Fulminant Hepatic Failure after Ingestion of Sustained-Release Nicotinic Acid
Authors: Gerard E. Mullin
Journal: Annals of Internal Medicine (1989)

Brief Reports1 August 1989Fulminant Hepatic Failure after Ingestion of Sustained-Release Nicotinic AcidGerard E. Mullin, MD, Joel K. Greenson, MD, Mack C. Mitchell, MDGerard E. Mullin, MD, Joel K. Greenson, MD, Mack C. Mitchell, MDAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-111-3-253 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptNicotinic acid is an effective, widely used treatment for hypercholesterolemia (1). Hepatotoxicity is a rare complication of therapy, which usually occurs with ingestion of more than 3 g daily. In most cases, patients have jaundice, pruritus, and mild elevations in serum bilirubin, alkaline phosphatase, and aminotransferase levels, although, in some instances, more severe hepatocellular injury has occurred (2). We report the case of a patient who developed fulminant hepatic failure shortly after switching to sustained-release nicotinic acid after having taken ordinary nicotinic acid for over 1 year without side effects.Case ReportIn February 1987, after having coronary angioplasty, a...References1. SchaeferLevy ER. Pathogenesis and management of lipoprotein disorders. N Engl J Med. 1985;20:1300-10. Google Scholar2. Pardue W. Severe liver dysfunction during nicotinic acid therapy. JAMA. 1961;175:161-2. CrossrefGoogle Scholar3. WinterBoyer SJ. Hepatic toxicity from large doses of vitamin B3 (nicotinamide). N Engl J Med. 1973;289:1180-2. CrossrefMedlineGoogle Scholar4. SugermanClark AC. Jaundice following the administration of niacin. JAMA. 1974;228:202. CrossrefMedlineGoogle Scholar5. Parsons W. Studies of nicotinic acid use in hypercholesterolemia: changes in hepatic function, carbohydrate tolerance, and uric acid metabolism. Arch Intern Med. 1961;107:653-67. CrossrefMedlineGoogle Scholar6. ChristensenAchorBergeMason NRKH. Nicotinic acid treatment of hypercholesterolemia, comparison of plain and sustained action preparations, and report of two cases of jaundice. JAMA. 1961;177:546-50. CrossrefMedlineGoogle Scholar7. KohnMontes RM. Hepatic fibrosis following long acting nicotinic acid therapy: a case report. Am J Med Sci. 1969;258:94-9. CrossrefMedlineGoogle Scholar8. PattersonDewGyorkeyGraham DEFD. Niacin hepatitis. South Med J. 1983;76:239-41. CrossrefMedlineGoogle Scholar9. EinsteinBakerGalperWolfe NAJH. Jaundice due to nicotinic acid therapy. Am J Dig Dis. 1975;20:282-6. CrossrefMedlineGoogle Scholar10. Rivin A. Jaundice occurring during nicotinic acid therapy for hypercholesterolemia. JAMA. 1959;170:2088-9. CrossrefMedlineGoogle Scholar11. ClementzHolmes GA. Nicotinic acid-induced fulminant hepatic failure. J Clin Gastroenterol. 1987;5:582-4. CrossrefGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: From The Johns Hopkins University School of Medicine, Baltimore, Maryland. For current author addresses, see end of text. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited ByNiacin‐Induced Anicteric Microvesicular Steatotic Acute Liver FailureDrugs and Toxins16 Use of Complementary and Alternative Therapies in Hepatic Disorders8 Integrative Nutritional Therapy for Cardiovascular DiseaseNiacin-Associated Acute Hepatotoxicity Leading to Emergency Liver TransplantationNicotinic acid and derivativesUse of Complementary and Alternative Therapies in Hepatic DisordersIntegrative Nutritional Therapy for Cardiovascular DiseaseThe Use of Complementary and Alternative Medicine for Liver DiseaseHepatotoxicity of Cardiovascular and Antidiabetic DrugsCAM SafetyNiacin reduces plasma CETP levels by diminishing liver macrophage content in CETP transgenic miceThe Heart Speaks IIHepatic injury due to drugs, herbal compounds, chemicals and toxinsDrug-Induced Liver DiseaseAntilipolytic and lipolytic effects of administering free or ruminally protected nicotinic acid to feed-restricted Holstein cowsNiacin Toxicity Resulting From Urine Drug Test Evasion SchemeLiver Disease Caused by DrugsDrug-Induced Hepatotoxicity or Drug-Induced Liver InjuryDYSLIPIDEMIASCombined treatment with niacin and chromium caused a protective effect on the small-intestine tissue of hyperlipidemic ratsToxicity From the Use of Niacin to Beat Urine Drug ScreeningLipid-Lowering Agents That Cause Drug-Induced HepatotoxicityDissolution profiles of nonprescription extended-release niacin and inositol niacinate productsCholesterolTreatment Advice on the Internet Leads to a Life-Threatening Adverse Reaction: Hypotension Associated with Niacin OverdoseManagement of the metabolic syndrome—nicotinic acidExtended-release