Your healthcare provider determines the optimum dosage of niacin for you depending on a number of factors that include the medical condition being treated, patient response to treatment, other medications currently taken, and other underlying medical conditions.
In general, the recommended dietary allowance (RDA) for niacin ranges from 2mg/day for infants up to 18mg/day for patient with increased body requirements. Since niacin is naturally occurring in many food products, most people get enough niacin through their regular diet.
However, some people who have deficiency for this vitamin (pellagra) may require supplementation. Niacin deficiency or pellagra may be treated with up to 500mg/day of oral niacin.
Treatment of High Cholesterol Levels
The recommended dosage of oral niacin tablet for treating high cholesterol levels in adults is 1 to 2 g taken two to three times a day. The maintenance dose should not exceed 6 g per day. When using the sustained-release tablets, the maximum daily dose is 2 g. Niacin should be started at low doses to reduce possible side effects during early therapy. The dose is gradually titrated until desired maintenance dose is well tolerated. To avoid gastrointestinal side effects, niacin should be taken with meals.
Extended-release tablets should be taken whole and should not be split, crushed or chewed. Sustained-release or extended-release tablets should not be substituted with regular tablets since this can lead to an overdose and potential liver failure. Usually, sustained-release tablets are taken once a day at bedtime, after a light meal or low-fat snack.
Niacin Titration for Cholesterol
High doses of niacin can cause intolerable side effects, particularly flushing or vasodilation. People who abruptly took the full dose usually fail to complete the therapy because of its disturbing effects. As such, the dose should be slowly titrated until the flush is gone or is well tolerated. Dosage is titrated differently for each type of drug formulation.
Immediate Release Tablets: For week 1, the recommended dose is 100 mg three times a day. For weeks 2 to 3 the dose is increased to 200mg – 350mg three times a day. From weeks 4 to 7, the dose is increased to 500mg three times a day. For weeks 8 to 11, the recommended dose is 750 mg three times a day. Then for week 12 and after, the daily dose may be increased up to 1000 mg three times a day.
Extended Release Tablets: For weeks 1 to 4, the recommended dose is 500 mg once a day. Then for weeks 5 to 8, the dose may be increased up to 1000 mg per day. After week 8, the dose may be increased by 500 mg depending on the patient’s response to treatment until the desired dose (1500 to 2000 mg per day) is well tolerated. Daily dose increase should not be more than 500 mg in a 4-week period and should not exceed 2000 mg daily.
To ensure compliance with the treatment regimen, the manufacturer recommends that healthcare providers discuss with their patients these potential side effects before initiating the drug and follow a gradual titration schedule. In addition, daily dose should be adjusted according to the patient’s response to treatment. Usually, women and older adults require lower doses than men. In some patients who experience severe side effects, other medications may be given to manage side effects.