New perspectives on the use of niacin in the treatment of lipid disorders

Arch Intern Med. 2004 Apr 12;164(7):697-705. doi: 10.1001/archinte.164.7.697.

Abstract

Therapy with niacin (nicotinic acid) is unique in that it improves all lipoprotein abnormalities. It significantly reduces low-density lipoprotein cholesterol, triglyceride, and lipoprotein(a) levels, while increasing high-density lipoprotein cholesterol levels. This makes niacin ideal for treating a wide variety of lipid disorders, including the metabolic syndrome, diabetes mellitus, isolated low high-density lipoprotein cholesterol, and hypertriglyceridemia. Niacin-induced changes in serum lipid levels produce significant improvements in both coronary artery disease and clinical outcomes. Niacin is currently available in 3 formulations (immediate release, extended release, and long acting), which differ significantly with respect to their safety and efficacy profiles. Immediate-release niacin is generally taken 3 times a day and is associated with adverse flushing, gastrointestinal symptoms, and elevations in blood glucose levels. Long-acting niacin can be taken once daily and is associated with significantly reduced flushing, but its metabolism increases the risk of hepatotoxic effects. Extended-release niacin, also given once daily, has an absorption rate intermediate between the other formulations and is associated with fewer flushing and gastrointestinal symptoms without increasing hepatotoxic risk.

Publication types

  • Review

MeSH terms

  • Cholesterol, HDL / drug effects
  • Cholesterol, LDL / drug effects
  • Delayed-Action Preparations
  • Dose-Response Relationship, Drug
  • Drug Therapy, Combination
  • Humans
  • Hyperlipidemias / complications
  • Hyperlipidemias / drug therapy*
  • Hypolipidemic Agents / adverse effects
  • Hypolipidemic Agents / pharmacology
  • Hypolipidemic Agents / therapeutic use*
  • Niacin / adverse effects
  • Niacin / pharmacology
  • Niacin / therapeutic use*
  • Simvastatin / therapeutic use

Substances

  • Cholesterol, HDL
  • Cholesterol, LDL
  • Delayed-Action Preparations
  • Hypolipidemic Agents
  • Niacin
  • Simvastatin