Editing Niacin (section)

==Preparations==
[[File:Inositol nicotinate.png|thumb|class=skin-invert-image|[[Inositol]] hexanicotinate]]
Niacin is incorporated into multi-vitamin and sold as a single-ingredient dietary supplement. The latter can be immediate or slow release.<ref name=Dunatchik>{{cite journal | vauthors = Dunatchik AP, Ito MK, Dujovne CA | title = A systematic review on evidence of the effectiveness and safety of a wax-matrix niacin formulation | journal = Journal of Clinical Lipidology | volume = 6 | issue = 2 | pages = 121–31 | date = 1 March 2012 | pmid = 22385545 | doi = 10.1016/j.jacl.2011.07.003 }}</ref>

[[Nicotinamide]] is used to treat niacin deficiency because it does not cause the flushing adverse reaction seen with niacin. Nicotinamide may be toxic to the liver at doses exceeding 3{{nbsp}}g/day for adults.<ref>{{cite journal | vauthors = Knip M, Douek IF, Moore WP, Gillmor HA, McLean AE, Bingley PJ, Gale EA | title = Safety of high-dose nicotinamide: a review | journal = Diabetologia | volume = 43 | issue = 11 | pages = 1337–45 | date = November 2000 | pmid = 11126400 | doi = 10.1007/s001250051536 | doi-access = free }}</ref>

Prescription products can be immediate release (Niacor, 500&nbsp;mg tablets) or [[extended release]] (Niaspan, 500 and 1000&nbsp;mg tablets). Niaspan has a film coating that delays release of the niacin, resulting in an absorption over a period of 8–12 hours. This reduces [[vasodilation]] and [[flushing (physiology)|flushing]] side effects, but increases the risk of [[hepatotoxicity]] compared to the immediate release drug.<ref>{{cite journal | vauthors = Bassan M | title = A case for immediate-release niacin | journal = Heart & Lung | volume = 41 | issue = 1 | pages = 95–8 | year = 2012 | pmid = 21414665 | doi = 10.1016/j.hrtlng.2010.07.019 }}</ref><ref>{{cite journal | vauthors = Reiche I, Westphal S, Martens-Lobenhoffer J, Tröger U, Luley C, Bode-Böger SM | title = Pharmacokinetics and dose recommendations of Niaspan in chronic kidney disease and dialysis patients | journal = Nephrology, Dialysis, Transplantation | volume = 26 | issue = 1 | pages = 276–82 | date = January 2011 | pmid = 20562093 | doi = 10.1093/ndt/gfq344 | doi-access = free }}</ref>

