Vitamin B3 - Niacin

Chemical Name

C6H5NO2

Immune support

Research suggests high dose vitamin B3 may be able to help our bodies fight some of the world’s deadliest bacteria or “superbugs.” It works to boost the immune system by as much as 1,000 fold, and can kill a life-threatening infection called methicillin-resistant Staphyloccocus aureus, or MRSA. Niacin also has known anti-viral properties. The most persuasive evidence comes from recent work with HIV patients. Niacin is required for cells to generate the energy they use to perform virtually all biological functions. Its effectiveness fighting viruses may have to do with accelerating wound healing as well as improving immunity.

Other uses

Abnormal levels of blood fats. Some niacin products are approved by the U.S. Food and Drug Administration (FDA) as prescription products for treating abnormal levels of blood fats. These prescription niacin products typically come in high strengths of 500 mg or higher. Dietary supplement forms of niacin usually come in strengths of 250 mg or less. Since very high doses of niacin are required for improving cholesterol levels, dietary supplement niacin usually isn't appropriate. For people who need to lower low-density lipoprotein (LDL or "bad") cholesterol, the prescription drug class called "statins" is used. Niacin might be used in people with high levels of both cholesterol AND blood fats called triglycerides. Niacin may be combined with other cholesterol-lowering drugs when diet and single-drug therapy is not enough. Niacin improves cholesterol levels, but does not improve cardiovascular outcomes such as heart attacks and strokes.

Treatment and prevention of niacin deficiency, and certain conditions related to niacin deficiency such as pellagra. Niacin is approved by the U.S. Food and Drug Administration (FDA) for these uses. However, using niacinamide instead of niacin is sometimes preferred because niacinamide doesn't cause "flushing," (redness, itching and tingling), a side effect of niacin treatment.

Diarrhea from an infection called cholera. Taking niacin by mouth seems to control the loss of fluid due to cholera.

Abnormal levels of blood fats in people with HIV/AIDS. Taking niacin seems to improve levels of cholesterol and blood fats called triglycerides in HIV/AIDS patients with abnormal blood fat levels due to antiretroviral treatment.

Metabolic syndrome. Taking niacin seems to increase levels of high-density lipoprotein (HDL or "good") cholesterol and reduce levels of blood fats called triglycerides in people with metabolic syndrome. Taking the niacin along with a prescription omega-3 fatty acid seems to work even better.

How it works

Niacin is absorbed by the body when dissolved in water and taken by mouth. It is converted to niacinamide if taken in amounts greater than what is needed by the body.

Niacin is required for the proper function of fats and sugars in the body and to maintain healthy cells. At high doses, niacin might help people with heart disease because of its beneficial effects on clotting. It may also improve levels of a certain type of fat called triglycerides in the blood.

Niacin deficiency can cause a condition called pellagra, which causes skin irritation, diarrhea, and dementia. Pellagra was common in the early twentieth century, but is less common now, since some foods containing flour are now fortified with niacin. Pellagra has been virtually eliminated in western culture.

People with poor diet, alcoholism, and some types of slow-growing tumors called carcinoid tumors might be at risk for niacin deficiency.

Safety

Niacin is LIKELY SAFE for most people when taken by mouth. A common minor side effect of niacin is a flushing reaction. This might cause burning, tingling, itching, and redness of the face, arms, and chest, as well as headaches. Starting with small doses of niacin and taking 325 mg of aspirin before each dose of niacin will help reduce the flushing reaction. Usually, this reaction goes away as the body gets used to the medication. Alcohol can make the flushing reaction worse. Avoid large amounts of alcohol while taking niacin.

Other minor side effects of niacin are stomach upset, intestinal gas, dizziness, pain in the mouth, and other problems.

When doses of over 3 grams per day of niacin are taken, more serious side effects can happen. These include liver problems, gout, ulcers of the digestive tract, loss of vision, high blood sugar, irregular heartbeat, and other serious problems.

When used daily for multiple years, niacin might increase the risk of developing diabetes.

Some concern has been raised about stroke risk in people taking niacin. In one large study, people who took high doses of niacin had a two-fold greater risk of stroke compared to those not taking niacin. However, it is unlikely that this outcome was due to niacin. Other research has shown that niacin has no effect on the risk of stroke.

Special Precautions & Warnings:

Pregnancy and breast-feeding: Niacin is LIKELY SAFE for pregnant and breast-feeding women when taken in the recommended amounts. The recommended amount of niacin for pregnant or breast-feeding women is 30 mg per day for women under 18 years of age, and 35 mg for women over 18.

Allergies: Niacin might worsen allergies by causing histamine, the chemical responsible for allergic symptoms, to be released.

Heart disease/unstable angina: Large amounts of niacin can increase the risk of irregular heartbeat. Use with caution.

Crohn's disease: People with Crohn's disease might have low niacin levels and require supplementation during flare-ups.

Diabetes: Niacin might increase blood sugar. People with diabetes who take niacin should check their blood sugar carefully.

Gallbladder disease: Niacin might make gallbladder disease worse.

Gout: Large amounts of niacin might bring on gout.

Kidney disease: Niacin might accumulate in people with kidney disease. This might cause harm.

Liver disease: Niacin might increase liver damage. Don't use large amounts if you have liver disease.

Stomach or intestinal ulcers: Niacin might make ulcers worse. Don't use large amounts if you have ulcers.

Very low blood pressure: Niacin might lower blood pressure and worsen this condition.

Surgery: Niacin might interfere with blood sugar control during and after surgery. Stop taking niacin at least 2 weeks before a scheduled surgery.

Fatty deposits around tendons (tendon xanthomas): Niacin might increase the risk of infections in xanthomas.

Thyroid disorders: Thyroxine is a hormone produced by the thyroid gland. Niacin might lower blood levels of thyroxine. This might worsen symptoms of certain thyroid disorders.

Interactions with medications

Alcohol (Ethanol)

Interaction Rating = Moderate Be cautious with this combination.

Talk to your health provider.

Niacin can cause flushing and itchiness. Consuming alcohol along with niacin might make the flushing and itching worse. There is also some concern that consuming alcohol with niacin might increase the chance of having liver damage.

Allopurinol (Zyloprim)

Interaction Rating = Moderate Be cautious with this combination.

Talk to your health provider.

Allopurinol (Zyloprim) is used to treat gout. Taking large doses of niacin might worsen gout and decrease the effectiveness of allopurinol (Zyloprim).

Aspirin

Interaction Rating = Minor Be watchful with this combination.

Talk to your health provider.

