Can i take niacin to pass a drug test

Calls regarding the 18 persons who either said their ADRs resulted from attempts to alter drug test results or who were categorized as possible users of niacin for that purpose came from all five states covered by RMPDC. Twelve calls came from Colorado, two from Idaho, and one each from Hawaii, Montana, and southern Nevada; one call came from California via a manufacturer's hotline telephone number. Among the 28 who either gave a nonmedical reason for niacin use 18 persons or who stated no reason but were categorized as possible users of niacin to alter drug test results 10 persons , the most common ADRs reported were tachycardia, flushed skin, rash, nausea, and vomiting.

Thirteen of the 28 were treated at or referred to a health-care facility. No deaths were reported. Editorial Note:. Niacin is well established as a medical treatment for hyperlipidemia 3 and available by prescription in mg to mg tablets or capsules.

The initial recommended therapeutic daily dose is mg, three times a day, titrated to a maximum daily dose of 1, mg 4. Extended-release niacin tablets and capsules at mg, mg also are available by prescription, usually in a dose of mg at bedtime, to a maximum of 2, mg per day.

The therapeutic use of niacin often is limited by dermatologic and gastrointestinal ADRs e. Hepatotoxicity is a rare but serious adverse effect, usually associated with chronic use 5.

No scientific evidence indicates that taking niacin can alter a urine drug test result. However, readily accessible information on the Internet lists ingestion of niacin as a way to prevent detection of tetrahydracannabinol THC , the main psychoactive ingredient of marijuana. An Internet search on the words "niacin" and "marijuana" can produce tens of thousands of results. In addition to sales as a prescription drug, niacin is sold over the counter in mg to mg tablets and generally is regarded as a safe nutritional supplement with well-known dermatologic and gastrointestinal ADRs that usually are self-limited and resolve with supportive care 1.

Death from acute overdose has not been reported, and a minimum lethal dose has not been established 6. However, severe effects in some patients have been reported. A report in press on use of niacin to defeat urine drug tests describes four cases of niacin toxicity that included hepatotoxicity, metabolic acidosis, variations in blood glucose, neutropenia, and electrocardiographic effects 7. Two of the four patients had life-threatening ADRs; one had taken 5, mg of niacin during a hour period, and the other had taken 2, mg during a hour period.

The findings in this report are subject to at least four limitations. First, the data were collected retrospectively from the RMPDC database; although a specific data set was gathered for each case, persons might have misrepresented the circumstances of their niacin use, leading to misclassification, underreporting of dosages, or inaccurate reporting of symptoms. A year-old gentleman with no previous medical history presented to our Emergency department with complaints of vomiting, diarrhoea, facial flushing, myalgias and palpitations.

He gave a history of using tetrahydrocannabinol THC on a weekly basis and had an upcoming pre-employment urine drug test. In order to pass the drug test, he had searched the Internet to quickly detoxify his body where he had found that niacin can be used for this purpose. Without discussing this information with any physician, he had ingested mg of extended-release niacin within 12 h after which he started experiencing the stated symptoms.

His skin appeared flushed but the rest of the examination was unremarkable. APTT was normal but prothrombin time was elevated to Acetaminophen, salicylate and alcohol levels were negative. Surprisingly, his urine drug test was also negative for any drugs including cannabinoids. He was started on dextrose-saline infusion for hypoglycemia and transferred to ICU for monitoring.

By day 2, his symptoms improved while lactic acidosis and hypoglycemia resolved. On the other hand, liver enzymes and prothrombin time worsened although he continued to remain stable demonstrating no signs of liver failure or coagulopathy. By day 3, he was asymptomatic and did not require any IV fluids. Meanwhile, prothrombin time and liver enzymes started to improve and thus he was downgraded to medical floor. Serial lab values are discussed in Table 2.

He made a full recovery and was discharged on the 4th day with advice to follow as an outpatient. Niacin, also known as Nicotinic acid or Vitamin B3, is a water-soluble vitamin which is FDA approved for the treatment of dyslipidemia and niacin deficiency. Niacin works by inhibiting hepatic lipogenesis and triglycerides production [ 1 ].

It is available by prescription either as an immediate-release, sustained-release or extended-release formulation Table 3. However, there are many over-the-counter OTC formulations of immediate-release and sustained-release niacin [ 2 ]. In addition, it can be found in a variety of energy drinks. Some drinks are documented to have as much as 10 mg of niacin per gm content. All these preparations, thus, make niacin readily available for unregulated and dangerous use.

This is particularly concerning in an era of advanced technology where unreliable medical information is readily available on Internet. This is supported by various studies and systemic reviews done in the recent years. Quality is a major issue in consumer health information available on World Wide Web as found in a systemic review [ 3 ]. Another study estimated that more than half of the patients use Internet for advice on health issues without discussing it with their physicians [ 4 ].

This behaviour has been found more prevalent in younger adults. Our patient reported to have ingested large doses of niacin in attempt to evade a urine marijuana test. Various illicit drugs such as cannabinoids and cocaine are stored in body fat and slowly released thus making them detectable in blood and urine for a long duration. A single search on Google can lead one to various forums and blogs where this claim is being highly touted and openly supported.

Another case review by Ellsworth et al. However, nowhere in medical literature, is this claim supported nor is there any recommendation about a safe dose of niacin for such use. Therefore, cases have been reported where young adults have presented with a variety of niacin adverse effects ranging from mild to life threatening.

These calls were identified in five US states within 9-month duration. Most common adverse effects reported were tachycardia, flushing, skin rash and vomiting. Thirteen were referred for medical treatment and no deaths were reported.

Our patient presented with hypotension and lactic acidosis. This can be explained by volume depletion secondary to persistent vomiting. However, quite interestingly, niacin has been documented to cause acute hypotension primarily due to prostaglandin-induced systemic vasodilation. Bays et al. Wide anion gap metabolic acidosis secondary to niacin overdose is an uncommon finding.

A review of clinical literature showed ten case reports [ 8 — 13 ] of metabolic acidosis due to niacin overdose — intentional or unintentional — out of whom five patients were documented to have elevated lactic acid levels.

In our patient, dehydration and hypotension could have contributed towards the lactic acidosis. But niacin has also gained a reputation as a way to beat urine drug tests. On top of that, one of the common side effects of niacin is flushing, or reddening of the skin. Two of the patients he and his colleagues describe suffered only skin reactions after taking high doses of niacin ahead of their workplace drug tests.

The other two had more serious reactions, arriving at the emergency room after hours of nausea, dizziness and vomiting. One had elevated liver enzymes, a sign of liver injury.