alone are inadequate: As an adjunct to diet, alone or in combination with other lipid-lowering agents: As conventional tab: Initially, 250 mg once daily, then increase every 4-7 days until the desired response is achieved or the 1st level therapeutic dose of 1,500-2,000 mg daily is reached. If still inadequately controlled after 2 months, may further increase to 3,000 mg daily (Max: 6,000 mg daily) in 3 divided doses at 2- to 4-week intervals. As extended-release tab: Initially, 500 mg at bedtime (after a low-fat snack); gradually increase to the recommended maintenance dose of 1,000 mg-2,000 mg once daily at bedtime. Daily dose should not be increased by more than 500 mg daily every 4 weeks. Individualise dosing according to the patient's tolerance and response. Dosage and treatment recommendations may vary among countries and between individual products (refer to specific product guidelines).
Oral Pellagra
Adult: As conventional tab: 250 mg bid. Alternatively, 50 to 100 mg 3-4 times daily. Max: 500 mg daily. Dosage and treatment recommendations may vary among countries and between individual products (refer to specific product guidelines).
What are the brands available for Nicotinic acid in Malaysia?
Niaspan
Administration
Nicotinic acid Should be taken with food. ER tab: Do not chew/crush but may cut if scored.
Contraindications
Active peptic ulcer disease, arterial haemorrhage. Significant or unexplained hepatic impairment (including unexplained persistent elevations of serum transaminases).
Special Precautions
Patient with unstable angina, acute MI, diabetes, predisposition to gout, history of peptic ulcer; history of gallbladder disease, jaundice, and those who consume large quantities of ethanol (alcoholism). Nicotinic acid is available in multiple dosage forms, which are not interchangeable. Renal or hepatic impairment. Pregnancy and lactation.
Adverse Reactions
Significant: Severe hepatoxicity, including fulminant hepatic necrosis; decreased platelet count (dose-related), prothrombin time; gastrointestinal distress, diarrhoea, vomiting, aggravated peptic ulcer; hypophosphataemia; atrial fibrillation (mostly in conventional tab use); new-onset diabetes or worsening glucose tolerance (particularly in patients with preexisting diabetes); hyperuricaemia; mild to severe cutaneous flushing and pruritus. Cardiac disorders: Tachycardia, palpitations, arrhythmias. Eye disorders: Cystoid macular oedema, toxic amblyopia, blurred vision. Gastrointestinal disorders: Nausea, dyspepsia. General disorders and administration site conditions: Sensation of heat, sweating, chills, oedema. Immune system disorders: Hypersensitivity reactions, including angioedema. Nervous system disorders: Headache, pounding in the head, dizziness. Respiratory, thoracic and mediastinal disorders: Increased cough, dyspnoea. Surgical and medical procedures: Rash, dry skin, hyperpigmentation. Vascular disorders: Hypotension.
Monitor lipid profile; LFTs (pretreatment, every 6-12 weeks on the 1st year, and periodically; or more frequently if with history of transaminase elevation); blood glucose levels (in diabetic patients); uric acid (if with predisposition to gout); and phosphorus levels (if with predisposition to hypophosphataemia). Assess for signs and symptoms of hepatoxicity (e.g. yellow skin or eyes, dark urine, stomach pain, vomiting), severe flushing, and muscle weakness or pain.
Increased risk of myopathy and rhabdomyolysis when concomitantly used with HMG-CoA reductase inhibitors. May potentiate the effects of vasoactive drugs and ganglionic blocking agents leading to postural hypotension. Reduced metabolic clearance with aspirin.
Food Interaction
May exacerbate cutaneous vasodilation and increase the risk of hepatoxicity with alcohol.
Lab Interference
May cause false elevations in some fluorometric determinations of plasma or urinary catecholamines. May produce false-positive results when Benedict's reagent is used in urine glucose determination.
Action
Description: Mechanism of Action: Nicotinic acid is a water soluble B-complex vitamin that decreases total cholesterol, triglycerides, VLDL, LDL and lipoprotein(a), and increases HDL or other important subfractions. It is bioconverted into nicotinamide and further converted into coenzymes nicotinamide adenine dinucleotide (NAD) and nicotinamide adenine dinucleotide phosphate (NADP), which are essential for lipid or tissue metabolism and glycogenolysis. The exact mechanism by which nicotinic acid alters plasma lipoproteins is not fully understood; however, several actions may be involved, including the reduction of free fatty acid mobilisation from adipose tissue with an increase in faecal output of sterols, and increased lipoprotein lipase activity which may increase the rate of chylomicron triglyceride removal from plasma. Synonym(s): Niacin. Pharmacokinetics: Absorption: Readily absorbed from the gastrointestinal tract. Time to peak plasma concentration: 30 to 60 minutes (conventional form); 4 to 5 hours (extended-release). Distribution: Widely distributed in body tissues. Enters breast milk. Metabolism: Metabolised in the liver into N-methylnicotinamide, 2-pyridone and 4-pyridone derivatives with some formation of nicotinuric acid; undergoes extensive 1st-pass metabolism. Excretion: Via urine (60-88%, as unchanged drug and metabolites). Elimination half-life: 20 to 48 minutes.
Chemical Structure
Nicotinic acid Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 938, Nicotinic acid. https://pubchem.ncbi.nlm.nih.gov/compound/Nicotinic-acid. Accessed Mar. 26, 2025.
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
Brayfield A, Cadart C (eds). Nicotinic Acid. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 05/12/2024.Joint Formulary Committee. Nicotinic Acid. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 05/12/2024.Niacin Tablet, Extended Release (Amneal Pharmaceuticals LLC). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 05/12/2024.Niacin, Niacinamide. Gold Standard Drug Database in ClinicalKey [online]. Elsevier Inc. https://www.clinicalkey.com. Accessed 05/12/2024.Niacor Tablet (Avondale Pharmaceuticals, LLC). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 05/12/2024.Nicotinic Acid [Niacin]. UpToDate Lexidrug, Lexi-Drugs Multinational Online. Waltham, MA. UpToDate, Inc. https://online.lexi.com. Accessed 05/12/2024.
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