Aspirin is often used with niacin to reduce the flushing caused by niacin. Taking high doses of aspirin might decrease how fast the body gets rid of niacin. This could cause there to be too much niacin in the body and possibly lead to side effects. However, the low doses of aspirin most commonly used for niacin-related flushing don't seem to be a problem.

Clonidine (Catapres)

Interaction Rating = Moderate Be cautious with this combination.

Talk to your health provider.

Clonidine and niacin both lower blood pressure. Taking niacin with clonidine might cause your blood pressure to become too low.

Gemfibrozil (Lopid)

Interaction Rating = Moderate Be cautious with this combination.

Talk to your health provider.

Taking niacin along with gemfibrozil might cause muscle damage in some people. Use with caution.

Medications for diabetes (Antidiabetes drugs)

Interaction Rating = Moderate Be cautious with this combination.

Talk to your health provider.

Use of high doses of niacin (about 3-4 grams daily) might increase blood sugar. By increasing blood sugar, niacin might decrease the effectiveness of diabetes medications. Monitor your blood sugar closely. The dose of your diabetes medication might need to be changed.

Some medications used for diabetes include glimepiride (Amaryl), glyburide (DiaBeta, Glynase PresTab, Micronase), insulin, pioglitazone (Actos), rosiglitazone (Avandia), metformin (Glucophage), nateglinide (Starlix), repaglinide (Prandin), chlorpropamide (Diabinese), glipizide (Glucotrol), tolbutamide (Orinase), and others.

Medications for high blood pressure (Antihypertensive drugs)

Interaction Rating = Moderate Be cautious with this combination.

Talk to your health provider.

Using niacin with drugs that lower blood pressure may increase the effects of these drugs and may lower blood pressure too much.

Some medications for high blood pressure include captopril (Capoten), enalapril (Vasotec), losartan (Cozaar), valsartan (Diovan), diltiazem (Cardizem), amlodipine (Norvasc), hydrochlorothiazide (HydroDIURIL), furosemide (Lasix), and many others.

Medications that can harm the liver (Hepatotoxic drugs)

Interaction Rating = Moderate Be cautious with this combination.

Talk to your health provider.

Niacin might harm the liver. Sustained-release niacin preparations seem to have the greatest risk. Taking niacin along with medication that might also harm the liver can increase the risk of liver damage. Do not take niacin if you are taking a medication that can harm the liver.

Some medications that can harm the liver include acetaminophen (Tylenol and others), amiodarone (Cordarone), carbamazepine (Tegretol), isoniazid (INH), methotrexate (Rheumatrex), methyldopa (Aldomet), fluconazole (Diflucan), itraconazole (Sporanox), erythromycin (Erythrocin, Ilosone, others), phenytoin (Dilantin), lovastatin (Mevacor), pravastatin (Pravachol), simvastatin (Zocor), and many others.

Medications that slow blood clotting (Anticoagulant / Antiplatelet drugs)

Interaction Rating = Moderate Be cautious with this combination.

Talk to your health provider.

Niacin might slow blood clotting. Taking niacin along with medications that also slow clotting might increase the chances of bruising and bleeding.

Some medications that slow blood clotting include aspirin, clopidogrel (Plavix), dalteparin (Fragmin), enoxaparin (Lovenox), heparin, indomethacin (Indocin), ticlopidine (Ticlid), warfarin (Coumadin), and others.

Medications used for lowering cholesterol (Bile acid sequestrants)

Interaction Rating = Moderate Be cautious with this combination.

Talk to your health provider.

Some medications for lowering cholesterol called bile acid sequestrants can decrease how much niacin the body absorbs. This might reduce the effectiveness of niacin. Take niacin and the medications at least 4-6 hours apart.

Some of these medications used for lowering cholesterol include cholestyramine (Questran) and colestipol (Colestid).

Medications used for lowering cholesterol (Statins)

Interaction Rating = Moderate Be cautious with this combination.

Talk to your health provider.

Niacin can adversely affect the muscles. Some medications used for lowering cholesterol called statins can also affect the muscles. Taking niacin along with these medications might increase the risk of muscle problems.

Some of these medications used for high cholesterol include rosuvastatin (Crestor), atorvastatin (Lipitor), lovastatin (Mevacor), pravastatin (Pravachol), fluvastatin (Lescol), and simvastatin (Zocor).

Nicotine patch (Transdermal nicotine)

Interaction Rating = Minor Be watchful with this combination.

Talk to your health provider.

Niacin can sometimes cause flushing and dizziness. The nicotine patch can also cause flushing and dizziness. Taking niacin or niacinamide and using a nicotine patch can increase the possibility of becoming flushed and dizzy.

Probenecid

Interaction Rating = Moderate Be cautious with this combination.

Talk to your health provider.

Probenecid is used to treat gout. Taking large doses of niacin might worsen gout and decrease the effectiveness of probenecid.

Sulfinpyrazone (Anturane)

Interaction Rating = Moderate Be cautious with this combination.

Talk to your health provider.

Sulfinpyrazone (Anturane) is used to treat gout. Taking large doses of niacin might worsen gout and decrease the effectiveness of sulfinpyrazone (Anturane).

Thyroid hormone

Interaction Rating = Moderate Be cautious with this combination.

Talk to your health provider.

The body naturally produces thyroid hormones. Niacin might decrease thyroid hormone levels. Taking niacin with thyroid hormone pills might decrease the effects and side effects of thyroid hormone.

Interactions with Herbs, Supplements, and Foods

Beta-carotene

A combination of niacin and the prescription drug simvastatin (Zocor) raises HDL (high density lipoprotein) cholesterol ("good cholesterol") in people with coronary heart disease and low HDL levels. However, taking niacin along with combinations of antioxidants, including beta-carotene, seems to blunt this rise in HDL. It is not known whether this effect happens in people who don't have coronary heart disease.

Chromium

Taking niacin and chromium together might lower blood sugar. If you have diabetes and take chromium and niacin supplements together, monitor your blood sugar to make sure it doesn't get too low.

Herbs and supplements that can lower blood pressure

Niacin might lower blood pressure. Taking niacin with other herbs and supplements that also lower blood pressure might cause blood pressure to drop too much. Other herbs and supplements that can lower blood pressure include andrographis, casein peptides, cat's claw, coenzyme Q10, L-arginine, lycium, stinging nettle, theanine, and others.

Herbs and supplements that might harm the liver

Niacin, especially in higher doses can cause liver damage. Taking niacin along with other herbs or supplements that might harm the liver could increase this risk. Some of these products include androstenedione, borage leaf, chaparral, comfrey, dehydroepiandrosterone (DHEA), germander, kava, pennyroyal oil, red yeast, and others.

