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High Cholesterol Message Board


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babydog,

Niaspan, being a time-release, or extended release or long acting(whatever silly term they use to make it sound SPECIAL and justify charging $1.50 a pill, $3 a day for something costing pennies in a Heath Foods Store) is kinder than any immediate release niacin, but a slow start is STILL a good idea. A runaway extended flush is something truly unbearable, among life's worst agonies. At least short term (week or two) maybe cracking the pills in half is a good idea.
[QUOTE=Lenin]At least short term (week or two) maybe cracking the pills in half is a good idea.[/QUOTE]Are you sure about that? Isn't Niaspan a coated pill? I know my Enduracin has a wax matrix coating, and I had the impression that cutting it in half would be like trying to split a capsule - you'd end up making an immediate release out of it.
[QUOTE=Lenin]babydog,

Niaspan, being a time-release, or extended release or long acting(whatever silly term they use to make it sound SPECIAL and justify charging $1.50 a pill, $3 a day for something costing pennies in a Heath Foods Store) is kinder than any immediate release niacin, but a slow start is STILL a good idea. A runaway extended flush is something truly unbearable, among life's worst agonies. At least short term (week or two) maybe cracking the pills in half is a good idea.[/QUOTE]

Lennin,

So after all is said and done, this actually is just a megadose of the B vitamin niacin?? If I were to pick up time release niacin from health food store in say 250mg capsules, it would work just the same? I thought I was saving some money by getting it thru my insurance.
Thanks :wave:
That's right babydog, It is niacin, aka nicotinic acid, in a matrix made to deliver the drug in a "medium" amount of time...4 to 6 hours or some such. The quick release causes a fast flush and is done...the extended release, which presumably takes longer to release than niaspan is harder on the liver.
To my way of thinking, Niaspan is really a time-release formulation and should have very similar cautions relative the liver as the time release versions in the Health Food stores.
Probably the same Liver enzyme tests should be run for niaspan as for statins.
From the manufacturer:
[quote]Liver Dysfunction
Cases of severe hepatic toxicity, including fulminant hepatic necrosis, have occurred in
patients who have substituted sustained-release (modified-release, timed-release) niacin
products for immediate-release (crystalline) niacin at equivalent doses.[/quote]
Thus more care should be taken with Niaspan than plain vanilla niacin.

Uff-da,
You COULD be right but the enteric coatings usually are made to pass through the acidic stomach, and dissolve in the alkaline small intestine. They are usually used for drugs that are damaged by acid. Niacin doesn't fall into this category.
Of course if the coating IS an intrinsic part of the Niaspan delivery system, then it shouldn't be broken.

OK I read the manufacturer's site closely: DON'T break it, KOS Pharmaceuticals recommends against it! :D:D
My husband's dr. wanted to put him on Niaspan, but did tell him he would need the same periodic tests as a statin. This is what I found on Niaspan:

Special warnings about this medication

Niaspan is an extended-released form of niacin. It is not interchangeable with immediate-release or sustained-release forms of niacin.

Niaspan can cause problems if your liver is weak. Before you start taking this medication, your doctor may order a blood test to check your liver. Blood tests will probably be repeated 6 and 12 weeks after you start taking Niaspan and periodically after that. While you are taking Niaspan, your doctor will monitor you very closely if you have ever had liver disease or if you are or have ever been a heavy drinker.

Do not drink alcohol or hot beverages with Niaspan because they may intensify the flushing and itching effect of the medication.

Niaspan should be used with caution if you have diabetes, a heart condition, or problems with gout. If you have diabetes, tell your doctor if you have a change in blood sugar levels while taking Niaspan. Also use Niaspan with caution if you have kidney problems.

Before undergoing surgery, make sure the doctor is aware that you are taking Niaspan. This medication tends to slow the clotting process, and could prolong bleeding.

To reduce the chance of side effects, Niaspan therapy is usually started at a low dosage and gradually increased. If you stop taking Niaspan for an extended period, contact your doctor. You'll probably need to build up to your old dose over a period of several months.

