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Vitamin B3 Continued
Dietary Sources:
The best dietary sources of vitamin B3 are found in beets, brewer's yeast, beef liver, beef kidney, pork, turkey, chicken, veal, fish, salmon, swordfish, tuna, sunflower seeds, and peanuts.
Available Forms:
Niacin is available in several different supplement forms: niacinamide, nicotinic acid, and inositol hexaniacinate. The form of niacin that is best tolerated with the least symptoms is inositol hexaniacinate. Niacin is available as a tablet or capsule in both regular and timed-release forms. The timed-release tablets and capsules may have fewer side effects than the regular niacin; however, the timed-release are more likely to cause liver damage and are therefore not recommended for long-term treatment. Regardless of the form of niacin being used, periodic checking of liver function tests is recommended when high-dose (2 – 6 gm per day) of niacin is used.
Precautions
Because of the potential for side effects and interactions with medications, dietary supplements should be taken only under the supervision of a knowledgeable healthcare provider.
High doses (75 mg or more) of niacin can cause side effects. The most common side effect is called "niacin flush," which is a burning, tingling sensation in the face and chest, and red or "flushed" skin. Taking an aspirin 30 minutes prior to the niacin may help reduce this symptom.
At the very high doses used to lower cholesterol and the other conditions mentioned previously, liver damage and stomach ulcers can occur. When taking pharmacologic doses of niacin, your doctor or other healthcare practitioner will periodically check your liver function through a blood test. People with a history of liver disease or stomach ulcers should not take niacin supplements. Those with diabetes or gallbladder disease should do so only under the close supervision of a healthcare provider. Niacin should not be used if you have gout.
Taking any one of the B complex vitamins for a long period of time can result in an imbalance of other important B vitamins. For this reason, it is generally important to take a B complex vitamin with any single B vitamin.
Possible Interactions:
If you are currently being treated with any of the following medications, you should not use niacin without first talking to your doctor.
Niacin should not be taken at the same time as the antibiotic tetracycline because it interferes with the absorption and effectiveness of this medication. Niacin either alone or in combination with other B vitamins should be taken at different times from tetracycline. (All vitamin B complex supplements act in this way and should therefore be taken at different times from tetracycline.)
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Taking aspirin before taking niacin may reduce flushing associated with this vitamin. This should only be done under the advice of a healthcare practitioner.
When niacin is taken with certain blood pressure medications known as alpha-blockers (such as prazosin, doxazosin, and guanabenz), the likelihood of side effects from these medications is increased.
Niacin binds bile-acid sequestrants (cholesterol-lowering medications such as colestipol, colesevelam, and cholestyramine) and may decrease their effectiveness. For this reason, niacin and these medications should be taken at different times of the day.
As described earlier, recent scientific evidence suggests that taking niacin with simvastatin (a drug that belongs to a class of cholesterol-lowering medications known as HMG-CoA reductase inhibitors or statins including atorvastatin and lovastatin as well), appears to slow down the progression of heart disease. However, the combination may also increases the likelihood for serious side effects, such as muscle inflammation or liver damage.
People taking insulin, metformin, glyburide, glipizide, or other medications used to treat high blood sugar levels should monitor their blood sugar levels closely when taking niacin supplements.
INH, a medication used to treat tuberculosis, may deplete levels of niacin and cause a deficiency.
The use of nicotine patches with niacin may worsen or increase the risk of flushing reactions associated with this vitamin when used medicinally.
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