Herbs and supplements that might slow blood clotting

Niacin might slow blood clotting. Using niacin along with other herbs and supplements that also slow blood clotting might increase the risk of bleeding in some people. Some other herbs of this type include angelica, clove, danshen, garlic, ginger, Panax ginseng, and others.

Kombucha tea

There is some concern that kombucha tea might decrease niacin absorption. However, this needs to be studied more.

Selenium

A combination of niacin and the prescription drug simvastatin (Zocor) raises HDL (high density lipoprotein) cholesterol ("good cholesterol") in people with coronary heart disease and low HDL levels. However, taking niacin along with combinations of antioxidants, including selenium, seems to blunt this rise in HDL. It is not known whether this effect happens in people who don't have coronary heart disease.

Tryptophan

Some tryptophan from the diet can be converted into niacin in the body. Taking niacin and tryptophan together might increase levels and side effects of niacin.

Vitamin C

A combination of niacin and the prescription drug simvastatin (Zocor) raises HDL (high density lipoprotein) cholesterol ("good cholesterol") in people with coronary heart disease and low HDL levels. However, taking niacin along with combinations of antioxidants, including vitamin C, seems to blunt this rise in HDL. It is not known whether this effect happens in people who don't have coronary heart disease.

Vitamin E

A combination of niacin and the prescription drug simvastatin (Zocor) raises HDL (high density lipoprotein) cholesterol ("good cholesterol") in people with coronary heart disease and low HDL levels. However, taking niacin along with combinations of antioxidants, including vitamin E, seems to blunt this rise in HDL. It is not known whether this effect happens in people who don't have coronary heart disease.

Zinc

The body can make niacin. People who are malnourished and have niacin deficiency, such as chronic alcoholics, make extra niacin if they take zinc. There might be an increased risk of niacin-related side effects such as flushing and itching if niacin and zinc are taken together.

Hot drinks

Niacin can cause flushing and itching. These effects might be increased if niacin is taken with a hot drink.

References

McEvoy GK, ed. AHFS Drug Information. Bethesda, MD: American Society of Health-System Pharmacists, 1998.

Gruenwald J, Brendler T, Jaenicke C. PDR for Herbal Medicines. 1st ed. Montvale, NJ: Medical Economics Company, Inc., 1998.

Garg R, Malinow MR, Pettinger M, et al. Niacin treatment increases plasma homocysteine levels. Am Heart J 1999;138:1082-7.

Hardman JG, Limbird LL, Molinoff PB, eds. Goodman and Gillman's The Pharmacological Basis of Therapeutics, 9th ed. New York, NY: McGraw-Hill, 1996.

Ioannides-Demos LL, Christophidis N, et al. Dosing implications of a clinical interaction between grapefruit juice and cyclosporine and metabolite concentrations in patients with autoimmune diseases. J Rheumatol 1997;24:49-54.

Reimund E. Sleep deprivation-induced dermatitis: further support of nicotinic acid depletion in sleep deprivation. Med Hypotheses 1991;36:371-3.

Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.

Yates AA, Schlicker SA, Suitor CW. Dietary reference intakes: The new basis for recommendations for calcium and related nutrients, B vitamins, and choline. J Am Diet Assoc 1998;98:699-706.

Knodel LC, Talbert RL. Adverse effects of hypolipidaemic drugs. Med Toxicol 1987;2:10-32.

Zema MJ. Gemfibrozil, nicotinic acid and combination therapy in patients with isolated hypoalphalipoproteinemia: a randomized, open-label, crossover study. J Am Coll Cardiol 2000;35:640-6.

Guyton JR, Blazing MA, Hagar J, et al. Extended-release niacin vs gemfibrozil for the treatment of low levels of high-density lipoprotein cholesterol. Niaspan-Gemfibrozil Study Group. Arch Intern Med 2000;160:1177-84.

Canner PL, Berge KG, Wenger NK, et al. Fifteen year mortality in Coronary Drug Project patients: long-term benefit with niacin. J Am Coll Cardiol 1986;8:1245-55.

Zhao XQ, Brown BG, Hillger L, et al. Effects of intensive lipid-lowering therapy on the coronary arteries of asymptomatic subjects with elevated apolipoprotein B. Circulation 1993;88:2744-53.

Park YK, Sempos CT, Barton CN, et al. Effectiveness of food fortification in the United States: the case of pellagra. Am J Public Health 2000;90:727-38.

Gibbons LW, Gonzalez V, Gordon N, Grundy S. The prevalence of side effects with regular and sustained-release nicotinic acid. Am J Med 1995;99:378-85.

Whelan AM, Price SO, Fowler SF, Hainer BL. The effect of aspirin on niacin-induced cutaneous reactions. J Fam Pract 1992;34:165-8.

Jungnickel PW, Maloley PA, Vander Tuin EL, et al. Effect of two aspirin pretreatment regimens on niacin-induced cutaneous reactions. J Gen Intern Med 1997;12:591-6.

Capuzzi DM, Guyton JR, Morgan JM, et al. Efficacy and safety of an extended-release niacin (Niaspan): a long-term study. Am J Cardiol 1998;82:74-81;disc. 85U-6U.

Gray DR, Morgan T, Chretien SD, Kashyap ML. Efficacy and safety of controlled-release niacin in dyslipoproteinemic veterans. Ann Intern Med 1994;121:252-8.

McKenney JM, Proctor JD, Harris S, Chinchili VM. A comparison of the efficacy and toxic effects of sustained- vs immediate-release niacin in hypercholesterolemic patients. JAMA 1994;271:672-7.

Knopp RH, Alagona P, Davidson M, et al. Equivalent efficacy of a time-release form of niacin (Niaspan) given once-a-night versus plain niacin in the management of hyperlipidemia. Metabolism 1998;47:1097-104.

Knopp RH. Clinical profiles of plain versus sustained-release niacin (Niaspan) and the physiologic rationale for nighttime dosing. Am J Cardiol 1998;82:24U-28U;discussion 39U-41U.

Crouse JR III. New developments in the use of niacin for treatment of hyperlipidemia: new considerations in the use of an old drug. Coron Artery Dis 1996;7:321-6.

Garg A, Grundy SM. Nicotinic acid as therapy for dyslipidemia in non-insulin-dependent diabetes mellitus. JAMA 1990;264:723-6.

Leighton RF, Gordon NF, Small GS, et al. Dental and gingival pain as side effects of niacin therapy. Chest 1998;114:1472-4.

American Society of Health-System Pharmacists. ASHP Therapeutic Position Statement on the safe use of niacin in the management of dyslipidemias. Am J Health Syst Pharm 1997;54:2815-9.