Tell your doctor if you experience any dizziness while taking Niaspan.
*****************************************************

It also says to start at about 500 mgs. at night after a small fatty snack, and if your dr. wants to increase your dose, it still should be taken ONLY once a day, at bedtime. To me, it seems like it is just a more expensive extended release form of Niacin....... :rolleyes:
Babydog,

The particular kind of niacin you take pretty much depends on what you are trying to accomplish. For example, for raising HDL levels, using an immediate-release niacin may work best. I've been using over-the-counter immediate-release niacin (250mg taken 4 times a day) for nearly twenty years. The last time I had my cholesterol checked my HDL was up to 107. Of course, I also take quite a few other supplements as well.

A time-release niacin, such as Niaspan or Enduracin, may work better if your main goal is to lower LDL. I really don't know if there are actually any real advantages to using Niaspan instead of another over-the-counter time-release product. It's true that Niaspan will cost considerably more than an over-the-counter product such as Enduracin. But if you have an insurance plan which picks up most of the cost, then you wouldn't end up paying so much for it. :wave:
[QUOTE=babydog]Hi Everybody,

Looks like I have given up the ship. My doctor has given me a prescription for Niacin which I began today. I will have my numbers checked again in 3 months.

Here are the current numbers:
TC 227
HDL 54 (down from 64!)
LDL 164 (up from 148!)
Trigs 65 (down from 76 - but so what)

I am 49. Also going thru menopause. I think menopause is affecting my numbers right now despite my best efforts with diet. :rolleyes:
I have to admit I have been a little remiss with exercise except for walking and housework.

Has anyone had a positive result from Niacin?
I am taking Niaspan 500mg 2x a day.

Best wishes to all my cholesterol fighting friends. :wave:[/QUOTE]


Yes,

I've been taking Niacin for approx. 3 years. Niacin corrects all lipid abnormalities. (No other prescription drug can make this claim). It raises HDL,
lowers LDL, lowers trigs, lowers total cholesterol, and improves LP(a). It also improves circulation, and removes arterial plaque.

I take a prescription niacin called "NIACOR" this is not an Extended release formula. NIASPAN is an extended release formula. The dose allowed is much less then an immediate release niacin. NIASPAN is an excellent niacin formulation and probably the most researched. With doctor supervision
it is a very safe and effective choice. I purchase NIACOR through my prescription plan (which is cheaper than OTC). The NIACIN flush will be much less with NIASPAN.

Note: The flush is very beneficial (It's both a cleansing reaction and a circulation enhancer) The flush will be much less when taken with food.
My numbers with my current dosage of niacin are approx :

Total = 195
LDL = 120
TRIGS =110
HDL = 52
CRP 0.7

(Not too bad considering I am not strict on diet and exercise) I hope this info helped.
[QUOTE=ACE28]Yes,

I've been taking Niacin for approx. 3 years. Niacin corrects all lipid abnormalities. (No other prescription drug can make this claim). It raises HDL,
lowers LDL, lowers trigs, lowers total cholesterol, and improves LP(a). It also improves circulation, and removes arterial plaque.

I take a prescription niacin called "NIACOR" this is not an Extended release formula. NIASPAN is an extended release formula. The dose allowed is much less then an immediate release niacin. NIASPAN is an excellent niacin formulation and probably the most researched. With doctor supervision
it is a very safe and effective choice. I purchase NIACOR through my prescription plan (which is cheaper than OTC). The NIACIN flush will be much less with NIASPAN.

Note: The flush is very beneficial (It's both a cleansing reaction and a circulation enhancer) The flush will be much less when taken with food.
My numbers with my current dosage of niacin are approx :

Total = 195
LDL = 120
TRIGS =110
HDL = 52
CRP 0.7

(Not too bad considering I am not strict on diet and exercise) I hope this info helped.[/QUOTE]

Hello
Yes! this is very helpful! Can you tell me what your numbers were before starting on niacin??

