Niacin dyslipidemia

The principal use of niacin is for mixed hyperlipidemia or as a second-line agent in combination therapy for hypercholesterolemia. It is a first-line agent or alternative for the treatment of hypertriglyceridemia and diabetic dyslipidemia. 

Primary hypercholesterolemia/mixed dyslipidemia For the treatment of primary hypercholesterolemia (heterozygous familial and nonfamilial) and mixed dyslipidemia (Frederickson Types lla and Mb) in the following Patients treated with lovastatin who require further TG-lowering or FIDL-raising who may benefit from having niacin added to their regimen patients treated with niacin who require further... 

McKenney J. Niacin for dyslipidemia considerations in product selection. Am J Health-Syst Pharm 2003 60 995-1005. 

Britton ML, Bradberry JC, Letassy NA, Mckenney JM, Sirmans SM. ASHP Therapeutic Position Statement on the safe use of niacin in the management of dyslipidemias. American Society of Health-System Pharmacists. Am J Health Syst Pharm 1997 54(24) 2815-19. 

PJ is a 60-year-old woman with a history of an abdominal aortic aneurysm who is taking niacin for her dyslipidemia. Her LDL-C is 120 mg/dL, so a statin is added to her therapy. Which of the following are true for statins ... 

Adverse effects of niacin are most commonly seen when this vitamin is used at pharmacological doses above I g/day in the treatment of dyslipidemia. Notable adverse effects include flushing due to vasodilatation dermatological effects including dry skin pruritus and hyperkeratosis gastrointestinal effects including peptic ulcer,. stomach pain, nausea. and diarrhea elevations in serum uric acid and glucose and hepatotoxicity. ... 

Niacin is a nutritional supplement used during periods of deficiency known as pellagra and for the treatment of dyslipidemia. Niacin needs may increase during chronic illness such as diabetes mellitus, malignancy, metabolic diseases, hyperthyroidism, infections, chronic fever, alcoholism, and during pregnancy and lactation. 

Miller M (2003) Niacin as a component of combination therapy for dyslipidemia. Mayo Clinic Proceedings 78(6) 735-742. 

The manufacturer does not recommend use of the fixed combination as initial therapy of primary hypercholesterolemia or mixed dyslipidemia. It is specifically Indicated in patients receiving lovastatin alone plus diet who require an additional reduction in triglyceride levels or increase in HDL cholesterol levels it is also Indicated In those treated with niacin alone who require additional decreases in LDL cholesterol. 

Grundy SM, Vega GL, McGovern ME, et al. Efficacy, safety, and tolerability of once-daily niacin for the treatment of dyslipidemia associated with type 2 diabetes Results of the assessment of diabetes control and evaluation of the efficacy of niaspan trial Arch Intern Med 2002 162 1568-1576. 

Niacin, a B-complex vitamin, is used in the treatment of pellagra, peripheral vascular disease, and circulatory disorders, and as an adjunctive treatment of hyperlipidemias, especially those associated with hypercholesterolemia. Niacin, nicotinic acid (pyridine-3-carboxylic acid), is one of the oldest drugs used to treat dyslipidemia and favorably affects virtually all lipid parameters. 

The pharmacological doses of regular (crystalline) niacin nsed to treat dyslipidemia are almost completely absorbed, and peak plasma concentrations (np to 0.24 mmol) are achieved, within 30 to 60 minutes. The half-life is about 60 minutes, which accounts for the necessity of twice- or thrice-daily dosing. At lower doses, most niacin is taken np... 

Niacin is indicated for hypertriglyceridemia and elevated LDL-C it is especially useful in patients with both hypertriglyceridemia and low HDL-C levels. There are two commonly available forms of niacin. Crystalline niacin (immediate-release or regular) refers to niacin tablets that dissolve quickly after ingestion. Sustained-release niacin refers to preparations that continuously release niacin for 6 to 8 hours after ingestion. Niaspan is the only preparation of niacin that has been approved by the FDA for treating dyslipidemia and that requires a prescription. 

Millions of people in the world suffer from cardiovascular disease, and it is a leading cause of death in both men and women. Elevation in plasma low-density lipoprotein (LDL) cholesterol levels is a major risk factor for myocardial infarction (heart attack) in these patients. Drugs to reduce dyslipidemia have included niacin and the fibrate class, but each of these has clinical limitations, such as low efficacy or toxic side effects. The development of HMG-CoA reductase inhibitors, or statins, has had an enormous clinical impact on the treatment of heart disease and prevention of heart attack, and these are taken by tens of millions of patients worldwide [1]. One of the first such drugs, lovastatin, was discovered in the 1970s as a fungal natural product [2] and lowered lipid levels in animals and healthy volunteers. Problems with the development of another early statin, compactin, halted advancement of lovastatin to regular clinical use until the late 1980s. Since then. 

Parhofer, K.G., 2009. Review of extended-release niacin/laropiprant fixed combination in the treatment of mixed dyslipidemia and primary hypercholesterolemia. Journal of Vascular Health and Risk Management. 5 901-908. 

A.L., Chen, W., Shen, H., Ding, F.-X., and Bodner, R. (2006) Preparation of (hetero) aryl amino acid amides as niacin receptor agonists for treatment of atherosclerosis, dyslipidemia, diabetes, and metabolic syndrome. PCT Patent W02007/075749. 

Insull Jr. W, Basile JN, Vo AN, Jiang P, Thakkar R, Padley RJ. Efficacy and safety of combination therapy with niacin extended-release and simvastatin versus atorvastatin in patients with dyslipidemia The SUPREME Study. J Clin Lipidol 2009 3(2) 109-18. 

Laropiprant (registered under the trademark Tredaptive (Merck) in combination with niacin) is a prostaglandin D2 (PG D2) receptor antagonist indicated for the treatment of dyslipidemia, particularly in patients with combined mixed dyslipidemia (characterized by elevated levels of low-density lipoprotein (LDL)-cholesterol and triglycerides and low high-density lipoprotein (HDL)-cholesterol) as well as in patients with primary hypercholesterolaemia (heterozygous familial and non-familial). Tredaptive can be used... 

---