Objectives

To report a case of hepatotoxicity when niacin was used by a patient through HIV to happen a drug test.

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Methods

Niacin is a soluble pyridine derivative widely used in the monitoring of dyslipidemia. Common adverse impacts include flushing, nausea, gastrointestinal discomfort, and also hepatotoxicity. The use of niacin because that nonmedical purposes has actually been boosting in pervasiveness in current years, specifically in make the efforts to change or mask outcomes of urine medicine tests. Although over there is no scientific proof that niacin can alter a to pee drug display result, easily retrievable info exists on the web touting niacin as a potential method to prevent detection that tetrahydrocannabinol (THC). The following report describes a situation of hepatotoxicity in one HIV-infected adult that reported making use of niacin to mask THC in pee drug display results.


Results

The patient developed marked elevations in his liver enzymes (aspartate aminotransferase better than 25 times the upper limit that normal and alanine aminotransferase higher than 3 time the upper limit of normal) that solved after discontinuation the the drug. Because of the patient’s self-reported use and also discontinuation of niacin, the Naranjo Adverse medicine Reaction Probability scale demonstrated a “definite” relationship in between the advance of hepatotoxicity and also the gulp down of over-the-counter sustained-release niacin. The patient did not build further clinical abnormalities proposed to be second to niacin toxicity in previously published situation reports, consisting of glucose abnormalities, coagulopathies, metabolic acidosis, QTc prolongation, and myalgias.


Conclusion

Health care providers need to be conscious of this nonmedical use of niacin to change or mask a drug test, especially when discerning the reason of hepatotoxicity. In addition, pharmacologists in the community setting should be mindful of this usage of niacin when encountering patients purchasing over-the-counter niacin, an especially in patient who might be more likely to usage illicit substances.


Spencer H. Durham, PharmD, BCPS (AQ-ID), Assistant Professor that Pharmacy Practice, Auburn university Harrison college of Pharmacy, Auburn, AL


Elizabeth W. Covington, PharmD, Assistant Professor the Pharmacy Practice, Samford university McWhorter school of Pharmacy, Samford university College of health Sciences, Birmingham, AL


Disclosure: The authors explain no conflicts of attention or jae won interests in any kind of product or service mentioned in this article.

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