Pregnancy Use

Nicotinic acid is classified as a category B2 medicine in pregnancy by the Australian Drug Evaluation Committee. (This means that it has been taken by a limited number of pregnant women and women of childbearing agewithout an increase in malformations or other direct or indirect harmful effects on the human fetus having been observed.)

PRACTICE POINTS/PATIENT COUNSELLING

• The term niacin is used interchangeably with nicotinic acid, and is also used collectively to include nicotinamide or niacinamide (the amide form of nicotinic acid).

• In practice, nicotinic acid decreases the incidence of secondary myocardial infarction and reduces total mortality incidence in these patients.

• Large doses of niacin reduce total cholesterol, LDL-cholesterol, triglycerides and lipoprotein-a levels and also markedly raise HDL-cholesterol levels.

• The extended-release form appears to have a better safety profile with reduced incidence of flushing.

• In high doses it can impair glucose regulation, resulting in insulin resistance, increased insulin secretion and increased fasting blood glucose in patients with type 2 diabetes, so care is advised when using the supplement in this group of patients. Alternatively, nicotinamide protects beta-cells from inflator damage and may improve residual beta-cell function in patients after onset of type 1 diabetes.

ANSWERS TO PATIENTS' FREQUENTLY ASKED QUESTIONS

What will this vitamin do for me?

Niacin in high doses will favourably alter lipid levels and reduce the risk of cardiovascular disease, risk of heart attack and risk of death post-heart attack. It may also be useful in diabetes when used under professional supervision. When will it start to work?

Beneficial effects on lipid levels have been seen within 4 weeks; however, several Vitamin B3 — Niacin 1234

months of use may be required for optimal effects.

Are there any safety issues?

There are several different forms of niacin supplements produced; however, the extended-release form appears to have a better safety profile than the others and a reduced risk of flushing.

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