Thanks. :wave:
Hi Babydog,

About 3 years ago I tried Lipitor. (My numbers were great but the side effects were awful). I then began to experiment with niacin (approx 500 - 1000 mg immediate release a day) At this time my doctor took me off the lipitor (due to neck and shoulder aches) My numbers about 4 years ago were approx:

TOTAL = 250
LDL = 150
HDL = 45
TRIGS = 370

6 months after 10 mg lipitor:

TOTAL = 170
LDL = 95
HDL = 41
TRIGS = 125

After lipitor my doctor switched me to 10mg of pravachol and approx.1000 mg of OTC niacin

TOTAL = 190
LDL = 110
HDL = 53
TRIG = 170

My doctor was fairly pleased with these results.

P.S As I mentioned NIASPAN is a very good choice. (listen to your doctor on this one) The Sustained Release (OTC) has caused liver failure in most of the cases of Niacin use. NIASPAN is also FDA approved (MD prescribed) Why take chances with your liver on unregulated OTC Niacin products.

Just my opinion...
[QUOTE=ACE28]As I mentioned NIASPAN is a very good choice. (listen to your doctor on this one) [B]The Sustained Release (OTC) has caused liver failure in most of the cases of Niacin use.[/B] NIASPAN is also FDA approved (MD prescribed) Why take chances with your liver on unregulated OTC Niacin products.[/QUOTE](bolding above mine)I think your statement might be easily misinterpreted. There have been more cases of liver damage with sustained release formulas than with the other formulas. But problems still affect only a very small proportion of users. And if they'd had their liver enzymes checked as they should, problems would be caught before they become irreversible. Also, from what I've read, one case resulted in needing a liver transplant when a doctor recommended a specific dosage immediate release and the patient, without conferring with the doctor, substituted an equal dosage sustained-release. Duh! The amount he took was, as I recall, about twice the maximum strength recommended by the manufacturer of that product!

I suspect the majority of problems are when people take an OTC product without being under supervision of a doctor at all, or who just don't go in for liver enzyme checks when they should. People who are heavy drinkers or who have other liver problems, for example, should not be taking niacin of any kind.

You might be interesting in reading this research abstract: [I]Varying Cost and Free Nicotinic Acid Content in Over-the-Counter Niacin Preparations for Dyslipidemia[/I]. You'll find it at
http://www.annals.org/cgi/content/abstract/139/12/996

For the 500 mg OTC products tested the research found:[quote]The average content of free nicotinic acid was 520.4 mg for immediate-release niacin, 502.6 mg for sustained-release niacin, and 0 for no-flush niacin.[/quote]I don't know about you, but I don't think if I get an average of 502.6 mg instead of 500, it is going to make much difference in my lipids or in risk.

Also, note that the lead author has financial ties to the maker of Niaspan. They state the toxicity risk this way:
[quote] Over-the-counter sustained-release niacin contains free nicotinic acid, but [B]some brands [/B] are hepatotoxic.[/quote](bolding mine) Unfortunately, they gave no indication of how many brands.

I've been taking Enduracin for about 21 months now. My liver enzymes in that time changed as follows:

AST - from 21 to 23 (reference range 5-40)
ALT - from 16 to 19 (reference range 5-50)

So for me, liver toxicity is not something I'm likely to have to worry about. However, though the greatest likelihood of problems is initially, problems can occur later, so I'd still encourage anyone taking niacin and getting good liver enzyme reports to continue getting checked out every six months or as directed by your doctor.

With all that said, [B]I would agree that if the cost of Niaspan is covered by insurance or if the cost out of pocket is not a major concern, by all means, go with the Niaspan.[/B] But for those like me who have to watch money carefully in retirement and whose every prescription dollar comes out of pocket, I see the OTC products as an easy way to save a bundle with relatively little extra risk, provided you take appropriate precautions.
[QUOTE=Uff-Da!](bolding above mine)I think your statement might be easily misinterpreted. There have been more cases of liver damage with sustained release formulas than with the other formulas. But problems still affect only a very small proportion of users. And if they'd had their liver enzymes checked as they should, problems would be caught before they become irreversible. Also, from what I've read, one case resulted in needing a liver transplant when a doctor recommended a specific dosage immediate release and the patient, without conferring with the doctor, substituted an equal dosage sustained-release. Duh! The amount he took was, as I recall, about twice the maximum strength recommended by the manufacturer of that product!

