At a time when so many people are taking large amounts of supplements, niacin toxicity is something of which to be aware. Niacin, also known as vitamin B3, is required in regular amounts, usually acquired through diet. Niacin, in its forms of nicotinic acid and nicotinamide, is mainly metabolized in the liver. The primary use of nicotinamide today is to treat nutritional niacin deficiency. For many years, the main clinical use of nicotinic acid was the treatment of hyperlipidemia. This approach changed as statin drugs became the mainstay therapy. Recent trials suggest no significant improvement by adding niacin to statin treatments. This review will focus on the various clinical manifestations and complications of niacin toxicity.
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