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High Cholesterol Message Board


High Cholesterol Board Index


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=ARIZONA73]Well, I can think of another advantage of taking the Niaspan at bedtime. I guess if you are going to flush from it, it's better to do it in the dark, and in the privacy of your own home rather than in broad daylight, and in the presence of a room full of people. :eek:[/QUOTE]

The prescription says to take 1 tablet 2x a day. I have decided to take 1 at night only. Had I taken it yesterday during the day, my coworkers and my boss would have called 911 and had me rushed to the hospital.

I wish I didn't have to stay one step ahead of the doctor all the time. :confused:

Last night I decided to take a warm bath. Something I had not done in 20 years. Thought it would make me relax. I guess it hastened the flush instead. The last time I took a tub bath, I broke out in hives from a sulfa drug which had elevated my liver enzymes. Guess it will be another 20 years before I try to relax in a tub. Too stressful for me. :eek:
[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.





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