Ishii N, Nishihara Y. Pellagra encephalopathy among tuberculous patients: its relation to isoniazid therapy. J Neurol Neurosurg Psychiatry 1985;48:628-34.

Darvay A, Basarab T, McGregor JM, Russell-Jones R. Isoniazid induced pellagra despite pyridoxine supplementation. Clin Exp Dermatol 1999;24:167-9.

National Cholesterol Education Program. Cholesterol Lowering in the Patient with Coronary Heart Disease. 1997. Available at: http://www.vidyya.com/pdfs/1225cholesterol.pdf. (Accessed 26 May 2016).

Rabbani GH, Butler T, Bardhan PK, Islam A. Reduction of fluid-loss in cholera by nicotinic acid: a randomized controlled trial. Lancet 1983;2:1439-42.

Johansson JO, Egberg N, Asplund-Carlson A, Carlson LA. Nicotinic acid treatment shifts the fibrinolytic balance favourably and decreases plasma fibrinogen in hypertriglyceridaemic men. J Cardiovasc Risk 1997;4:165-71.

Pozzilli P, Browne PD, Kolb H. Meta-analysis of nicotinamide treatment in patients with recent-onset IDDM. The Nicotinamide Trialists. Diabetes Care 1996;19:1357-63.

Illingworth DR, Stein EA, Mitchel YB, et al. Comparative effects of lovastatin and niacin in primary hypercholesterolemia. A prospective trial. Arch Intern Med 1994;154:1586-95.

Vacek JL, Dittmeier G, Chiarelli T, et al. Comparison of lovastatin (20 mg) and nicotinic acid (1.2 g) with either drug alone for type II hyperlipoproteinemia. Am J Cardiol 1995;76:182-4.

Vega GL, Grundy SM. Lipoprotein responses to treatment with lovastatin, gemfibrozil, and nicotinic acid in normolipidemic patients with hypoalphalipoproteinemia. Arch Intern Med 1994;154:73-82.

Guyton JR, Goldberg AC, Kreisberg RA, et al. Effectiveness of once-nightly dosing of extended-release niacin alone and in combination for hypercholesterolemia. Am J Cardiol 1998;82:737-43.

Lal SM, Hewett JE, Petroski GF, et al. Effects of nicotinic acid and lovastatin in renal transplant patients: a prospective, randomized, open-labeled crossover trial. Am J Kidney Dis 1995;25:616-22.

American Dietetic Association Website. Available at: www.eatright.org/adap1097.html (Accessed 16 July 1999).

Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline (2000). Washington, DC: National Academy Press, 2000. Available at: http://books.nap.edu/books/0309065542/html/.

Kuroki F, Iida M, Tominaga M, et al. Multiple vitamin status in Crohn's disease. Correlation with disease activity. Dig Dis Sci 1993;38:1614-8.

Cumming RG, Mitchell P, Smith W. Diet and cataract: the Blue Mountains Eye Study. Ophthalmology 2000;10:450-6.

Brown BG, Zhao XQ, Chait A, et al. Simvastatin and niacin, antioxidant vitamins, or the combination for the prevention of coronary disease. N Engl J Med 2001;345:1583-93.

Wolfe ML, Vartanian SF, Ross JL, et al. Safety and effectiveness of Niaspan when added sequentially to a statin for treatment of dyslipidemia. Am J Cardiol 2001;87:476-9,A7..

Wink J, Giacoppe G, King J. Effect of very-low-dose naicin on high-density lipoprotein in patients undergoing long-term statin therapy. Am Heart J 2002;143:514-8..

Chesney CM, Elam MB, Herd JA, et al. Effect of niacin, warfarin, and antioxidant therapy on coagulation parameters in patients with peripheral arterial disease in the Arterial Disease Multiple Intervention Trial (ADMIT). Am Heart J 2000;140:631-6..

Cheung MC, Zhao XQ, Chait A, et al. Antioxidant supplements block the response of HDL to simvastatin-niacin therapy in patients with coronary artery disease and low HDL. Arterioscler Thromb Vasc Biol 2001;21:1320-6.

Urberg M, Zemel MB. Evidence for synergism between chromium and nicotinic acid in the control of glucose tolerance in elderly humans. Metabolism 1987;36:896-9.

Vannucchi H, Moreno FS. Interaction of niacin and zinc metabolism in patients with alcoholic pellagra. Am J Clin Nutr 1989;50:364-9.

Bays HE, Dujovne CA. Drug interactions of lipid-altering drugs. Drug Saf 1998;19:355-71.

Figge HL, Figge J, Souney PF, et al. Nicotinic acid: a review of its clinical use in the treatment of lipid disorders. Pharmacotherapy 1988;8:287-94.

Rader JI, Calvert RJ, Hathcock JN. Hepatic toxicity of unmodified and time-release preparations of niacin. Am J Med 1992;92:77-81.

Kahn SE, Beard JC, Schwartz MW, et al. Increased B-cell secretory capacity as mechanism for islet adaptation to nicotinic acid-induced insulin resistance. Diabetes 1989;38:562-8.

Schwartz ML. Severe reversible hyperglycemia as a consequence of niacin therapy. Arch Int Med 1993;153:2050-2.

Anon. Niacinamide Monograph. Alt Med Rev 2002;7:525-9.

Miralbell R, Mornex F, Greiner R, et al. Accelerated radiotherapy, carbogen, and nicotinamide in glioblastoma multiforme: report of European Organization for Research and Treatment of Cancer trial 22933. J Clin Oncol 1999;17:3143-9.

Hoskin PJ, Stratford MR, Saunders MI, et al. Administration of nicotinamide during chart: pharmacokinetics, dose escalation, and clinical toxicity. Int J Radiat Oncol Biol Phys 1995;32:1111-9.

Raising HDL and Niacin Use. Pharmacist's Letter/Prescriber's Letter 2004;20(5):200504.

McKenney J. New perspectives on the use of niacin in the treatment of lipid disorders. Arch Intern Med 2004;164:697-705.

Morris MC, Evans DA, Bianias JL, et al. Dietary niacin and the risk of incident Alzheimer's disease and of cognitive decline. J Neurol Neurosurg Psychiatry 2004;75:1093-99.

Papa CM. Niacinamide and acanthosis nigricans (letter). Arch Dermatol 1984;120:1281.

Gillman MA, Sandyk R. Nicotinic acid deficiency induced by sodium valproate (letter). S Afr Med J 1984;65:986.

Rockwell KA. Potential interaction between niacin and transdermal nicotine (letter). Ann Pharmacother 1993;27:1283-4.

