Dear colleague,

Here's the literature answering your question:

https://livertox.nih.gov/Niacin.htm

https://www.ncbi.nlm.nih.gov/pubmed/1626557

https://www.ncbi.nlm.nih.gov/pubmed/21291680

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2048990/

https://www.researchgate.net/publication/14914008_Niacin-Induced_Hepatotoxicity

https://www.ncbi.nlm.nih.gov/pubmed/18380993

https://www.ncbi.nlm.nih.gov/pubmed/1411264

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC528844/

Sincerely,

Hércules Freitas

Dear Hercules F. Thanks for adding such beneficial information

It is well known influence niacin on hepatic toxicity.

Liver Dysfunction

Cases of severe hepatic toxicity, including fulminant hepatic necrosis, have occurred in patients who have substituted sustained-release (modified-release, timed-release) Niacin products for immediate-release (crystalline) Niacin at equivalent doses.

Niacin extended-release should be used with caution in patients who consume substantial quantities of alcohol and/or have a past history of liver disease. Active liver diseases or unexplained transaminase elevations are contraindications to the use of Niacin extended-release.

Niacin preparations have been associated with abnormal liver tests. In three placebo-controlled clinical trials involving titration to final daily Niacin extended-release doses ranging from 500 to 3000 mg, 245 patients received Niacin extended-release for a mean duration of 17 weeks. No patient with normal serum transaminase levels (AST, ALT) at baseline experienced elevations to more than 3 times the upper limit of normal (ULN) during treatment with Niacin extended-release. In these studies, fewer than 1% (2/245) of Niacin extended-release patients discontinued due to transaminase elevations greater than 2 times the ULN.

Liver-related tests should be performed on all patients during therapy with Niacin extended-release. Serum transaminase levels, including AST and ALT (SGOT and SGPT), should be monitored before treatment begins, every 6 to 12 weeks for the first year, and periodically thereafter (e.g., at approximately 6-month intervals). Special attention should be paid to patients who develop elevated serum transaminase levels, and in these patients, measurements should be repeated promptly and then performed more frequently. If the transaminase levels show evidence of progression, particularly if they rise to 3 times ULN and are persistent, or if they are associated with symptoms of nausea, fever, and/or malaise, the drug should be discontinued.

Therefore in some patients it is limited to use!

Laboratory Abnormalities

Increase in Blood Glucose: Niacin treatment can increase fasting blood glucose. Frequent monitoring of blood glucose should be performed to ascertain that the drug is producing no adverse effects. Diabetic patients may experience a dose-related increase in glucose intolerance. Diabetic or potentially diabetic patients should be observed closely during treatment with Niacin extended-release, particularly during the first few months of use or dose adjustment; adjustment of diet and/or hypoglycemic therapy may be necessary.

Therefore we should thinking about risk/benefit in each patients.