The Cholesterol Lowering Atherosclerosis Study reported an increase in plasma homocyst(e)ine levels in patients receiving both colestipol and niacin compared with placebo. Niacin substantially increased plasma homocyst(e)ine levels, which could potentially reduce the expected benefits of niacin associated with lipoprotein modification.
- Am Heart J 1999 Dec;138(6 Pt 1):1082-7 -- Niacin treatment increases plasma homocyst(e)ine levels. -- Garg R, Malinow M, Pettinger M, Upson B, Hunninghake D.
Niacin has consistently been shown to significantly reduce levels of total cholesterol, low-density lipoprotein (LDL) cholesterol, triglycerides, and lipoprotein (a), while having the greatest high-density lipoprotein (HDL) cholesterol-raising effects of all available agents.
- Am J Manag Care 2002 Sep;8(12 Suppl):S308-14 -- Understanding niacin formulations. -- Pieper JA.
Forty-three percent of individuals given regular nicotinic acid and 42% of those given sustained-release nicotinic acid were forced to discontinue the medication because of side effects; some of these side effects necessitating discontinuing nicotinic acid did not occur until the patient had been taking the drug for 1 or 2 years. Nicotinic acid in both regular and sustained-release forms is a powerful drug when used in doses needed to treat lipid disorders and causes disturbing side effects a very high percentage of the time. No one should use nicotinic acid in these doses without continued careful supervision of a physician.
- Am J Med 1995 Oct;99(4):378-85 -- The prevalence of side effects with regular and sustained-release nicotinic acid. -- Gibbons LW, Gonzalez V, Gordon N, Grundy S.
Niacin should be avoided in patients with hepatic dysfunction or a history of liver disease, patients with diabetes mellitus, and patients who abuse alcohol. Because controlled-release niacin seems to be more potent than crystalline niacin, product substitution without dose adjustment should be avoided.
- Ann Intern Med 1994 Aug 15;121(4):252-8 -- Efficacy and safety of controlled-release niacin in dyslipoproteinemic veterans. -- Gray DR, Morgan T, Chretien SD, Kashyap ML.
Nicotinic acid (niacin) may have potential drug interactions with high dose aspirin (acetylsalicylic acid), uricosuric agents (such as sulfapyrazone) and alcohol (ethanol).
- Drug Saf 1998 Nov;19(5):355-71 -- Drug interactions of lipid-altering drugs. -- Bays HE, Dujovne CA.
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