Niacin / Nicotinamide

Water-Soluble (B3)·Vitamins & Minerals

Prevention of recurrent basal cell and squamous cell carcinomas (Nicotinamide)

VITAMINVarious OTC500 mg tabletUNSCHEDULEDTGA

Max Dose

1000 mg/day

Half-life

Hours

Skin Cancer

PROPHYLAXIS

Flushing

NIACIN ONLY

Rapid Summary

Overview

Vitamin B3. Exists in two distinct forms: Niacin (Nicotinic Acid) which lowers lipids but causes horrific flushing, and Nicotinamide which does not flush and is used to prevent skin cancer.

Maximum Dose

Max 1000 mg/day (Nicotinamide for skin cancer).

Clinical Focus

Never confuse the two forms. Niacin causes a massive, burning, full-body flush mediated by prostaglandins.

Bottom Line

Niacin / Nicotinamide is used for pellagra treatment and as adjunctive lipid-lowering therapy, but causes intense flushing at therapeutic doses and hepatotoxicity with sustained-release forms.

Formulation & Access

Brand Names

Various OTC

Oral Routes

Tablets (500 mg).

Prescribing & PBS

Over The Counter (OTC).

Indications & Use

Primary

TGA

Prevention of recurrent basal cell and squamous cell carcinomas (Nicotinamide). Treatment of Pellagra.

Clinical Place

Nicotinamide 500mg BD is standard-of-care across Australia for elderly patients with heavily sun-damaged skin to stop continuous skin cancers.

Quick reference

Class & Role

Water-Soluble (B3) — Vitamin B3.

Route / Formulation

Tablets (500 mg). (Various OTC)

Usual Dose & Max

PO Nicotinamide 500 mg BD (Proven in the ONTRAC trial to reduce new BCCs and SCCs by 23%). Max 1000 mg/day (Nicotinamide for skin cancer).

Key Indication Doses

Non-Melanoma Skin Cancer Prophylaxis: PO Nicotinamide 500 mg BD (Proven in the ONTRAC trial to reduce new BCCs and SCCs by 23%). Pellagra (Severe Deficiency): PO Nicotinamide 100-300 mg/day. Dyslipidemia (Obsolete): PO Niacin (Nicotinic acid) up to 2000 mg/day.

Best Uses

Niacin / Nicotinamide is used for pellagra treatment and as adjunctive lipid-lowering therapy, but causes intense flushing at therapeutic doses and hepatotoxicity with sustained-release forms.

Avoid / Cautions

Active liver disease, active peptic ulcer (for Niacin). At standard dietary doses.

Key Risks

Dermatological: The 'Niacin Flush' (intense redness, burning, itching of the face and torso). Only occurs with Nicotinic Acid, NOT Nicotinamide. Hepatic: Severe hepatotoxicity with high-dose sustained-release Niacin. Metabolic: Niacin can worsen gout (hyperuricemia) and worsen blood sugars in diabetics.

Key Interactions

Niacin combined with Statins exponentially increases the risk of rhabdomyolysis.

Monitoring

Ensure the patient buys 'Nicotinamide' (or Niacinamide), NOT 'Niacin' or 'Nicotinic Acid', to prevent the flushing reaction.

Clinical Pearl

If a patient MUST take Niacin and suffers the horrific flush, it can be entirely blocked by taking 300mg of Aspirin 30 minutes before the Niacin. The flush is driven by prostaglandins, which aspirin blocks.

Access

Various OTC500 mg tablet

Brand: Various OTC
Formulation: Tablets (500 mg)

Niacin / Nicotinamide

Water-Soluble (B3)·Vitamins & Minerals

Prevention of recurrent basal cell and squamous cell carcinomas (Nicotinamide)

VITAMINVarious OTC500 mg tabletUNSCHEDULEDTGA

Max Dose

1000 mg/day

Half-life

Hours

Skin Cancer

PROPHYLAXIS

Flushing

NIACIN ONLY

Rapid Summary

Overview

Vitamin B3. Exists in two distinct forms: Niacin (Nicotinic Acid) which lowers lipids but causes horrific flushing, and Nicotinamide which does not flush and is used to prevent skin cancer.

Maximum Dose

Max 1000 mg/day (Nicotinamide for skin cancer).

Clinical Focus

Never confuse the two forms. Niacin causes a massive, burning, full-body flush mediated by prostaglandins.

Bottom Line

Niacin / Nicotinamide is used for pellagra treatment and as adjunctive lipid-lowering therapy, but causes intense flushing at therapeutic doses and hepatotoxicity with sustained-release forms.

Formulation & Access

Brand Names

Various OTC

Oral Routes

Tablets (500 mg).

Prescribing & PBS

Over The Counter (OTC).

Indications & Use

Primary

TGA

Prevention of recurrent basal cell and squamous cell carcinomas (Nicotinamide). Treatment of Pellagra.

Clinical Place

Nicotinamide 500mg BD is standard-of-care across Australia for elderly patients with heavily sun-damaged skin to stop continuous skin cancers.

Quick reference

Class & Role

Water-Soluble (B3) — Vitamin B3.

Route / Formulation

Tablets (500 mg). (Various OTC)

Usual Dose & Max

PO Nicotinamide 500 mg BD (Proven in the ONTRAC trial to reduce new BCCs and SCCs by 23%). Max 1000 mg/day (Nicotinamide for skin cancer).

Key Indication Doses

Best Uses

Niacin / Nicotinamide is used for pellagra treatment and as adjunctive lipid-lowering therapy, but causes intense flushing at therapeutic doses and hepatotoxicity with sustained-release forms.

Avoid / Cautions

Active liver disease, active peptic ulcer (for Niacin). At standard dietary doses.

Key Risks

Key Interactions

Niacin combined with Statins exponentially increases the risk of rhabdomyolysis.

Monitoring

Ensure the patient buys 'Nicotinamide' (or Niacinamide), NOT 'Niacin' or 'Nicotinic Acid', to prevent the flushing reaction.

Clinical Pearl

Access

Various OTC500 mg tablet

Brand: Various OTC
Formulation: Tablets (500 mg)