Reaven P, Witztum JL. Lovastatin, nicotinic acid and rhabdomyolysis (letter). Ann Int Med 1988;109:597-8.

Ito MK. Advances in the understanding and management of dyslipidemia: using niacin-based therapies. Am J Health-Syst Pharm 2003;60(suppl 2):s15-21.

Schwab RA, Bachhuber BH. Delirium and lactic acidosis caused by ethanol and niacin coingestion. Am J Emerg Med 1991;9:363-5.

Product information: Niaspan. Kos Pharmaceuticals. Cranbury, NJ. 2005. Available at www.niaspan.com/professional/content/pdfs/productinfo.pdf. (Accessed 3 March 2006).

Jarrett P, Duffill M, Oakley A, Smith A. Pellagra, azathioprine and inflammatory bowel disease. Clin Exp Dermatol 1997;22:44-5.

Stratigos JD, Katsambas A. Pellagra: a still existing disease. Br J Dermatol 1977;96:99-106.

Ludwig GD, White DC. Pellagra induced by 6-mercaptopurine. Clin Res 1960;8:212.

Bender DA, Earl CJ, Lees AJ. Niacin depletion in Parkinsonian patients treated with L-dopa, benserazide and carbidopa. Clinical Sci 1979;56:89-93. .

Brooks-Hill RW, Bishop ME, Vellend H. Pellagra-like encephalopathy complicating a multiple drug regimen for the treatment of pulmonary infection due to Mycobacterium avium-intracellulare (letter). Am Rev Resp Dis 1985;131:476.

Swash M, Roberts AH. Reversible pellagra-like encephalopathy with ethionamide and cycloserine. Tubercle 1972;53:132.

Stevens H, Ostlere L, Begent R, et al. Pellagra secondary to 5-fluorouracil. Br J Dermatol 1993;128:578-80.

Bender DA, Russell-Jones R. Isoniazid-induced pellagra despite vitamin B6 supplementation (letter). Lancet 1979;2:1125-6.

Wood B, Rademaker M, Oakley A, Wallace J. Pellagra in a woman using alternative remedies. Australas J Dermatol 1998;39:42-4.

Kaur S, Goraya JS, Thami GP, Kanwar AJ. Pellagrous dermatitis induced by phenytoin (letter). Pediatr Derm 2002;19:93.

Lyon VB, Fairley JA. Anticonvulsant-induced pellagra. J Am Acad Dermatol 2002;46:597-9.

Ding RW, Kolbe K, Merz B, et al. Pharmacokinetics of nicotinic acid-salicylic acid interaction. Clin Pharmacol Ther 1989;46:642-7.

Nahata MC. Chloramphenicol. In: Evans WE, Schentag JJ, Jusko WJ (eds). Applied Pharmacokinetics: Principles of Therapeutic Drug Monitoring. 3rd ed., Vancouver, WA: Applied Therapeutics, Inc., 1992.

Bingham LG, Verma SB. A photodistributed rash. (Self-Assessment examination of the American Academy of Dermatology). J Am Acad Dermatol 2005;52:929-32.

Hendricks WM. Pellagra and pellagralike dermatoses: etiology, differential diagnosis, dermatopathology, and treatment. Semin Dermatol 1991;10:282-92.

Karthikeyan K, Thappa DM. Pellagra and skin. Int J Dermatol 2002;41:476-81.

PL Detail-Document, Niacin Plus Statin to Reduce Cardiovascular Risk: AIM-HIGH Study. Pharmacist's Letter/Prescriber's Letter. July 2011.

NIH News. NIH stops clinical trial on combination cholesterol treatment. May 26, 2011. http://www.nih.gov.ccnm.idm.oclc.org/news/health/may2011/nhlbi-26.htm. (Accessed 3 June 2011).

FDA statement on the AIM-HIGH trial. http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm256841.htm. (Accessed 3 June 2011).

Maes BD, Hiele MI, Geypens BJ, et al. Pharmacological modulation of gastric emptying rate of solids as measured by the carbon labelled octanoic acid breath test: influence of erythromycin and propantheline. Gut 1994;35(3):333-7.

Goldberg AC. A meta-analysis of randomized controlled studies on the effects of extended-release niacin in women. Am J Cardiol. 2004;94(1):121-4.

Charland SL, Malone DC. Prediction of cardiovascular event risk reduction from lipid changes associated with high potency dyslipidemia therapy. Curr Med Res Opin. 2010;26(2):365-75.

Elam MB, Hunninghake DB, Davis KB, et al. Effect of niacin on lipid and lipoprotein levels and glycemic control in patients with diabetes and peripheral arterial disease: the ADMIT study: A randomized trial. Arterial Disease Multiple Intervention Trial. JAMA. 2000;284(10):1263-70.

Balasubramanyam A, Coraza I, Smith EO, et al. Combination of niacin and fenofibrate with lifestyle changes improves dyslipidemia and hypoadiponectinemia in HIV patients on antiretroviral therapy: results of "heart positive," a randomized, controlled trial. J Clin Endocrinol Metab. 2011;96(7):2236-47.

Dubé MP, Wu JW, Aberg JA, et al. Safety and efficacy of extended-release niacin for the treatment of dyslipidaemia in patients with HIV infection: AIDS Clinical Trials Group Study A5148. Antivir Ther. 2006;11(8):1081-9.

Gerber MT, Mondy KE, Yarasheski KE, et al. Niacin in HIV-infected individuals with hyperlipidemia receiving potent antiretroviral therapy. Clin Infect Dis. 2004;39(3):419-25.

Malfait P, Moren A, Dillon JC, et al. An outbreak of pellagra related to changes in dietary niacin among Mozambican refugees in Malawi. Int J Epidemiol. 1993;22(3):504-11.

Spies TD, Grant JM, Stone RE, et al. Recent observations on the treatment of six hundred pellagrins with special emphasis on the use of nicotinic acid in prophylaxis. South Med J 1938;31(12):1231.

Bruckert E, Labreuche J, Amarenco P. Meta-analysis of the effect of nicotinic acid alone or in combination on cardiovascular events and atherosclerosis. Atherosclerosis. 2010;210(2):353-61.

Brown G, Albers JJ, Fisher LD, et al. Regression of coronary artery disease as a result of intensive lipid-lowering therapy in men with high levels of apolipoprotein B. N Engl J Med. 1990;323(19):1289-98.

Brown BG, Zambon A, Poulin D, et al. Use of niacin, statins, and resins in patients with combined hyperlipidemia. Am J Cardiol. 1998;81(4A):52B-59B.

