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High Cholesterol Message Board


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Taking slo- release or no flush niacin will harm your liver, especially at 2000mg a day. At 1000mg there is a 54% increased risk of hepatotoxicity. Because you don't flush with the no flush niacin your liver takes a beating because it is constantly bombarded with niacin over a long time. It never has a chance to breath. Immediate realease niacins may cause flushing but flushing is harmless. Also, if you are taking any other over the counter forms of Niacin I would advise you to stop. Recently, the Univ. of Washington did a study with 14 different brands of over the counter niacin and guess what, 8 of the brands sampled didn't have any Niacin in them whatsoever. These products are not FDA regulated and the companies that produce them can make any claims they want b/c they are not approved nor regulated by the FDA. The safest form of niacin out there is approved by the FDA and it is called Niaspan. Ask your Doctor about it. You only have one liver and I suggest you give it a break from the slo niacin or no flush niacin.
Taking slo- release or no flush niacin will harm your liver, especially at 2000mg a day. At 1000mg there is a 54% increased risk of hepatotoxicity. Because you don't flush with the no flush niacin your liver takes a beating because it is constantly bombarded with niacin over a long time. It never has a chance to breath. Immediate realease niacins may cause flushing but flushing is harmless. Also, if you are taking any other over the counter forms of Niacin I would advise you to stop. Recently, the Univ. of Washington did a study with 14 different brands of over the counter niacin and guess what, 8 of the brands sampled didn't have any Niacin in them whatsoever. These products are not FDA regulated and the companies that produce them can make any claims they want b/c they are not approved nor regulated by the FDA. The safest form of niacin out there is approved by the FDA and it is called Niaspan. Ask your Doctor about it. You only have one liver and I suggest you give it a break from the slo niacin or no flush niacin.
Ok , guys and ladies to set the record straight. The reason Niaspan has a patent is because of its delivery system. Arizona you are right in stating that it is just niacin and what a great idea on how to market it by a drug company. However, let me point out that all niacins are not the same. Let's imagine in our heads a line. This line represents liver toxicity. Slo-niacin and no flush niacin are consistently over this line therefore increasing the risk of hepatotoxicity. Niaspan through its delivery system keeps below this line and at the same time is an extended release niacin. Niaspan was able to reduce the flushing compared to immediate release niacin by 70% and still have the same effect on lipids as immediate release niacin.
As far as the use with diabetics, Niaspan 1500mg had the same amount of increase in fasting blood glucose as Tricor. And minimal effect on hba1c.

There are two great studies on Niacin in Diabetics
ADVENT Trial with Niaspan and ADMIT trial with immediate release niacin. I hope this clears some issues up.
Anyone taking SloNiacin should read this. It is not effective and it is dangerous. Your doctor should know this.


bob


The dosing regimen of IR nicotinic acid is known to provide a very beneficial effect on blood lipids as discussed in Knopp et al.; "Contrasting Effects of Unmodified and Time-Release Forms of Niacin on Lipoproteins in Hyperlipidemic Subjects: Clues to Mechanism of Action of Niacin"; Metabolism 34/7, 1985, page 647. The chief advantage of this profile is the ability of IR nicotinic acid to decrease total cholesterol, LDL cholesterol, triglycerides and Lp(a) while increasing "HDL" particles. In fact, IR nicotinic acid has been well regarded as an effective drug in the treatment of high cholesterol since about the early 1960s. Unfortunately, IR nicotinic acid has never really become widely used because of the high incidence of flush that often occurs when an IR dose is taken. That means an individual may develop a visible, uncomfortable, hot or flushed feeling three or four times a day for about one hour following each IR dose.

In order to avoid or reduce the cutaneous flushing, a number of materials have been suggested for administration with an effective antihyperlipidemic amount of immediate release nicotinic acid, including guar gum in U.S. Pat. No. 4,956,252, and mineral salts as disclosed in U.S. Pat. No. 5,023,245; or inorganic magnesium salts as reported in U.S. Pat. No. 4,911,917. These materials have been reported to avoid or reduce the cutaneous flushing side effect commonly associated with nicotinic acid treatment.

