Niacin is used in the process of releasing energy from carbohydrates, forming fat from carbohydrates and to process alcohol. Vitamin B3 comes in two basic forms—niacin (also called nicotinic acid) and niacinamide (also called nicotinamide). Inositol hexaniacinate, a “flush-free” niacin, is also available and has many of the same benefits of niacin, and is becoming increasingly popular. Dietary niacin and niacin formed within the body from the amino acid tryptophan are converted to niacinamide. Niacinamide is the biologically active form of niacin.
Niacin, in doses as low as 50mg, may cause flushing, headache, and stomachache in some people. Larger amounts can cause liver damage, and elevated blood levels of uric acid and may raise homocysteine levels. Symptoms caused by niacin supplements, such as flushing, have been reduced with sustained-release niacin products but these forms of niacin have caused significant liver toxicity, and are not advised. Niacinamide and inositol hexaniacinate have not been linked with the side effects associated with niacin supplementation.
Pellagra, the disease caused by a frank vitamin B3 deficiency, is rare in modernized societies. Symptoms include loss of appetite, dermatitis, diarrhea, mental changes, beefy tongue, and digestive and emotional disturbance.
Frequent causes of a deficiency include a poor diet, alcoholism, isoniazid therapy and carcinoid tumors. Rarely a deficiency can occur in the presence of hyperthyroidism, diabetes mellitus, cirrhosis, pregnancy or lactation.
The RDA for men and women is in the range of 14-18mg, and is easily achieved. Prescribed doses of the supplement go as high as 3gm per day and sometimes higher.
The best food sources of vitamin B3 are peanuts, brewer’s yeast, fish, and meat. Some vitamin B3 is also found in whole grains. Vitamin B3 is found in most vitamin supplements, but additional supplementation is needed to achieve many of the researched health benefits.
NIASPAN offers significant advantages over IR and SR niacin. Older niacin preparations are available in immediate-release (IR) and sustained-release (SR) formulations. IR niacin, with its multidose regimen and frequent, intense flushing, has a history of poor patient compliance and tolerance.
Sustained-release niacin is dosed less frequently, which may decrease the incidence of flushing. But use of SR niacin has been associated with potentially severe adverse effects including significantly elevated liver transaminase levels. These events can usually be detected by appropriate monitoring, but use of SR niacins has been reported to result in hepatotoxic effects in up to 50% of patients. In addition, the US FDA has issued a guidance stating its opposition to the sale of OTC products for the treatment of hypercholesterolemia.
Prescription NIASPAN utilizes Once-a-Night tablet dosing and an innovative HydroGel Programmed-Release formulation to control drug release. The result is a niacin preparation that maintains traditional niacin lipid-altering efficacy, while avoiding the safety and tolerability pitfalls common with other niacin preparations.