Blankenhorn DH, Selzer RH, Crawford DW, et al. Beneficial effects of colestipol-niacin therapy on the common carotid artery. Two- and four-year reduction of intima-media thickness measured by ultrasound. Circulation. 1993;88(1):20-8.

Mack WJ, Selzer RH, Hodis HN, et al. One-year reduction and longitudinal analysis of carotid intima-media thickness associated with colestipol/niacin therapy. Stroke. 1993;24(12):1779-83.

Blankenhorn DH, Nessim SA, Johnson RL, et al. Beneficial effects of combined colestipol-niacin therapy on coronary atherosclerosis and coronary venous bypass grafts. JAMA. 1987;257(23):3233-40.

Carlson LA, Rosenhamer G. Reduction of mortality in the Stockholm Ischaemic Heart Disease Secondary Prevention Study by combined treatment with clofibrate and nicotinic acid. Acta Med Scand. 1988;223(5):405-18.

Duggal JK, Singh M, Attri N, et al. Effect of niacin therapy on cardiovascular outcomes in patients with coronary artery disease. J Cardiovasc Pharmacol Ther. 2010;15(2):158-66.

Ng CF, Lee CP, Ho AL, Lee VW. Effect of niacin on erectile function in men suffering erectile dysfunction and dyslipidemia. J Sex Med. 2011;8(10):2883-93.

Sampathkumar K, Selvam M, Sooraj YS, Gowthaman S, Ajeshkumar RN. Extended release nicotinic acid - a novel oral agent for phosphate control. Int Urol Nephrol. 2006;38(1):171-4.

Dearing BD, Lavie CJ, Lohmann TP, Genton E. Niacin-induced clotting factor synthesis deficiency with coagulopathy. Arch Intern Med. 1992;152(4):861-3.

O'Brien T, Silverberg JD, Nguyen TT. Nicotinic acid-induced toxicity associated with cytopenia and decreased levels of thyroxine-binding globulin. Mayo Clin Proc. 1992;67(5):465-8.

Gadegbeku CA, Dhandayuthapani A, Shrayyef MZ, Egan BM. Hemodynamic effects of nicotinic acid infusion in normotensive and hypertensive subjects. Am J Hypertens. 2003;16(1):67-71.

Garnett WR. Interactions with hydroxymethylglutaryl-coenzyme A reductase inhibitors. Am J Health Syst Pharm. 1995;52(15):1639-45.

Hexeberg S, Retterstøl K. [Hypertriglyceridemia--diagnostics, risk and treatment]. Tidsskr Nor Laegeforen. 2004;124(21):2746-9.

Litin SC, Anderson CF. Nicotinic acid-associated myopathy: a report of three cases. Am J Med. 1989;86(4):481-3.

Dunn RT, Ford MA, Rindone JP, Kwiecinski FA. Low-Dose Aspirin and Ibuprofen Reduce the Cutaneous Reactions Following Niacin Administration. Am J Ther. 1995;2(7):478-480.

Cashin-Hemphill L, Spencer CA, Nicoloff JT, et al. Alterations in serum thyroid hormonal indices with colestipol-niacin therapy. Ann Intern Med. 1987;107(3):324-9.

Drinka PJ. Alterations in thyroid and hepatic function tests associated with preparations of sustained-release niacin. Mayo Clin Proc. 1992;67(12):1206.

Davignon J, Roederer G, Montigny M, et al. Comparative efficacy and safety of pravastatin, nicotinic acid and the two combined in patients with hypercholesterolemia. Am J Cardiol. 1994;73(5):339-45.

Shakir KM, Kroll S, Aprill BS, Drake AJ 3rd, Eisold JF. Nicotinic acid decreases serum thyroid hormone levels while maintaining a euthyroid state. Mayo Clin Proc. 1995;70(6):556-8.

Etchason JA, Miller TD, Squires RW, et al. Niacin-induced hepatitis: a potential side effect with low-dose time-release niacin. Mayo Clin Proc. 1991;66(1):23-8.

Henkin Y, Johnson KC, Segrest JP. Rechallenge with crystalline niacin after drug-induced hepatitis from sustained-release niacin. JAMA. 1990;264(2):241-3.

Henkin Y, Oberman A, Hurst DC, Segrest JP. Niacin revisited: clinical observations on an important but underutilized drug. Am J Med. 1991;91(3):239-46.

Colletti RB, Neufeld EJ, Roff NK, et al. Niacin treatment of hypercholesterolemia in children. Pediatrics. 1993 Jul;92(1):78-82.

- Blankenhorn DH, Malinow MR, Mack WJ. Colestipol plus niacin therapy elevates plasma homocysteine levels. Coron Art Dis 1991;2(3):357-360.

Lisi DM. Niacin and hyperuricemia: how often does it occur and how often are patients started on hypouricemic agents. Int Pharm Abstracts 1999;36(21):2223.

Alhadeff L, Gualtieri CT, Lipton M. Toxic effects of water-soluble vitamins. Nutr Rev. 1984;42(2):33-40.

No authors listed. Clofibrate and niacin in coronary heart disease. JAMA. 1975 Jan 27;231(4):360-81.

Berge KG, Canner PL. Coronary drug project: experience with niacin. Coronary Drug Project Research Group. Eur J Clin Pharmacol. 1991;40 Suppl 1:S49-51.

Lanska DJ. Chapter 30: historical aspects of the major neurological vitamin deficiency disorders: the water-soluble B vitamins. Handb Clin Neurol. 2010;95:445-76.

Ban TA. Academic psychiatry and the pharmaceutical industry. Prog Neuropsychopharmacol Biol Psychiatry. 2006 May;30(3):429-41.

Brown BG, Bardsley J, Poulin D, et al. Moderate dose, three-drug therapy with niacin, lovastatin, and colestipol to reduce low-density lipoprotein cholesterol <100 mg/dl in patients with hyperlipidemia and coronary artery disease. Am J Cardiol. 1997;80(2):111-5.

Fouts PJ, Helmer OM, Lepkovsky S, and et al. Treatment of human pellagra with nicotinic acid. Proc Soc Exp Biol Med 1937;37:405-407.

Smith DT, Ruffin JM, and Smith SG. Pellagra successfully treated with nicotinic acid: a case report. JAMA 1937;109:2054-2055.

Goldberg A, Alagona P Jr, Capuzzi DM, et al. Multiple-dose efficacy and safety of an extended-release form of niacin in the management of hyperlipidemia. Am J Cardiol. 2000;85(9):1100-5.

