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Niacin (nicotinic acid)
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<blockquote data-quote="dnfuss" data-source="post: 110178" data-attributes="member: 15487"><p>I have been on nicotinic acid but no longer am. FWIW, here's my 2¢ (and that's all it is, you should consult your doctor before going on any drug, including niacin):</p><p> </p><p>1. IF you're going to be on it, use ONLY the regular kind and take it only once a day, no time-release, slo-release, etc. I know the prescription form is slo-release; the drug companies developed that formulation in order to have a patentable drug. The supposed benefits of all the non-immediate formulations were to a) always have a steady stream of the drug in the bloodstream, which we now know is potentially very dangerous, and b) ameliorate the flushing and related sides. The non-immediate formulations can be toxic to the liver, possibly even induce liver failure in the case of the time-released. Even the regular formulation is hard on your liver (note that in a majority of patients it raises blood sugar levels -- that's a reaction to it by the liver, which is involved in blood sugar regulation). If you've decided to use this drug, use only the regular formulation (you can get it very cheaply at CVS, etc.) and start very low, maybe begin at 100 mg./day, and titrate dosage up very slowly, at least one week on each dosage level, preferably longer. And as far as the flushing, you just have to enjoy it, or at least be able to tolerate it. If you absolutely can't stand it, you shouldn't take nicotinic acid. The flush never goes away completely if you're on a therapeutic dosage, at least it didn't for me (I was on 3,000 mg./day for a couple of years).</p><p> </p><p>2. But I think the bigger issue comes down to why use it at all? It does have an effect on certain lipid levels. It raised my HDL moderately, lowered my LDL ever-so-slightly, and lowered my triglycerides dramatically. But those are surrogate markers, not clinical endpoints. (And BTW, it also raised my blood sugar significantly). My review of the literature regarding this drug leads me to much the same conclusion about it as I have come to regarding statins. I.e., the weight of evidence is that the ability of this drug to prevent all-cause mortality (certainly in primary prevention) to statistical significance has not been consistently demonstrated. And all-cause mortality, to me, is the sine qua non, all other endpoints are either confusing at best or misleading at worst (e.g., instance of coronary events) or simply surrogates (i.e., lab values). Turned around, the question is "Since no drug is without side effects, is it clear that taking this drug will prolong my life compared to not taking it?" As with statins, I've come to the view that the answer is "no," so why take it? I'm sure others, perhaps many, will disagree.</p></blockquote><p></p>
[QUOTE="dnfuss, post: 110178, member: 15487"] I have been on nicotinic acid but no longer am. FWIW, here's my 2¢ (and that's all it is, you should consult your doctor before going on any drug, including niacin): 1. IF you're going to be on it, use ONLY the regular kind and take it only once a day, no time-release, slo-release, etc. I know the prescription form is slo-release; the drug companies developed that formulation in order to have a patentable drug. The supposed benefits of all the non-immediate formulations were to a) always have a steady stream of the drug in the bloodstream, which we now know is potentially very dangerous, and b) ameliorate the flushing and related sides. The non-immediate formulations can be toxic to the liver, possibly even induce liver failure in the case of the time-released. Even the regular formulation is hard on your liver (note that in a majority of patients it raises blood sugar levels -- that's a reaction to it by the liver, which is involved in blood sugar regulation). If you've decided to use this drug, use only the regular formulation (you can get it very cheaply at CVS, etc.) and start very low, maybe begin at 100 mg./day, and titrate dosage up very slowly, at least one week on each dosage level, preferably longer. And as far as the flushing, you just have to enjoy it, or at least be able to tolerate it. If you absolutely can't stand it, you shouldn't take nicotinic acid. The flush never goes away completely if you're on a therapeutic dosage, at least it didn't for me (I was on 3,000 mg./day for a couple of years). 2. But I think the bigger issue comes down to why use it at all? It does have an effect on certain lipid levels. It raised my HDL moderately, lowered my LDL ever-so-slightly, and lowered my triglycerides dramatically. But those are surrogate markers, not clinical endpoints. (And BTW, it also raised my blood sugar significantly). My review of the literature regarding this drug leads me to much the same conclusion about it as I have come to regarding statins. I.e., the weight of evidence is that the ability of this drug to prevent all-cause mortality (certainly in primary prevention) to statistical significance has not been consistently demonstrated. And all-cause mortality, to me, is the sine qua non, all other endpoints are either confusing at best or misleading at worst (e.g., instance of coronary events) or simply surrogates (i.e., lab values). Turned around, the question is "Since no drug is without side effects, is it clear that taking this drug will prolong my life compared to not taking it?" As with statins, I've come to the view that the answer is "no," so why take it? I'm sure others, perhaps many, will disagree. [/QUOTE]
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