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Profile Uses and Administration Adverse Effects and Treatment Medium-chain Acid 2083 USP 36: (Niacinamide). A white crystalline powder, 4. Elam ME, et al. Effect of niacin on lipid and lipoprotein levels and P.r�P.?.r?ti?�� ·· .......................................... glycemic control inpatients with diabetes and peripheral arterial disease: odourless or practically so. Soluble I in 1.5 of water, I in 284: ProprietaryPreparations · · (details are given in Volume B) lO the ADMIT study: a randomized trial. lAMA 2000; 1263-70. of boiling water, and I in 5.5 of alcohol; soluble in 5. Grundy SM, et a!. Efficacy, safety, and tolerability of once-daily niacin Single-ingredient Preparations. Fr.: Molybdene Injectablet: glycerol. Its solutions are neutral to litmus. Store in airtight for the treatment of dyslipidemia associated with type 2 diabetes: results USA: Molypent. containers. of the assessment of diabetes control and evaluation of the efficacy of Niaspan trial. Arch InternMed 2002; 162: 1568-76. Multi-ingredient Preparations. Canad. : T-OS; Hung.: Humet-R; Thai.: Ferrovit; Ukr.: Vimifor Multivitamin with Beta-Carotene Uses and Administration Hyperlipidaemias. The first-line treatment for hyperlipi­ (BiMi¢op MynhTHBiTaMiH 3 Eera-KapoTHHOM)t. Nicotinic acid and nicotinamide, the form that occurs daemias remains dietary and lifestyle modification; where naturally in the body, are water-soluble vitamin B this fails, drug therapy may be considered (p. 1248.1 ). PharmacopoeialPreparations Nicotinic acid is reported to have a favourable effect on USP 36: Ammonium Molybdate Injection; Minerals Capsules; substances that are converted to nicotinamide adenine blood-lipid profiles, raising high-density lipoprotein Minerals Tablets; Oil- and Water-soluble Vitamins with Minerals dinucleotide (nadide, p. 2567.1) and nicotinamide adenine (HDL)-cholesterol and lowering low-density lipoprotein Capsules; Oil- and Water-soluble Vitamins with Minerals Oral dinucleotide phosphate (NADP). These coenzymes are Solution; Oil- and Water-soluble Vitamins with Minerals Tablets; involved in electron transfer reactions in the respiratory (LDL)·cholesterol.1·3 Nicotinic acid is used particularly in Oil-Soluble Vitamins with Minerals Capsules; Oil-Soluble chain. familial hypertriglyceridaemia, or in familial combined Vitamins with Minerals Oral Solution; Oil-Soluble Vitamins Nicotinic acid deficiency develops when the dietary hyperlipidaemia when both triglyceride and cholesterol with .Minerals Tablets; Trace Elements Injection; Water-soluble intake is inadequate. Deficiency leads to the development of concentrations are similarly elevated. Nicotinic acid was Vitamins with Minerals Capsules; Water-soluble Vitamins with a syndrome known as pellagra, characterised by skin less effective than lovastatin at reducing LDL-cholesterol Minerals Tablets. lesions, especially on areas exposed to sunlight. with in patients with primary hypercholesterolaemia, but more hyperpigmentation and hyperkeratinisation. Other symp­ effective at increasing HDL-cholesterol; lovastatin was bet­ toms include diarrhoea, abdominal pain, glossitis, stomat­ ter tolerated.4 A combination of nicotinic acid with lovas­ Nicotinamide Ascorbate IBANM r!NNM) itis, loss of appetite, headache, lethargy, and mental and tatin was found to be comparable to atorvastatin and neurological disturbances. Nicotinic acid deficiency may more effective than simvastatin in reducing LDL-cholester­ ��otlnarrtlda; Niacinamide Ascorbate de � Astorbat�; occur with other vitamin B -complex deficiency states, for ol, and more effective than either atorvastatin or simva­ Nicptinamlde; Nkos�ort.Jioe; •. Ascorbate de; Nicqtinamfdi example in alcoholism. statin in increasing HDL-cholesterol, in a study of patients H�<KQTvtftaMI1Aa A5corbj1$; . AcKopqay. Nicotinic acid and nicotinamide are used in the with dyslipidaemia. 5 Some have recommended that nico­ ,H C !4�<07�98.3 treatment and prevention of nicotinic acid deficiency. tinic acid be substituted for a statin to lower LDL-choles­ CAS ..___ 1.987-:n,g, Nicotinamide is preferred as it does not cause vasodilatation. terol when patients cannot tolerate a statin.2 Combination UNtf _;...e.. JTLBB7TvWZ They are usually given orally, the preferred route, but may therapy is recommended when the reduction in LDL-cho­ also be given by the intramuscular route or by slow lesterol is insufficient with statin monotherapy, 2,6 or when intravenous injection. Doses of up to 500 mg daily (of either raising HDL-cholesterol would be beneficiai,7-9 as in Profile compound) in divided doses have been recommended. patients with type 2 diabetes mellitns, or the metabolic Nicotinamide ascorbate is a complex Nicotinic acid has been used for its vasodilator action in syndrome.8 The risk of muscle toxicity with