Aronov DM, Keenan JM, Akhmedzhanov NM, et al. Clinical trial of wax-matrix sustained-release niacin in a Russian population with hypercholesterolemia. Arch Fam Med. 1996;5(10):567-75.

Morgan JM, Capuzzi DM, Guyton JR, et al. Treatment Effect of Niaspan, a Controlled-release Niacin, in Patients With Hypercholesterolemia: A Placebo-controlled Trial. J Cardiovasc Pharmacol Ther. 1996;1(3):195-202.

Andersson RG, Aberg G, Brattsand R, Ericsson E, Lundholm L. Studies on the mechanism of flush induced by nicotinic acid. Acta Pharmacol Toxicol (Copenh). 1977 Jul;41(1):1-10.

Eklund B, Kaijser L, Nowak J, Wennmalm A. Prostaglandins contribute to the vasodilation induced by nicotinic acid. Prostaglandins. 1979;17(6):821-30.

Kaijser L, Eklund B, Olsson AG, Carlson LA. Dissociation of the effects of nicotinic acid on vasodilatation and lipolysis by a prostaglandin synthesis inhibitor, indomethacin, in man. Med Biol. 1979;57(2):114-7.

Windler E, Zyriax BC, Bamberger C, Rinninger F, Beil FU. Current strategies and recent advances in the therapy of hypercholesterolemia. Atheroscler Suppl. 2009;10(5):1-4.

Brown WV. Niacin for lipid disorders. Indications, effectiveness, and safety. Postgrad Med. 1995 Aug;98(2):185-9, 192-3.

Earthman TP, Odom L, Mullins CA. Lactic acidosis associated with high-dose niacin therapy. South Med J. 1991;84(4):496-7.

O'REILLY PO, CALLBECK MJ, HOFFER A. Sustained-release nicotinic acid (nicospan); effect on (1) cholesterol levels and (2) leukocytes. Can Med Assoc J. 1959;80(5):359-62.

Gharavi AG, Diamond JA, Smith DA, Phillips RA. Niacin-induced myopathy. Am J Cardiol. 1994;74(8):841-2.

Litin SC, Anderson CF. Nicotinic acid-associated myopathy: a report of three cases. Am J Med. 1989;86(4):481-3.

Fraunfelder FW, Fraunfelder FT, Illingworth DR. Adverse ocular effects associated with niacin therapy. Br J Ophthalmol 1995;79:54-56.

Chen KK, Rose CL, Robbins EB. Toxicity of nicotinic acid. Proc Soc Exp Biol Med 1938;38:241-245.

Brazda FG and Coulson RA. Toxicity of nicotinic acid and some of its derivatives. Proc Soc Exp Biol Med 1946;62:19-20.

Unna K. Studies on the toxicity and pharmacology of nicotinic acid. J Pharmacol Exp Ther 1939;65:95-103.

Turjman N, Cardamone A, Gotterer GS, Hendrix TR. Effect of nicotinic acid on cholera-induced fluid movement and unidirectional sodium fluxes in rabbit jejunum. Johns Hopkins Med J. 1980;147(6):209-11.

Datta S, Das DK, Engelman RM, et al. Enhanced myocardial preservation by nicotinic acid, an antilipolytic compound: mechanism of action. Basic Res Cardiol. 1989;84(1):63-76.

Vincent JE, Zijlstra FJ. Nicotinic acid inhibits thromboxane synthesis in platelets. Prostaglandins. 1978;15(4):629-36.

Jin FY, Kamanna VS, Kashyap ML. Niacin decreases removal of high-density lipoprotein apolipoprotein A-I but not cholesterol ester by Hep G2 cells. Implication for reverse cholesterol transport. Arterioscler Thromb Vasc Biol. 1997;17(10):2020-8.

Morgan JM, Capuzzi DM, Baksh RI, et al. Effects of extended-release niacin on lipoprotein subclass distribution. Am J Cardiol. 2003;91(12):1432-6.

Tornvall P, Hamsten A, Johansson J, Carlson LA. Normalisation of the composition of very low density lipoprotein in hypertriglyceridemia by nicotinic acid. Atherosclerosis. 1990;84(2-3):219-27.

Ganji SH, Tavintharan S, Zhu D, Xing Y, Kamanna VS, Kashyap ML. Niacin noncompetitively inhibits DGAT2 but not DGAT1 activity in HepG2 cells. J Lipid Res. 2004;45(10):1835-45.

Cases S, Smith SJ, Zheng YW, et al. Identification of a gene encoding an acyl CoA:diacylglycerol acyltransferase, a key enzyme in triacylglycerol synthesis. Proc Natl Acad Sci U S A. 1998;95(22):13018-23.

Karpe F, Frayn KN. The nicotinic acid receptor--a new mechanism for an old drug. Lancet. 2004;363(9424):1892-4.

Menon RM, Adams MH, González MA, Tolbert DS, Leu JH, Cefali EA. Plasma and urine pharmacokinetics of niacin and its metabolites from an extended-release niacin formulation. Int J Clin Pharmacol Ther. 2007;45(8):448-54.

Neuvonen PJ, Roivas L, Laine K, Sundholm O. The bioavailability of sustained release nicotinic acid formulations. Br J Clin Pharmacol. 1991;32(4):473-6.

Mrochek JE, Jolley RL, Young DS, Turner WJ. Metabolic response of humans to ingestion of nicotinic acid and nicotinamide. Clin Chem. 1976;22(11):1821-7.

Figge HL, Figge J, Souney PF, et al. Comparison of excretion of nicotinuric acid after ingestion of two controlled release nicotinic acid preparations in man. J Clin Pharmacol. 1988 Dec;28(12):1136-40.

Hendrix, C. R., Housh, T. J., Mielke, M., Zuniga, J. M., Camic, C. L., Johnson, G. O., Schmidt, R. J., and Housh, D. J. Acute effects of a caffeine-containing supplement on bench press and leg extension strength and time to exhaustion during cycle ergometry. J Strength.Cond.Res 2010;24(3):859-865.

Urberg, M., Benyi, J., and John, R. Hypocholesterolemic effects of nicotinic acid and chromium supplementation. J Fam.Pract. 1988;27(6):603-606.

Ali EH, McJunkin B, Jubelirer S, Hood W. Niacin induced coagulopathy as a manifestation of occult liver injury. W V Med J. 2013 Jan-Feb;109(1):12-4

Aramwit P, Srisawadwong R, Supasyndh O. Effectiveness and safety of extended-release nicotinic acid for reducing serum phosphorus in hemodialysis patients. J Nephrol. 2012 May-Jun;25(3):354-62.

Bassan M. A case for immediate-release niacin. Heart Lung. 2012 Jan-Feb;41(1):95-8.

