Management of Niacin-Induced Diarrhea

Treatment and Monitoring

The Centers for Disease Control and Prevention recommends replacing ongoing fluid losses with oral rehydration solutions to prevent dehydration in patients with acute diarrhea caused by niacin 1
The Centers for Disease Control and Prevention suggests administering 10 mL/kg of oral rehydration solution for each watery stool passed in patients with mild to moderate diarrhea 1
The American Heart Association recommends monitoring for signs of dehydration such as decreased urine output, dry mouth, and dizziness in patients taking niacin 1
The American Heart Association suggests assessing for other symptoms of niacin toxicity including flushing, pruritus, and elevated liver enzymes in patients taking niacin 2
The European Society for Clinical Nutrition and Metabolism recommends evaluating for possible pellagra (niacin deficiency) if diarrhea occurs in patients with risk factors such as malnutrition, alcoholism, or malabsorptive states 3

The Centers for Disease Control and Prevention recommends maintaining adequate hydration with clear fluids in patients with niacin-induced diarrhea 1
The European Society for Clinical Nutrition and Metabolism suggests consuming foods high in soluble fiber to help firm stools in patients with niacin-induced diarrhea 3
The Centers for Disease Control and Prevention recommends avoiding foods high in simple sugars and fats that may worsen diarrhea in patients with niacin-induced diarrhea 1
The Centers for Disease Control and Prevention suggests continuing normal dietary intake as tolerated to maintain nutritional status in patients with niacin-induced diarrhea 1

The American Heart Association recommends considering discontinuation of niacin if diarrhea is severe, persistent, or significantly impacts quality of life despite management strategies, and evaluating alternative lipid-lowering therapies with lower rates of gastrointestinal side effects 2