Another method of avoiding or reducing the side effects associated with immediate release nicotinic acid is the use of SR nicotinic acid formulations. SR nicotinic acid formulations are designed to slowly release the compound from the tablet or capsule. The slow drug release reduces and prolongs blood levels of drug in an attempt to lower peak nicotinic acid concentrations with the goal of reducing or eliminating nicotinic acid induced flush. Examples of currently marketed SR formulations of nicotinic acid include Nicobid.RTM. capsules (Rhone-Poulenc Rorer), Enduracin.RTM. (Innovative Corporation) and SloNiacin.RTM. (Upsher-Smith Laboratories, Inc., U.S. Pat. No. 5,126,145, which describes a sustained release niacin formulation containing two different types of hydroxypropyl methylcellulose and a hydrophobic component).

Studies in hyperlipidemic patients have been conducted with a number of SR nicotinic acid products. These studies have demonstrated that the sustained release products do not have the same advantageous lipid altering effects as IR nicotinic acid, and in fact often have a worse side effect profile compared to the IR products. The major disadvantage of the SR formulations, as can be seen in Knopp et al., in 1985, is the significantly lower reduction in triglycerides (-2% for the sustained versus -38% for the immediate release) and lower increase in HDL cholesterol, represented as HDL2 particles which are known by the art to be most beneficial, (-5% for the sustained release versus +37/% for the immediate release).

Additionally, SR nicotinic acid formulations have been noted as causing greater incidences of liver toxicity as described in Henken et al.: Am J Med, 91:1991 (1991) and Dalton et al.: Am J Med, 93:102 (1992). There is also great concern regarding the potential of these formulations in disrupting glucose metabolism and uric acid levels.

In a recent edition of the Journal of the American Medical Association, an article appeared which presented research results investigating the liver toxicity problems associated with an SR form of nicotinic acid. See McKenney et al.: A Comparison of the Efficacy and Toxic Effects of Sustained- vs. Immediate-Release Niacin in Hypercholesterolemic Patients, JAMA, (271)9: 672 (Mar. 2, 1994). This McKenney et al. article presented a study of twenty-three patients. Of that number, 18 or 78 percent were forced to withdraw because liver function tests (FTs) increased indicating potential liver damage. The conclusion of the authors of that article was that the SR form of nicotinic acid "should be restricted from use."

A similar conclusion was reached in an article authored by representatives of the Food and Drug Administration. See Radar, et al.: Hepatic Toxicity of Unmodified and Time-Release Preparations of Niacin, JAMA, 92:77 (January 1992). Because of these studies and similar conclusions drawn by other health care professionals, the sustained release forms of nicotinic acid have experienced limited utilization.

Can anyone bear, or has anyone here KNOWN anyone who can bear a dose of "regular" immediate releast niacin of 1000 mg.(or god, 2000 mg.) with or without 81, 325, or even 650 mg aspirin...and then to do it for LIFE!

If not, you have to wonder why all the books keep prattling on and on about using doses like this for cholesterol control. If nobody can bear this much "flush," why don't the texts just drop the subject. I guess I answered my own question....to SELL MORE VITAMINS and now PHARMACEUTICALS. Sad!

The word "flush" is such a misnomer. For me, it's like calling being smashed between two railroad cars a "pinch injury." Only advantage to the flush is that at least you know there's SOME niacin in the pills you bought :D!

My final take on niacin efficacy: Immediate Release works pretty well(cholesterol lowering) and causes extreme flush and is dirt cheap. Extended Release doesn't work at all and thus causes no flush but puts the liver at big risk.

Niaspan ("sustained release"- really somewhat extended release)) goes mid-road and gives some flush, some benefit, and some liver damage. Cost is really huge!





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