this combina­ (below) with ascorbic acid (p. 2!l0.3) that is used in the treatment of a variety of disorders; its value is not tion is not considered to be significantly different to that multivitamin preparations. It has also been given with considered to be established. with statin monotherapy.uo A combination preparation of betaine glucuronate and diolamine glucuronate for liver In high doses, nicotinic acid has beneficial effects on nicotinic acid with laropiprant was developed in an disorders. blood lipid profiles, and has been used, with dietary attempt to reduce flushing, but this preparation was with­ modification and often with other lipid regulating drugs, in drawn when it was found to have no benefit over statin hyperlipidaemias (see below). For the immediate-release therapy and an increased risk of adverse effects.n,I2 ::�:z;;i�:��.i���-ict�;�;is ���·�;���-;� ¥�-i�;;;�·ii;· preparations, an initial oral dose of 250mg once daily is 1. McKenney JM, et al. A comparison of the efficacy and toxic effects of increased every 4 to 7 days until a dose of 1.5 to 2 g daily is sustained- vs immediate-release niacin in hypercholesterolemic patients. lAMA I994; 271: 672-7. Multi-ingredient Preparations. Hong Kong: Jetepart: Malaysia: reached or the desired effect is seen. If hyperlipidaemia is 2. McKenney J. Niacin for dyslipidemia: considerations in product 60: Jetepar; Philipp.: Jetepar; Singapore: Jetepart. not controlled after 2 months at this dose, the dose can be selection. Am 1 Health-Syst Phann 2003; 995-1005. increased at 2· to 4-week intervals to 3 g daily in 3 divided 3. McCormack PL, Keating GM. Prolonged-release nicotinic acid: a review 65: doses. Although US licensed product information suggests of its use in the treatment of dyslipidaemia. Drugs 2005; 27I9--40. 4. Illingworth DR, et al. Comparative effects of lovastatin and niacin in that doses up to 6 g daily may be required in some patients, IBAN, rtNN! primary hypercholesterolemia: a prospective trial. Arch Intern Med 1994; Nicotinic Acid the National Heart, Lung, and Blood Institute in the USA 154: 1586-95. recommends a maximum dose of 4.5 g daily. 5. Bays HE, et al. Comparison of once-daily, Niacin extended-release/ Acide Nli:()tinique;Acido nicotfnico; Acidum nicotlni­ lovastatin with standard doses of atorvastatin and simvastatin (The Kwas , Alternatively, an initial dose of 500 mg at night has been cum; .Oi.kc;tyno'"'Y; . Kyselina nikotinpva; Niacin; Ntaclna; Advicor Versus Other Cholesterol-Modulating Agents Trial Evaluation given as a modified-release preparation and gradually 91: Nfw:fnico, acldb;Nltotlns;iure; Nil<otil ihapporNlkori nik Asit; [ADVOCATE]). Am 1 Cardiol 2003; 667-72. � increased according to response to a maintenance dose of I 6. Miller M. Niacin as a component of combination therapy for Nikotlqo rOgstis; .. Nil<otlnsaure; Nikotinsav;. · Nikotirlsyra; > to 2 gat bedtime. The daily dose should not be increased by dyslipidemia. Mayo ClinProc 2003; 78: 735--42. H11KOTHHPB3R.· Kficnora: 7. McKenney J. New perspectives on the use of niacin in the treatment of more than 500 mg in any 4-week period. 164: Pyridine-3-carboxylic. .acid. lipid disorders. Arch InternMed 2004; 697-705. Topical nicotinamide is used in the treatment of mild to 8. Chapman MJ, et al. Raising high-density lipoprotein cholesterol with C,HsNOl';'t43:l moderate inflammatory acne (see below), typically as a 4% reduction of cardiovascular risk: the role of nicotinic acid-a position gel applied twice daily. paper developed by the European Consensus Panel on HDL-C. Curr Med CA!i•.-,-- .5.9-6!-6, 20: ATe "7 (04/jCQI,' QPA'D{Ji. Nicotinamide has been shown to inhibit the destruction Res Opin 2004; 1253-68. OC10AD02. 9. Yim BT, Chong PH. Niacin-ER and lovastatin treatment of Art:.Ve t '--, OCO-f\(0 1; of pancreatic beta cells in vitro and is therefore being hypercholesterolemia and mixed dyslipidemia. Ann Pharmacother 2003; UNII :...:. 2.619MF6 87,A. investigated in the prevention and treatment of type I 37: 106-1 5. 10. Robinson JG. Management of complex lipid abnormalities with a fixed NOTE. Some published sources use niacin as a diabetes mellitus (see below). dose combination of simvastatin and extended release niacin. Vase Health generic term to include both nicotinic acid and nicotin­ Risk Manag 2009; 5: 31-43. Acne. Topical nicotinamide may be used in the treatment amide. I l. HPS2-THRIVE Collaborative Group. HPS2-THRIVE randomi:r.edplacebo­ Pharmacopoeias. In Chin., Bur. (see p. vii), Int., Jpn, US, and of inflammatory acne (p. 1682.2); nicotinamide 4% was as controlled trial in 25 673 high-risk patients ofER niacinllaropiprant: trial effective as clindamycin l% when applied topically twice design. pre-specified muscle and liver outcomes, and reasons for Viet. Bur Heart 34: daily for 8 weeks
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