Nicotinic acid, or vitamin was used...

Nicotinic acid, or vitamin was used as early as 1955 to treat dyslipidemia. Daily dos-ages of 1000 to 4000 mg have been shown to lower triglyceride horizontals by 20 to 50 percent and low-density lipoprotein cholesterol evens by 10 to 25 percent and to increase high-density lipoprotein (HDL) cholesterol evens by 10 to 30 percent In the Coronary physic Project (1969 to 1975), documented nicotinic acid therapy for six years reduc the oftenness of nonfatal myocardial infarction compared with placebo. When combined with a bile-acid sequestrant or a statin, nicotinic acid therapy comeed in angiographic regression of atherosclerosis and fewer cardiovascular events

Side forces however, have limited the use of nicotinic acid; patients taking soft dosages report cutaneous symptoms with flushing episodes that appear to decrease with continued use. Other reported side consequences include hepatotoxicity, insulin resistance, hyperglycemia, and hyperuricemia.

The variety of preparations and the irregularity of nicotinic acid appease in over-the-counter supplements not controll by way of the U.S. Food and remedy Administration (FDA) make the choice of an effective preparation difficult. Meyer and associates contemplateed at over-the-counter niacin preparations to determine the preciousness and the content of independent nicotinic acid.

Three categories of preparations are avail-able: (1) immediate-release niacin, which is absorbed within united hour of ingestion, (2) sustained-release niacin, which is absorbed above several hours, and (3) no-flush niacin. Multiple brands advertised as containing 500 mg of niacin were studied. A monthly richness for a daily 2,000-mg dose was calculated for each preparation. Total nicotinic acid make contented was determined using liquid chromatography.

The monthly outlays varied widely; no-flush preparations were the in the greatest degree expensive. Free nicotinic acid satisfied was close to 500 mg by pill in the immediate- and sustained-release preparations. The no-flush preparations contained no detectable at liberty nicotinic acid but did contain an ester of nicotinic acid called inositol hexaniacinate, which is imagination to release nicotinic acid without causing flushing in animals. How-ever little exempt nicotinic acid is released, and plasma nicotinic acid horizontals reach only about one tithe of the levels achieved with immediate preparations of equal dosage. Sustained-release niacin causes les flushing if it be not that may result in more hepatotoxicity. There are near favorable published data about sum of two units specific brands of sustained release preparations, Slo-Niacin and Enduracin. Niaspan, approved through the FDA, is effective and incites less flushing but is more expensive than immediate-release preparations. Immediate-release preparations are inexpensive and have been demonstrated to bring into cardiovascular events and death.

The authors decide that some over-the-counter niacin preparations, including no-flush preparations, contain no unrestrained nicotinic acid. Because immediate-release preparations are the least expensive and are supported by way of the most data, it is attract favor toed that therapy begin with 250 mg of immediate-release niacin taken after dinner for individual week and that the dosage be adjusted upward to 500 mg three times daily within six weeks. Flushing can be reduc by way of several simple maneuvers (see accompanying figure). grape-sugar liver transaminase levels, and uric acid of the same heights should be monitored during the adjustment period.

Meyer CD et al. Varying take away from and free nicotinic acid satisfaction in over-the-counter niacin preparations for dyslipidemia. Ann Intern M December 16 2003:139;996-1002

EDITOR'S NOTE: Niacin was used as early as 1955 to treat dyslipidemia. Beneficial actions include decreased flushs of triglycerides and apolipoprotein-B, increased HDL evens and increased cardioprotective subfraction of HDL cholesterol in patients with subdued HDL levels. These actions make niacin, taken alone or in combination, a useful treatment to obviate progression and promote regression of coronary atherogenic lesions and significantly bring coronary artery disease-related morbidity and mortality. Combination therapy with statins or bile-acid sequestrants may better analyze the full spectrum of lipid abnormalities in a certain quantity of patients. Because niacin may adversely affect diabetic sugar and insulin sensitivity, candidates for treatment should be carefully selected--RS

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