Niacin, the Internet, and Urine Drug Testing: A Cause of Acute Liver Failure

Niacin (Vitamin B3) is a naturally occurring human nutrient found in abundance in meat, yeast, vegetables, and seeds. Deficiencies of this vitamin lead to pellagra and it has also been found to be useful in the treatment of hypercholesterolemia. As the use of niacin has increased, several cases of hepatotoxicity have been reported resulting in the recommendation to initiate treatment with a lower dose and to monitor liver function test. We report two cases of hepatotoxicty in young adults who attempted to pass a drug screening test based on faulty internet advice to use niacin.