Prescription niacin preparations in combination with statin drugs (discontinued) are described above. A combination of niacin and [[laropiprant]] had been approved for use in Europe and marketed as Tredaptive. Laropiprant is a [[prostaglandin D2]] binding drug shown to reduce niacin-induced vasodilation and flushing side effects.<ref name="Villines, T. C. 2012 p 14"/><ref>{{cite journal | vauthors = Lai E, De Lepeleire I, Crumley TM, Liu F, Wenning LA, Michiels N, Vets E, O'Neill G, Wagner JA, Gottesdiener K | title = Suppression of niacin-induced vasodilation with an antagonist to prostaglandin D2 receptor subtype 1 | journal = Clinical Pharmacology and Therapeutics | volume = 81 | issue = 6 | pages = 849–57 | date = June 2007 | pmid = 17392721 | doi = 10.1038/sj.clpt.6100180 | s2cid = 2126240 }}</ref><ref>{{cite journal | vauthors = Paolini JF, Bays HE, Ballantyne CM, Davidson M, Pasternak R, Maccubbin D, Norquist JM, Lai E, Waters MG, Kuznetsova O, Sisk CM, Mitchel YB | title = Extended-release niacin/laropiprant: reducing niacin-induced flushing to better realize the benefit of niacin in improving cardiovascular risk factors | journal = Cardiology Clinics | volume = 26 | issue = 4 | pages = 547–60 | date = November 2008 | pmid = 19031552 | doi = 10.1016/j.ccl.2008.06.007 }}</ref> A clinical trial showed no additional efficacy of Tredaptive in lowering cholesterol when used together with other statin drugs, but did show an increase in other side effects.<ref>{{cite journal |vauthors=Landray MJ, Haynes R, Hopewell JC, Parish S, Aung T, Tomson J, Wallendszus K, Craig M, Jiang L, Collins R, Armitage J |title=Effects of extended-release niacin with laropiprant in high-risk patients |journal=N. Engl. J. Med. |volume=371 |issue=3 |pages=203–12 |date=July 2014 |pmid=25014686 |doi=10.1056/NEJMoa1300955 |s2cid=23548060 |doi-access=free }}</ref> The study resulted in the withdrawal of Tredaptive from the international market.<ref>{{Cite web|url=http://www.medscape.com/viewarticle/777519|title=Niacin/Laropiprant Products to Be Suspended Worldwide|vauthors=Nainggolan L|date=11 January 2013|website=Medscape|access-date=20 February 2017|archive-date=26 April 2015|archive-url=https://web.archive.org/web/20150426032404/http://www.medscape.com/viewarticle/777519|url-status=live}}</ref><ref>{{cite news | url=https://www.reuters.com/article/us-merck-cholesteroldrug-withdrawal-idUSBRE90A0MB20130111?feedType=RSS&feedName=healthNews | work=Reuters | title=Merck begins overseas recall of HDL cholesterol drug | date=11 January 2013 | access-date=6 July 2021 | archive-date=21 April 2023 | archive-url=https://web.archive.org/web/20230421215022/https://www.reuters.com/article/us-merck-cholesteroldrug-withdrawal-idUSBRE90A0MB20130111?feedType=RSS&feedName=healthNews | url-status=live }}</ref>

One form of dietary supplement sold in the US is inositol hexanicotinate (IHN), also called [[inositol nicotinate]]. This is [[inositol]] that has been [[ester]]ified with niacin on all six of inositol's alcohol groups.<ref name="efsa.europa.eu">{{cite journal | journal = The EFSA Journal | date = January 2009 | volume = 949 | pages = 1–20 | title = Inositol hexanicotinate (inositol hexaniacinate) as a source of niacin (vitamin B3) added for nutritional purposes in food supplements | vauthors = Aguilar F, Charrondiere UR, Dusemund B, Galtier PM, Gilbert J, Gott DM, Grilli S, Guertler R, Kass GE, Koenig J, Lambré C, Larsen JC, Mortensen A, Parent-Massin D, Pratt I, Rietjens IM, Stankovic I, Tobback P, Verguieva T, Woutersen RA | url = https://www.efsa.europa.eu/en/efsajournal/pub/949 | access-date = 4 March 2017 | archive-date = 5 March 2017 | archive-url = https://web.archive.org/web/20170305035332/https://www.efsa.europa.eu/en/efsajournal/pub/949 | url-status = live }}</ref> IHN is usually sold as "flush-free" or "no-flush" niacin in units of 250, 500, or 1000&nbsp;mg/tablets or capsules. In the US, it is sold as an over-the-counter formulation, and often is marketed and labeled as niacin, thus misleading consumers into thinking they are getting an active form of the medication. While this form of niacin does not cause the flushing associated with the immediate-release products, there is not enough evidence to recommend IHN to treat hyperlipidemia.<ref name=Taheri>{{cite web | url = http://www.medscape.com/viewarticle/447528 | title = No-Flush Niacin for the Treatment of Hyperlipidemia | vauthors = Taheri | website = [[Medscape]] | date = 15 January 2003 | access-date = 31 March 2008 | archive-date = 5 December 2008 | archive-url = https://web.archive.org/web/20081205051549/http://www.medscape.com/viewarticle/447528 | url-status = live }}</ref>