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 ,Revised 3 January 2007 ,Accepted 19 January 2007.

References 

  1. Food and Nutrition Board, Institute of Medicine. Niacin. Dietary Reference Intakes: Thiamin, Riboflavin, Niacin, Vitamin B-6, Vitamin B-12, Pantothenic Acid, Biotin, and Choline. In: Washington, DC: National Academy Press; 1998;p. 123–149
  2. McCormack PL, Keating GM. Prolonged-release nicotinic acid: a review of its use in the treatment of dyslipidaemia. Drugs. 2005;65:2719–2740
  3. Centers for Disease Control and Prevention (Niacin intoxication from pumpernickel bagels—New York). MMWR Morb Mortal Wkly Rep. 1983;32:305
  4. Tato F, Vega GL, Grundy SM. Effects of crystalline nicotinic acid-induced hepatic dysfunction on serum low-density lipoprotein cholesterol and lecithin cholesteryl acyl transferase. Am J Cardiol. 1998;81:805–807
  5. Wikipedia. Niacin [Wikipedia Web site]. Available at: http://en.wikipedia.org/w/index.php?title=Niacin&oldid=82352656. Accessed October 22, 2006.
  6. Paopairochanakorn C, White S, Baltarowich L. Hepatotoxicity in acute sustained-release niacin overdose. [abstract] J Toxicol Clin Toxicol. 2001;39:516
  7. Mills E, Prousky J, Raskin G, et al. The safety of over-the-counter niacin (A randomized placebo-controlled trial). BMC Clin Pharmacol. 2003;3:4
  8. Gibbons LW, Gonzalez V, Gordon N, et al. The prevalence of side effects with regular and sustained-release nicotinic acid. Am J Med. 1995;99:378–385
  9. Morse JW, Morse SJ, Patterson J. Niacin reaction: common vitamin, uncommon ED diagnosis. Am J Emerg Med. 1999;17:320–321
  10. Dunn RT, Ford MA, Rindone JP, et al. Low-dose aspirin and ibuprofen reduce the cutaneous reactions following niacin administration. Am J Ther. 1995;2:478–480
  11. Dalton TA, Berry RS. Hepatotoxicity associated with sustained-release niacin. Am J Med. 1992;93:102–104
  12. Henkin Y, Oberman A, Hurst DC, et al. Niacin revisited: clinical observations on an important but underutilized drug. Am J Med. 1991;91:239–246
  13. Dearing BD, Lavie CJ, Lohmann TP, et al. Niacin-induced clotting factor synthesis deficiency with coagulopathy. Arch Intern Med. 1992;152:861–863
  14. Coppola A, Brady PG, Nord HJ. Niacin-induced hepatotoxicity: unusual presentations. South Med J. 1994;87:30–32
  15. Mullin GE, Greenson JK, Mitchell MC. Fulminant hepatic failure after ingestion of sustained-release nicotinic acid. Ann Intern Med. 1989;111:253–255
  16. Miettinen TA, Taskinen M, Pelkonen R, et al. Glucose tolerance and plasma insulin in man during acute and chronic administration of nicotinic acid. Acta Med Scand. 1969;186:247–253
  17. Earthman TP, Odom L, Mullins CA. Lactic acidosis associated with high-dose niacin therapy. South Med J. 1991;84:496–497
  18. Schwab RA, Bachhuber BH. Delirium and metabolic acidosis caused by ethanol and niacin coingestion. Am J Emerg Med. 1991;9:363–365
  19. Best TH, Franz DN, Gilbert DL, et al. Cardiac complications in pediatric patients on the ketogenic diet. Neurology. 2000;54:2328–2330

 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

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

Article Tools