Can be describes as
2. Nicotinic acid
• ●RNI Malaysia recommended:
• Men: 16 mg NE/day.
• Women: 14 mg NE/day.
• Pregnant women: 18 mg NE/day.
• Lactating women: 17 mg NE/day.
• ● Both cooked and raw foods provide vitamin B3,
which does not break down with heating.
• ●Can leach into cooking water.
• ●Diverse types of healthy foods naturally contain
vitamin B3; others are fortified with B3 during
-Baked tuna tops the list ( 18.7
milligrams of vitamin B3 per 3ounce serving)
-Canned tuna packed in water is a
healthy alternative, providing 11.3
milligrams of niacin per 3-ounce
-Others: salmon, swordfish, halibut
and rainbow trout
WHOLE GRAIN CEREALS
-ready-to-eat cereals and bread
provide much of the vitamin B3 in
the average diet
-Three-quarters of a cup of wheat,
corn or whole-grain breakfast flakes
contains approximately 8 to 20
milligrams of vitamin B3 (depends
-provide approximately 6 to 12
milligrams of niacin per 3-ounce
-baked, skinless chicken breast;
roasted, light meat turkey;
broiled top sirloin beef; and
roasted pork or lamb loin.
VEGETABLES AND NUTS
-Potatoes, corn and green or blackeyed peas boost the vitamin B3
content of a meal by roughly 2 to 3
milligrams per 1-cup serving
-Dry-roasted peanuts are a healthy,
nutritious snack and provide 3.8
milligrams of vitamin B3 per ounce.
• Vitamin B3 or niacin deficiency due to malabsorption is
common in celiac disease before gluten is removed from
• Niacin deficit can be aggravated by a lack of niacin or the
amino acid tryptophan in the diet.
• Our body uses tryptophan to make niacin as a back up
• High cholesterol may just be the result of a bad diet vitamin
B3, or niacin.
• Vitamin B3 is responsible for maintaining the cholesterol
• Vitamin B3 can lowers our cholesterol by fighting against bad
cholesterol and raising the levels of good cholesterol in our
• By doing this , arteries do not get clogged up by bad cholesterol
and have a lower chance of suffering from heart disease.
• When we get the vitamin B3 deficiency, the body cannot
produce more good cholesterol and can get a high levels on bad
cholesterol in our blood.
Problems with metabolism: muscle weakness, lack of
energy, weight loss, decreased tolerance to cold.
Problems with the nervous system: irritability, dizziness,
fatigue, poor concentration, poor memory, anxiety, apathy,
depression, headache, neuritis (numbness, burning in various
parts), tremors, restlessness and hyperactivity in children.
Problems in the digestive tract: anorexia, distorted taste,
indigestion, scarlet colored tongue, burning of the mouth,
throat, and esophagus, abdominal discomfort and distention,
nausea, diarrhea or constipation.
Problems with the skin and mucous membranes:
sensitivity of skin exposed to sunlight causing a red, itchy,
scaly rash that resembles mild sunburn, and inflammation of
mucous membranes of vagina and urethra.
• A disease characterised by diarrhoea, dermatitis and dementia. If left
untreated, death is the usual outcome.
Diarrhea can be bloody and other digestive disturbances worsen with
Dermatitis develops symmetrically in areas exposed to sunlight with
hyperpigmentation (dark color), thickening and cracking of the skin,
itchy red wet areas from chafing, and “necklace” sores on the lower neck.
Subcutaneous fibrosis and scarring within the skin may be seen in late
stages. A bright red swollen tongue which in chronic stage is fissured and
is similar to raw meat. Inflammation of other mucous membranes
worsens with increasing deficit.
Dementia is due to neuronal loss (death of nerve cells) with
development of amnesia, disorientation, confabulation, and delirium.
Death ensues eventually if the niacin deficiency is left untreated such as
dermatitis and dementia.
