ASHP
Therapeutic Position Statement on the safe use of niacin in
the management of dyslipidemias.
American Society of Health-System Pharmacists [see comments]
SOURCE: Am J Health Syst Pharm 1997 Dec 15; 54(24): 2815-9
CITATION IDS: PMID: 9428952 UI: 98090635
COMMENT: Comment in: Am J Health Syst Pharm 1997 Dec 15;
54(24): 2803
ABSTRACT: ASHP supports the use of niacin as an effective
therapy for the management of dyslipidemias in adults. Successful
and safe therapy requires ongoing supervision and instruction
by qualified health care providers to monitor the efficacy
of therapy and minimize niacin's potential for adverse effects.
Because many niacin products are available without a prescription,
pharmacists are in a unique position to help ensure that
patients make the best use of this medication.
Effect of two aspirin pretreatment regimens on niacin-induced
cutaneous reactions.
AUTHORS Jungnickel PW; Maloley PA; Vander Tuin EL; Peddicord
TE; Campbell JR
AUTHOR AFFILIATION Department of Clinical Pharmacy Practice,
Auburn University, Ala. 36849- 5501, USA. SOURCE: J Gen
Intern Med 1997 Oct; 12(10): 591-6 CITATION IDS: PMID: 9346454
UI: 98004440
ABSTRACT: OBJECTIVE: To compare the effects of pretreatment
with two aspirin regimens and placebo on niacin-induced
cutaneous reactions.
DESIGN: Randomized, double-blind, placebo-controlled, crossover
study.
SETTING: Internal medicine clinic in an academic health
center.
PARTICIPANTS: Forty-two healthy subjects (22 males and
20 females) between the ages of 35 and 65 (mean age 44.2
years) were recruited and completed the study. Subjects
received aspirin 325 mg, aspirin 650 mg, and placebo for
4 consecutive days, and on the fourth day also ingested
500 mg of immediate-release niacin 30 minutes after taking
aspirin or placebo. They reported the intensity of flushing,
headache, pruritus, tingling, and warmth on a 10-cm visual
analogue scale. Reactions were evaluated at time 0 (before
the niacin dose), and at 15, 30, 60, and 120 minutes following
the niacin dose. Cutaneous reactions were compared at each
evaluation time and scored by two other methods. The peak
intensity was the highest score recorded at any of the four
evaluation times after niacin administration. An intensity-time
factor was calculated by totaling the scores of each of
the four evaluation times.
MEASUREMENT AND MAIN RESULTS: The symptom scores for flushing,
itching, tingling, and warmth were all significantly reduced
by both aspirin regimens (p < .05 in all cases), although
there were no significant differences between the 325-mg
and 650-mg doses. The results were similar for each scoring
method.
CONCLUSIONS: An aspirin regimen of 325 mg is effective
in suppressing niacin-induced cutaneous reactions. Increasing
the dose to 650 mg does not provide additional benefit.
Relative effectiveness of niacin and lovastatin for treatment
of dyslipidemias in a health maintenance organization.
AUTHORS: O'Connor PJ; Rush WA; Trence DL AUTHOR AFFILIATION
HealthPartners Group Health Foundation, Minneapolis, MN
5440-1309, USA. SOURCE:J Fam Pract 1997 May;44(5):462-7
CITATION IDS: PMID: 9152263 UI: 97296794 COMMENT: Comment
in: J Fam Pract 1997 May;44(5):449-50
ABSTRACT: BACKGROUND: We conducted a historical cohort
study to evaluate the relative effectiveness of niacin and
lovastatin in the treatment of dyslipidemias in patients
enrolled in a health maintenance organization (HMO).
METHODS: To be eligible for this study, adults aged 18
years and older who were initially treated with either niacin
or lovastatin between January 1, 1992, and December 31,
1993, were identified from pharmacy databases. Each potentially
eligible member with a fasting lipid panel prior to initiation
of drug therapy and with a second fasting lipid panel between
9 and 15 months after initiation of drug therapy was included
in the study. A total of 244 patients treated with niacin
and 160 patients treated with lovastatin had complete data
and are subjects of this report.
