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Understanding Cholesterol-Lowering Medications (cont.)

Nicotinic Acid Agents

What are examples of nicotinic acid agents available in the U.S.?

Examples of nicotinic acid agents include:

  • Niacin,

  • Niacor, and

  • Slo-Niacin.

How do nicotinic acid agents work?

Nicotinic acid (also called niacin), a water-soluble B vitamin, improves blood levels of all lipoproteins when given in doses well above the vitamin requirement. Nicotinic acid lowers total cholesterol, LDL cholesterol, and triglyceride levels, while raising HDL cholesterol levels. Nicotinic acid reduces LDL cholesterol levels by 10%-20%, reduces triglycerides by 20%-50%, and raises HDL cholesterol by 15%-35%. Nicotinamide is a niacin by-product after it is broken down by the body. Nicotinamide does not lower cholesterol levels and should not be used in place of nicotinic acid.

Who should not use these medications?

Individuals who are allergic to nicotinic acid, and those who have liver disease, active peptic ulcer, or arterial bleeding, should not use nicotinic acid agents.

Use: When niacin is started, the dose should be gradually increased to minimize side effects until the effective cholesterol-lowering dose is reached.

  • There are two types of nicotinic acid preparations: immediate release and extended release. The immediate-release form of niacin is inexpensive and widely available without a prescription, but because of the potential side effects, it must not be used for cholesterol lowering without monitoring by a doctor.

  • Extended-release niacin is often better tolerated than crystalline niacin. However, its potential to cause liver damage is probably greater. Therefore, the dose of extended-release niacin is usually limited to 2 grams per day.

Drug or food interactions: The effects of high blood pressure medicines may also be increased while taking niacin. If a patient is taking high blood pressure medication, it is important to set up a blood pressure monitoring system while he/she is getting used to the new niacin regimen.

Side effects: A common and troublesome side effect of nicotinic acid is flushing or hot flashes, which are the result of blood vessels dilating. Most people develop a tolerance to flushing, which can sometimes be decreased by taking the drug during or after meals or by the use of aspirin or other similar medications prescribed by your doctor 30 minutes prior to taking niacin. The extended-release form may cause less flushing than the other forms. A variety of gastrointestinal symptoms, including nausea, indigestion, gas, vomiting, diarrhea, and the activation of peptic ulcers, has been seen with the use of nicotinic acid.

Three other major adverse effects include liver problems, gout, and high blood sugar (hyperglycemia). Risk of the latter three complications increases as the dose of nicotinic acid is increased. Because of the effect on a patient's blood sugar level, the doctor may not prescribe this medicine for a patient with diabetes.

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