• Pellagra can occur in 2 ways:
Primary pellagra: results from inadequate niacin and/or
tryptophan in the diet (mainly in developing countries or poverty
Secondary pellagra: occurs when there is enough niacin in the
diet but something prevents its absorption and processing. Causes
of secondary pellagra include:
• Chronic alcoholism
• Prolonged diarrhoea
• Gastrointestinal diseases such as ulcerative colitis
• Liver cirrhosis
• Carcinoid tumours
• Hartnup disease (tryptophan metabolism disorder)
• Drugs e.g. isoniazid, azathioprine
• Dosage >3000 mg per day cause severe toxicity which affect
multiple system in body
• cause severe digestive complications including vomiting,
cramping and diarrhea
• Cause flushing or reddening skin
• Side effect :
Jaundice : skin yellowing
• Infants birth – 6 months : 2mg/day (adequate intake)
• Infants 7 months – 1 years : 4mg/day (adequate intake)
• Children 1 – 3 years : 6 mg/day (RDA)
• Children 4 - 8 years : 8 mg/day (RDA)
• Children 9 – 13 years : 12 mg/day (RDA)
• Adolescents and Adults
Males age 14 and older : 16mg/day
Females age 14 and older : 14mg/day
Pregnant women : 18 mg/day (RDA)
Breastfeeding women : 17 mg/day (RDA)
• People with a history of liver disease, kidney disease, or
stomach ulcers should not take niacin supplements
• Stop taking niacin or niacinamide at least two weeks
before a scheduled surgery
• Niacin and niacinamide may make allergies worse by
• People with low blood pressure should not take niacin or
niacinamide because they may cause a dangerous drop in
• People with coronary artery disease or unstable angina
should not take niacin, as large doses can raise the risk of
heart rhythm problems.
• Form of vitamin B3.
• water-soluble B-complex vitamins.
• a potent lipid-modifying agent with broad-spectrum
• reduces low-density lipoprotein cholesterol, triglyceride,
and lipoprotein(a) levels.
• increasing high-density lipoprotein cholesterol.
• Activation of the G protein– coupled receptor
GPR109A can produce differential responses
depending on the location of the receptor. It has
been suggested that when nicotinic acid activates
GPR109A on adipocytes, the resultant
antilipolytic effects contribute to the highly
desirable normalization of lipoprotein profiles.
• However, when nicotinic acid activates GPR109A
on dermal dendritic cells (DC) or dermal
macrophages, the subsequent mobilization of
arachidonic acid and its conversion to
vasodilatory prostaglandins result in the
• Because GPR109A expression extends beyond adipose
and immune cells located in the skin (eg, spleen,
lymphoid cells, lung), it is likely that the activation of
GPR109A in these cells and tissues may also contribute to
the clinical efficacy of nicotinic acid.
• onset of flushing : 20 minutes to 1hour after niacin dosing.
• duration : 1 hour.
• Niacin dosing has been found to be associated with
• Available in 3 formulations, including immediate-release, ER,
and long-acting niacin. Each differs with respect to safety and
efficacy profiles, with long-acting niacin having less of a
flushing effect, although its metabolism can increase the risk
for hepatotoxic effects.
• 50 to 500-mg tablets or capsules.
• Initial recommended therapeutic daily dose : 100 mg 3 times a
• maximum daily dose : 1,000 mg.
Strategies for improving adherence and
managing flushing with niacin:
Long-term adherence with niacin is dependent on patient
awareness and education.
● Patients should be instructed to avoid interrupting therapy
with niacin whenever possible.
● Initiate therapy using small doses, taken with meals, and
then slowly titrate upward over several weeks to achieve
● Advise patients to take an adult aspirin or other nonsteroidal
anti-inflammatory agent 30 minutes before dose.
● Recommend that patients avoid spicy foods and hot or
alcoholic beverages near dose.
● Use extended-release instead of intermittent-release niacin
to minimize adverse effects and enhance adherence.
• Because niacin has recognized cardiovascular
benefits, promoting patient awareness of factors
that can minimize niacin-induced flushing can
help enhance the tolerability of this valuable
dyslipidemic agent. Niacin is an attractive option
for treating dyslipidemic patients, and tolerance
to niacin-induced flushing develops rapidly.
Healthcare professionals should particularly
address flushing during niacin dose titration.