I suspect the majority of problems are when people take an OTC product without being under supervision of a doctor at all, or who just don't go in for liver enzyme checks when they should. People who are heavy drinkers or who have other liver problems, for example, should not be taking niacin of any kind.

You might be interesting in reading this research abstract: [I]Varying Cost and Free Nicotinic Acid Content in Over-the-Counter Niacin Preparations for Dyslipidemia[/I]. You'll find it at
http://www.annals.org/cgi/content/abstract/139/12/996

For the 500 mg OTC products tested the research found:I don't know about you, but I don't think if I get an average of 502.6 mg instead of 500, it is going to make much difference in my lipids or in risk.

Also, note that the lead author has financial ties to the maker of Niaspan. They state the toxicity risk this way:
(bolding mine) Unfortunately, they gave no indication of how many brands.

I've been taking Enduracin for about 21 months now. My liver enzymes in that time changed as follows:

AST - from 21 to 23 (reference range 5-40)
ALT - from 16 to 19 (reference range 5-50)

So for me, liver toxicity is not something I'm likely to have to worry about. However, though the greatest likelihood of problems is initially, problems can occur later, so I'd still encourage anyone taking niacin and getting good liver enzyme reports to continue getting checked out every six months or as directed by your doctor.

With all that said, [B]I would agree that if the cost of Niaspan is covered by insurance or if the cost out of pocket is not a major concern, by all means, go with the Niaspan.[/B] But for those like me who have to watch money carefully in retirement and whose every prescription dollar comes out of pocket, I see the OTC products as an easy way to save a bundle with relatively little extra risk, provided you take appropriate precautions.[/QUOTE]


Hi Uff-Da

Sorry for the mis-interpretation..

To clarify "my opinion". If a choice were given by my MD, for NIASPAN a researched and tested (FDA approved) Extended release Niacin formula with excellent and proven results with a very low insurance co-pay or; OTC (questionable non-consistent ingredients) sustained release NIACIN, I would choose the NIASPAN. (Just my opinion..) There is also a difference between Extended Release formulas versus Suspended release formulas. Oddly the NIASPAN Extended release has proven extremely safe even with statin use.
I choose the Immediate release because even at 20,000 - 30,000 mg a day (as was used at psych clinics for different ailments) there were very few cases of elevated enzymes, which reversed quickly after lowering the dose.
Extended Release/Sustained Release warn not to exceed 2,000 - 3,000 mg a day. I once took several OTC niacin products with very poor blood test results. Some products gave me no flush at all. The prescription NIACOR gave me better and more consistent results. The best OTC Niacins which helped my numbers were CARLSON(500 mg) PURITAN'S (250 mg) and CVS (100mg).

Note: I agree, the most important thing is to be monitored by your MD, regardless of the type or brand of Niacin used.
[QUOTE=ACE28]Hi Babydog,

About 3 years ago I tried Lipitor. (My numbers were great but the side effects were awful). I then began to experiment with niacin (approx 500 - 1000 mg immediate release a day) At this time my doctor took me off the lipitor (due to neck and shoulder aches) My numbers about 4 years ago were approx:

[B]After lipitor my doctor switched me to 10mg of pravachol[/B] and approx.1000 mg of OTC niacin

TOTAL = 190
LDL = 110
HDL = 53
TRIG = 170

Just my opinion...[/QUOTE]
ACE28,
Are you saying that you have also been on Pravachol for the past 3 years, along with the niacin? Pravachol lowered my numbers about 6 years ago until I could hardly walk from the leg weakness and stopped taking it.





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