Usage
Niacinamide, a form of vitamin B3 (niacin), is used to treat niacin deficiency (pellagra). Symptoms of niacin deficiency include inflamed skin, diarrhea, dementia, and sores in the mouth. It’s also used for other conditions, including acne, diabetes, high phosphate levels in the blood (hyperphosphatemia), osteoarthritis, and certain skin cancers.
- Pharmacological Classification: Vitamin, water-soluble
- Mechanism of Action: Niacinamide is a precursor to nicotinamide adenine dinucleotide (NAD) and nicotinamide adenine dinucleotide phosphate (NADP), coenzymes essential for numerous metabolic processes, including energy production, DNA repair, and cellular signaling.
Alternate Names
How It Works
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Pharmacodynamics: Niacinamide influences various physiological processes by acting as a precursor for NAD and NADP, impacting cellular energy metabolism, DNA repair, and inflammatory responses.
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Pharmacokinetics: Niacinamide is readily absorbed orally. It’s widely distributed throughout the body, metabolized in the liver, and excreted primarily by the kidneys.
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Mode of Action: Increases intracellular NAD/NADP levels, thereby supporting metabolic functions and influencing cellular signaling pathways related to inflammation and DNA repair.
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Elimination Pathways: Renal excretion
Dosage
Standard Dosage
Adults:
The recommended daily allowance (RDA) for adults is 14 mg/day for women and 16 mg/day for men. Therapeutic doses range from 100-300 mg daily for pellagra, up to 3 grams per day for conditions like osteoarthritis. Dosages for other conditions like diabetes and hyperphosphatemia vary.
Children:
The RDA varies with age. Therapeutic doses should be determined based on weight and the specific condition being treated.
Special Cases:
- Elderly Patients: Dosage adjustments may be necessary based on kidney function.
- Patients with Renal Impairment: Caution and possible dose reductions are advised.
- Patients with Hepatic Dysfunction: Use with caution.
- Patients with Comorbid Conditions: Consider individual patient factors, especially with diabetes, liver disease, or peptic ulcers.
Clinical Use Cases
Dosage recommendations for specific clinical use cases like intubation, surgical procedures, mechanical ventilation, or ICU use aren’t established for niacinamide. Its primary clinical uses are vitamin B3 deficiency and conditions mentioned above.
Dosage Adjustments
Dose modification may be needed in patients with renal or hepatic dysfunction.
Side Effects
Common Side Effects
- Stomach upset
- Gas
- Dizziness
- Mild itching
- Mild rash
Rare but Serious Side Effects
- Liver problems
- High blood sugar (especially with high doses)
Long-Term Effects
Potential liver toxicity with prolonged high doses.
Adverse Drug Reactions (ADR)
Severe allergic reactions are rare.
Contraindications
- Severe liver disease
- Active peptic ulcer disease
- Arterial bleeding
- Hypersensitivity to niacinamide
Drug Interactions
- Alcohol can exacerbate flushing.
- Niacinamide might interfere with blood sugar control during and after surgery, requiring discontinuation at least two weeks prior.
Pregnancy and Breastfeeding
Generally safe in recommended amounts during pregnancy and breastfeeding. Maximum recommended intake is 30 mg/day for those under 18 and 35 mg/day for those over 18.
Drug Profile Summary
- Mechanism of Action: Precursor of NAD/NADP, essential coenzymes for metabolic processes.
- Side Effects: Stomach upset, gas, dizziness, itching, rash. Liver problems and high blood sugar at high doses.
- Contraindications: Severe liver disease, active peptic ulcer, arterial bleeding, hypersensitivity.
- Drug Interactions: Alcohol (increases flushing), medications affecting blood sugar control.
- Pregnancy & Breastfeeding: Likely safe in recommended doses.
- Dosage: Varies by indication and patient characteristics (see above).
- Monitoring Parameters: Liver function tests with high-dose or prolonged use. Blood glucose monitoring in patients with diabetes.
Popular Combinations
Niacinamide is sometimes used in combination with other ingredients in topical acne treatments.
Precautions
- Screen patients for liver and kidney function.
- Consider potential exacerbation of pre-existing conditions like diabetes, gallbladder disease, and gout.
- Discontinue prior to surgery to avoid interfering with blood sugar control.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Niacinamide?
A: The RDA is 14-16 mg/day for adults, but therapeutic doses vary widely depending on the indication. Please refer to the detailed dosage section above.
Q2: What are the primary uses of Niacinamide?
A: Treating and preventing niacin deficiency (pellagra) is the main use. It’s also used for acne, diabetes, high phosphate levels, osteoarthritis, and some skin cancers.
Q3: How does Niacinamide work in the body?
A: It acts as a precursor to NAD and NADP, coenzymes involved in many metabolic processes, influencing energy production, DNA repair, and inflammation.
Q4: What are the common side effects?
A: Common side effects include stomach upset, gas, dizziness, and mild itching or rash.
Q5: Are there any serious side effects?
A: High doses can cause liver problems and elevated blood sugar.
Q6: Who should not take Niacinamide?
A: People with severe liver disease, active peptic ulcers, arterial bleeding, or niacinamide hypersensitivity.
Q7: Does Niacinamide interact with any medications?
A: Alcohol can exacerbate flushing. Caution is advised with diabetes medications due to its potential effect on blood sugar. It can also interact with medications metabolized by the liver.
Q8: Can I take Niacinamide during pregnancy or breastfeeding?
A: It’s considered likely safe at recommended intake levels (30 mg/day under 18 years, 35 mg/day over 18 years). Consult your doctor.
Q9: What should I do if I miss a dose?
A: Take the missed dose as soon as you remember, unless it’s almost time for your next dose. Don’t double up on doses.
A: Yes, niacinamide is widely available as a generic medication.
