Annals of Emergency Medicine
Volume 50, Issue 5 , Pages 587-590, November 2007

Toxicity From the Use of Niacin to Beat Urine Drug Screening

Presented at the 8th Annual Clinical Pathological Case Presentation Competition, 2006 North American Congress of Clinical Toxicology (NACCT) meeting, October 2006, San Francisco, CA.

  • Manoj K. Mittal, MD, MRCP

      Affiliations

    • Division of Emergency Medicine, The Children’s Hospital of Philadelphia, Philadelphia, PA
    • Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA
    • Corresponding Author InformationAddress for correspondence: Manoj K. Mittal, MD, MRCP, Division of Emergency Medicine, The Children’s Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104-4399; 215-590-1944, fax 215-590-4454
    • ,
  • Todd Florin, MD

      Affiliations

    • Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA
    • ,
  • Jeanmarie Perrone, MD

      Affiliations

    • Department of Emergency Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA
    • ,
  • João H. Delgado, MD

      Affiliations

    • Divisions of Emergency Medicine and Medical Toxicology, Hartford Hospital, Hartford, CT.
    • ,
  • Kevin C. Osterhoudt, MD, MSCE

      Affiliations

    • Division of Emergency Medicine, The Children’s Hospital of Philadelphia, Philadelphia, PA
    • Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA

Received 28 October 2006; received in revised form 29 November 2006 and 3 January 2007; accepted 19 January 2007. published online 06 April 2007.

Niacin (vitamin B3) is promoted for rapidly clearing the body of drugs of abuse, such as cocaine and cannabis, and is alleged to interfere with urine drug screening. We present 4 cases of such novel use associated with significant adverse effects. Two cases had isolated skin manifestations, whereas the other 2 presented with life-threatening manifestations, including nausea, vomiting, dizziness, hepatotoxicity, metabolic acidosis, and hypoglycemia evolving into hyperglycemia. One patient also had profound neutrophilia and QTC-interval prolongation. All patients improved after cessation of the drug use and supportive treatment. Health care providers should be aware of these potential adverse effects of niacin and of the misguided use of this vitamin by patients seeking to interfere with urine drug screening.

 

 Supervising editor: Richard C. Dart, MD, PhDFunding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article, that may create any potential conflict of interest. The authors have stated that no such relationships exist. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement.Publication dates: Available online April 5, 2007.Reprints not available from the authors.

PII: S0196-0644(07)00074-1

doi:10.1016/j.annemergmed.2007.01.014

Refers to article:

  • Consequences of Attempts to Mask Urine Drug Screens , 11 May 2007

    Kennon Heard, Carrie D. Mendoza
    Annals of Emergency Medicine November 2007 (Vol. 50, Issue 5, Pages 591-592)

Annals of Emergency Medicine
Volume 50, Issue 5 , Pages 587-590, November 2007