Davidson MH, Rooney M, Pollock E, Drucker J, Choy Y. Effect of colesevelam and niacin on low-density lipoprotein cholesterol and glycemic control in subjects with dyslipidemia and impaired fasting glucose. J Clin Lipidol. 2013 Sep-Oct;7(5):423-32.

Guyton JR, Fazio S, Adewale AJ, Jensen E, Tomassini JE, Shah A, Tershakovec AM. Effect of extended-release niacin on new-onset diabetes among hyperlipidemic patients treated with ezetimibe/simvastatin in a randomized controlled trial. Diabetes Care. 2012 Apr;35(4):857-60.

He YM, Feng L, Huo DM, Yang ZH, Liao YH. Benefits and harm of niacin and its analog for renal dialysis patients: a systematic review and meta-analysis. Int Urol Nephrol. 2014 Feb;46(2):433-42.

Keene D, Price C, Shun-Shin MJ, Francis DP. Effect on cardiovascular risk of high density lipoprotein targeted drug treatments niacin, fibrates, and CETP inhibitors: meta-analysis of randomised controlled trials including 117,411 patients. BMJ. 2014 Jul 18;349:g4379.

Kei A, Liberopoulos EN, Mikhailidis DP, Elisaf M. Comparison of switch to the highest dose of rosuvastatin vs. add-on nicotinic acid vs. add-on fenofibrate for mixed dyslipidaemia. Int J Clin Pract. 2013 May;67(5):412-9.

Lakey WC, Greyshock N, Guyton JR. Adverse reactions of Achilles tendon xanthomas in three hypercholesterolemic patients after treatment intensification with niacin and bile acid sequestrants. J Clin Lipidol. 2013 Mar-Apr;7(2):178-81.

Lavigne PM, Karas RH. The current state of niacin in cardiovascular disease prevention: a systematic review and meta-regression. J Am Coll Cardiol. 2013 Jan 29;61(4):440-6.

Loebl T, Raskin S. A novel case report: acute manic psychotic episode after treatment with niacin. J Neuropsychiatry Clin Neurosci. 2013 Fall;25(4):E14.

Philpott AC, Hubacek J, Sun YC, Hillard D, Anderson TJ. Niacin improves lipid profile but not endothelial function in patients with coronary artery disease on high dose statin therapy. Atherosclerosis. 2013 Feb;226(2):453-8.

Sazonov V, Maccubbin D, Sisk CM, Canner PL. Effects of niacin on the incidence of new onset diabetes and cardiovascular events in patients with normoglycaemia and impaired fasting glucose. Int J Clin Pract. 2013 Apr;67(4):297-302.

Shearer GC, Pottala JV, Hansen SN, Brandenburg V, Harris WS. Effects of prescription niacin and omega-3 fatty acids on lipids and vascular function in metabolic syndrome: a randomized controlled trial. J Lipid Res. 2012 Nov;53(11):2429-35.

Teo KK, Goldstein LB, Chaitman BR, Grant S, Weintraub WS, Anderson DC, Sila CA, Cruz-Flores S, Padley RJ, Kostuk WJ, Boden WE; AIM-HIGH Investigators. Extended-release niacin therapy and risk of ischemic stroke in patients with cardiovascular disease: the Atherothrombosis Intervention in Metabolic Syndrome with low HDL/High Triglycerides: Impact on Global Health Outcome (AIM-HIGH) trial. Stroke. 2013 Oct;44(10):2688-93.

PL Detail-Document, Role of Non-Statins for Dyslipidemia. Pharmacist's Letter/Prescriber's Letter. June 2016;32(6):320601.

Goldie C, Taylor AJ, Nguyen P, McCoy C, Zhao XQ, Preiss D. Niacin therapy and the risk of new-onset diabetes: a meta-analysis of randomized controlled trials. Heart. 2016 Feb;102(3):198-203.

Brunner G, Yang EY, Kumar A, et al. The effect of lipid modification on peripheral artery disease after endovascular intervention trial (ELIMIT). Atherosclerosis. 2013 Dec;213(2):371-7.

Scoffone HM, Krajewski M, Zorca S, et al. Effect of extended-release niacin on serum lipids and on endothelial function in adults with sickle cell anemia and low high-density lipoprotein cholesterol levels. Am J Cardiol. 2013 Nov 1;112(9):1499-504.

Lin C, Grandinetti A, Shikuma C, et al. The effects of extended release niacin on lipoprotein sub-particle concentrations in HIV-infected patients. Hawaii J Med Public Health. 2013 Apr;72(4):123-7.

Schandelmaier S, Briel M, Saccilotto R, Olu KK, Arpagaus A, Hemkens LG, Nordmann AJ. Niacin for primary and secondary prevention of cardiovascular events. Cochrane Database Syst Rev. 2017 Jun 14;6:CD009744.

Gaynon MW, Paulus YM, Rahimy E, Alexander JL, Mansour SE. Effect of oral niacin on central retinal vein occlusion. Graefes Arch Clin Exp Ophthalmol. 2017 Jun;255(6):1085-92.

Sahebkar A, Reiner Z, Simental-Mendia LE, Ferretti G, Cicero AF. Effect of extended-release niacin on plasma lipoprotein(a) levels: A systematic review and meta-analysis of randomized placebo-controlled trials. Metabolism. 2016 Nov;65(11):1664-78.

Jenkins DJA, Spence JD, Giovannucci EL, et al. Supplemental vitamins and minerals for CVD prevention and treatment. J Am Coll Cardiol 2018;71(22):2570-84.

Montserrat-de la Paz S, Lopez S, Bermudez B, et al. Effects of immediate-release niacin and dietary fatty acids on acute insulin and lipid status in individuals with metabolic syndrome. J Sci Food Agric 2018;98(6):2194-200.

Lloyd-Jones DM, Morris PB, Ballantyne CM, et al. 2016 ACC Expert consensus decision rathway on the role of non-statin therapies for LDL-cholesterol lowering in the management of atherosclerotic cardiovascular disease risk: a report of the American College of Cardiology task force on clinical expert consensus documents. J Am Coll of Cardiol 2016;68(1):92-125.

Stone NJ, Robinson JG, Lichtenstein AH, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association task force on practice guidelines. J Am Coll Cardiol 2014;63(25):2889-934.

Anderson TJ, Grégoire J, Pearson GJ, et al. 2016 Canadian Cardiovascular Society Guidelines for the Management of Dyslipidemia for the Prevention of Cardiovascular Disease in the Adult. Can J Cardiol. 2016;32(11):1263-1282.