niacin for modifying the lipoprotein profileVarying Cost and Free Nicotinic Acid Content in Over-the-Counter Niacin Preparations for DyslipidemiaC. Daniel Meyers, MD, Molly C. Carr, MD, Sang Park, PhD, and John D. Brunzell, MDPharmacotherapy for dyslipidaemia – current therapies and future agentsTreating Dyslipidemic Patients with Lipid-Modifying and Combination TherapiesReferencesModification of High-Density Lipoprotein Cholesterol in the Management of Cardiovascular RiskOpposite Effects of Nicotinic Acid and Pyridoxine on Systemic Prostacyclin, Thromboxane and Leukotriene Production in ManHepatitis inducida por niacinaPostprandial dyslipidemia: an atherogenic disorder common in patients with diabetes mellitusCurrent perspectives on the management of hypertriglyceridemiaEfficacy and safety of an extended-release niacin (niaspan): a long-term studyA new extended-release niacin (niaspan): efficacy, tolerability, and safety in hypercholesterolemic patientsClinical profiles of plain versus sustained-release niacin (niaspan) and the physiologic rationale for nighttime dosingClinical trial experience with extended-release niacin (niaspan): dose-escalation studyEquivalent efficacy of a time-release form of niacin (Niaspan) given once-a-night versus plain niacin in the management of hyperlipidemiaCONTROL OF LIPID DISORDERS IN PATIENTS WITH ATHEROSCLEROTIC VASCULAR DISEASEEffects of Crystalline Nicotinic Acid-Induced Hepatic Dysfunction on Serum Low-Density Lipoprotein Cholesterol and Lecithin Cholesteryl Acyl Transferase 11This work was supported in part by Grants HL-29252 and HL-22682 from the Department of Veterans Affairs; Grant MO-IRR00663 from the National Institutes of Health, Bethesda, Maryland; The Southwestern Medical Foundation; and the Moss Heart Foundation, Dallas, Texas.A Randomized Trial of the Effects of Atorvastatin and Niacin in Patients with Combined Hyperlipidemia or Isolated HypertriglyceridemiaModerate Dose, Three-Drug Therapy With Niacin, Lovastatin, and Colestipol to Reduce Low-Density Lipoprotein Cholesterol <100 mg/dl in Patients With Hyperlipidemia and Coronary Artery DiseaseTreatment Effect of Niaspan, a Controlled-release Niacin, in Patients with Hypercholesterolemia: A Placebo-controlled TrialEffect of a Combination of Gemfibrozil and Niacin on Lipid LevelsClinical pharmacologic concepts for the rational selection and use of drugs for the management of dyslipidemiaHepatotoxicity of Cardiovascular DrugsCurrent and Future Therapeutic Approaches to HyperlipidemiaHEPATOTOXICITY OF DRUGS USED IN THE TREATMENT OF GASTROINTESTINAL DISORDERSPREVENTION AND TREATMENT OF DRUG-INDUCED LIVER DISEASECurrently available hypolipidaemic drugs and future therapeutic developmentsUpdate on the treatment of hypercholesterolemia, with a focus on hmg-coa reductase inhibitors and combination regimensHigh-Density Lipoprotein Cholesterol, Plasma Triglyceride, and Coronary Heart Disease: Pathophysiology and ManagementThe pharmacology of fluvastatin, a new HMG-CoA reductase inhibitorNiacin: A therapeutic dilemma "one man's drink is another's poison"Fluvastatin with and without niacin for hypercholesterolemiaCombination therapy with fluvastatin and niacin in hypercholesterolemia: A preliminary report on safetyVitamin supplements: current controversies.Drugs for treatment of patients with high cholesterol blood levels and other dyslipidemiasNicotinic Acid and DerivativesDrug treatment of dyslipoproteinemiaHepatotoxityDrug-induced hepatotoxicityFulminant hepatic failureDrugs and Liver DiseaseDrug therapy of hyperlipidemiaThe Triglyceride Connection in AtherosclerosisHepatotoxicity associated with sustained-release niacinHepatic toxicity of unmodified and time-release preparations of niacinTreatment of Hypercholesterolemia: Comparison of Younger versus Older Patients Using Wax-Matrix Sustained-Release NiacinNiacin revisited: Clinical observations on an important but underutilized drugComment: Adverse-Effect Profile of Sustained-Release NiacinAuthors' ReplyNicotinic Acid for the Treatment of HyperlipoproteinemiaDelirium and lactic acidosis caused by ethanol and niacin coingestionDrug Information Analysis ServiceNiacin-Induced Hepatitis: A Potential Side Effect With Low-Dose Time-Release NiacinDrugs affecting lipid metabolismLowering the cost of lowering the cholesterolDrug Treatment of DyslipoproteinemiaNiacin and Hepatic FailureRobert H. Knopp, MDManagement of Dyslipidemias 1 August 1989Volume 111, Issue 3Page: 253-255KeywordsAcute liver failureAminotransferasesBilirubinCoronary angioplastyIngestionNiacinPhosphatasesPruritus Issue Published: 1 August 1989 PDF DownloadLoading ...