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- W2014676102 abstract "“Industrial-strength doses” of niacin have been used safely for years for the treatment of hyperlipidemia,la2 and have been associated with reduced risk of coronary artery disease in primary and secondary prevention trials.3-6 Recently, there has been renewed interest in the use of niacin for lipid-lowering therapy. Several excellent articles that highlight its efficacy as well as its toxicity have been published within the past year.7-g It is curious that we have been “sold a bill of goods” about the benefits of modified-release niacin over unmodified niacin (regular, crystalline), when the medical literature clearly indicates that such preparations are only slightly less likely to be associated with the adverse skin effects and more likely to be associated with gastrointestinal complaints and abnormal liver function.7J0~11 These studies confirm that the unmodified forms of niacin are as well or better tolerated and less likely to be associated with adverse effects than the modified-release preparations, and that adverse effects are dose-related for both types of preparations. The literature suggests that approximately 50% to 75% of patients can tolerate niacin, particularly if reasonable doses are used.7-g,‘2 Modified-release preparations should probably never be used in excess of 2,000 mg/d, while the doses of unmodified niacin are more flexible; some patients can safely take very high doses.gr13-15 It may be reasonable for most primary care physicians to limit their prescription of unmodified niacin to 13,000 mg/d, and of slow-release preparations to 1,500-2,000 mg/d, and to refer resistant or difficult patients to lipid experts for treatment. There appear to be both dose-response and preparation-dependent relationships of niacin to changes in low-density lipoprotein cholesterol (LDLC), triglyceride, and high-density lipoprotein cholesterol (HDL-C) levels.7 The unmodified forms of niacin are better for increasing the HDL-C, and the modified-release preparations are better for decreasing the triglyceride levels; the two preparations appear to be equipotent at decreasing the LDL-C levels. Thus, the initial lipid pattern, as well as the goal(s) of therapy could serve to determine the dose, and perhaps the preparation, that is selected." @default.
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- W2014676102 title "Niacin: A therapeutic dilemma “one man's drink is another's poison”" @default.
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- W2014676102 doi "https://doi.org/10.1016/0002-9343(94)90296-8" @default.
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