Objectives

To report a instance of hepatotoxicity once niacin was offered by a patient through HIV to pass a medicine test.

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Methods

Niacin is a soluble pyridine derivative widely used in the management of dyslipidemia. Common adverse results include flushing, nausea, cradle discomfort, and also hepatotoxicity. The usage of niacin for nonmedical purposes has actually been enhancing in ubiquity in recent years, an especially in make the efforts to transform or mask outcomes of urine medicine tests. Although there is no scientific evidence that niacin can transform a pee drug screen result, conveniently retrievable information exists ~ above the internet touting niacin as a potential way to protect against detection that tetrahydrocannabinol (THC). The adhering to report explains a instance of hepatotoxicity in one HIV-infected adult who reported making use of niacin to mask THC in pee drug display screen results.


Results

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


Conclusion

Health treatment providers have to be conscious of this nonmedical use of niacin to transform or mask a drug test, specifically when discerning the cause of hepatotoxicity. In addition, pharmacists in the community setting should be aware of this use of niacin once encountering patients purchasing over-the-counter niacin, an especially in patient who might be an ext likely to use illicit substances.


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


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


Disclosure: The authors explain no problems of interest or financial interests in any type of product or service mentioned in this article.

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