RESULTS: Patients initially treated with lovastatin had
higher baseline mean cholesterol and low-density lipoprotein
(LDL) levels as well as higher rates of diabetes mellitus
and heart disease than did patients initially treated with
niacin. Lovastatin use was associated with a mean 25.8%
decrease in LDL cholesterol, while niacin use was associated
with a mean 17.5% drop in LDL cholesterol (t = 3.19, P <
.002). Niacin use was associated with a 16.3% improvement
in high-density lipoprotein (HDL) cholesterol, while HDL-cholesterol
levels in the lovastatin group improved1.5% (t = 4.74, P
< .001). Niacin use was associated with an 18.4% improvement
in triglycerides, while lovastatin use was associated with
an 8% improvement in triglyceride levels (t = 2.81, P =
.005). Differences in LDL/HDL ratio from before treatment
to follow-up were no different in the two groups of patients
(t = -1.21, P = .22). A total of 46% of patients initially
treated with either drug reached their treatment goals in
accordance with those set by the National Cholesterol Education
Program. Drug discontinuation rates were 73% for niacin
and 52% for lovastatin at follow-up, which averaged 10.7
months in each group.
CONCLUSIONS: These results suggest that both niacin and
lovastatin are effective in treating dyslipidemic patients
in this care system, and that physicians appropriately use
lovastatin more often for patients with higher baseline
LDL levels and more comorbidity. The data also strongly
suggest that establishing an organized, population-based
approach to systematically identify, treat, and monitor
patients with dyslipidemias may be the single most important
intervention HMOs should consider for improving control
of dyslipidemias on a population basis.
Niacin deficiency and cancer in women.
AUTHORS: Jacobson EL AUTHOR AFFILIATION: Dept. of Clinical
Sciences, Markey Cancer Center, University of Kentucky,
Lexington 40536-0080. SOURCE: J Am Coll Nutr 1993 Aug; 12(4):
412-6 CITATION IDS: PMID: 8409103 UI: 94014001
ABSTRACT: A new interest in the relationship between niacin
and cancer has evolved from the discovery that the principal
form of this vitamin, NAD, is consumed as a substrate in
ADP-ribose transfer reactions. Poly (ADP-ribose) polymerase,
an enzyme activated by DNA strand breaks, is the ADP-ribosyltransferase
of greatest interest with regard to effects on the niacin
status of cells since its Km for NAD is high, and its activity
can deplete NAD. Studies of the consequences of DNA damage
in cultured mouse and human cells as a function of niacin
status have supported the hypothesis that niacin may be
a protective factor that limits carcinogenic events. To
test this hypothesis in humans, we used a biochemical method
based on the observation that as niacin nutriture decreases,
NAD readily declines and NADP remains relatively constant.
This has been demonstrated in both fibroblasts and in whole
blood from humans. Thus, we use "niacin number,"
(NAD/NAD+NADP) x 100% from whole blood, as a measure of
niacin status. Healthy control subjects showed a mean niacin
number of 62.8 +/- 3.0 compared to 64.0 for individuals
on a niacin-controlled diet. Analyses of women in the Malmo
Diet and Cancer Study showed a mean niacin number of 60.4
with a range of 44 to 75. The distribution of niacin status
in this population was nongaussian, with an unpredictably
large number of individuals having low values. niacin/children/high
blood lipids treatment.
A survey of pediatric management of dyslipidemias in New
England.
AUTHORS: Lavin A; Nauss AH; Newburger JW AUTHOR AFFILIATION:
Department of Pediatrics and Adolescent Medicine, Lahey
Clinic Medical Center, Burlington, Massachusetts.
SOURCE: Pediatr Cardiol 1992 Apr;13(2):76-9 CITATION IDS:
PMID: 1614923 UI: 92311059
ABSTRACT: We recently surveyed physicians attending the
New England Pediatric preventive CardiologySociety. Sixteen
physicians who actively evaluated children with dyslipidemia
completed questionnaires; at least one representative from
six of the seven medical schools in New England was included.
The survey elicited responses to five hypothetical cases
of childhood dyslipidemia which were representative of the
types of lipid problems commonly referred to pediatric lipid
specialists. Diet modification was the initial treatment
of choice of all participants. For any set of lipid values,
postpubertal age increased the proportion of respondents
who would have prescribed medication. When pharmacologic
intervention was elected, resin binders (cholestyramine
or cholestipol) and niacin were most commonly prescribed.
The responses of the physicians showed considerable variation
in the threshold for beginning medications. In summary,
this survey suggests substantial variation in the approach
to pharmacologic management of pediatric dyslipidemias in
the New England region.
