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New perspectives on the use of niacin in the treatment of lipid disorders McKenney JArch Intern Med 2004[Apr]; 164 (7): 697-705Therapy with niacin (nicotinic acid) is unique in that it improves all lipoprotein abnormalities. It significantly reduces low-density lipoprotein cholesterol, triglyceride, and lipoprotein(a) levels, while increasing high-density lipoprotein cholesterol levels. This makes niacin ideal for treating a wide variety of lipid disorders, including the metabolic syndrome, diabetes mellitus, isolated low high-density lipoprotein cholesterol, and hypertriglyceridemia. Niacin-induced changes in serum lipid levels produce significant improvements in both coronary artery disease and clinical outcomes. Niacin is currently available in 3 formulations (immediate release, extended release, and long acting), which differ significantly with respect to their safety and efficacy profiles. Immediate-release niacin is generally taken 3 times a day and is associated with adverse flushing, gastrointestinal symptoms, and elevations in blood glucose levels. Long-acting niacin can be taken once daily and is associated with significantly reduced flushing, but its metabolism increases the risk of hepatotoxic effects. Extended-release niacin, also given once daily, has an absorption rate intermediate between the other formulations and is associated with fewer flushing and gastrointestinal symptoms without increasing hepatotoxic risk.|Cholesterol, HDL/drug effects[MESH]|Cholesterol, LDL/drug effects[MESH]|Delayed-Action Preparations[MESH]|Dose-Response Relationship, Drug[MESH]|Drug Therapy, Combination[MESH]|Humans[MESH]|Hyperlipidemias/complications/*drug therapy[MESH]|Hypolipidemic Agents/adverse effects/pharmacology/*therapeutic use[MESH]|Niacin/adverse effects/pharmacology/*therapeutic use[MESH]|Simvastatin/therapeutic use[MESH] |
