NEW DEVELOPMENTS IN THE USE OF NIACIN FOR TREATMENT OF HYPERLIPIDEMIA- NEW CONSIDERATIONS IN THE USE OF AN OLD DRUG

Niacin has been used for many years to treat hyperlipidemia, It has be en shown to reduce coronary death and non-fatal myocardial infarction and, in a separate analysis of long-term (15-year) follow-up, all caus e mortality, It reduces total cholesterol, low density lipoprotein cho elsterol (LDL-C) and triglycerides and increases high density lipoprot ein cholesterol (HDL-C), Sustained-release niacin may be associated wi th more dramatic changes in LDL-C and triglyceride, whereas the short acting preparation causes greater increases in HDL-C. The increase of HDL-C occurs at a lower dose (1500 mg/day) than the reduction of LDL-C ( > 1500 mg/day), Niacin also favorably influences other lipid parame ters including lipoprotein(a) [Lp(a)], alimentary lipemia, familial de fective apolipoprotein B-100 and small dense LDL, Combination of niaci n with a bile acid sequestrant or a reductase inhibitor represents a p owerful lipid-altering regimen. Whereas the reductase inhibitors and b ile acid binding resins primarily affect LDL-C, the combined therapy h as a synergistic effect to reduce LDL-C and, in addition, the niacin r educes triglycerides and increases HDL-C. The major drawback in the us e of niacin is associated side effects (flushing and palpitations) and toxicity (worsening of diabetes control, exacerbation of peptic ulcer disease, gout, hepatitis). Niacin has a long history of use as a lipi d lowering agent and has several attractive features, Unfortunately, t he side effect profile of this agent warrants its use only in patients with marked dyslipidemia in whom side effects and potential toxicity are closely monitored.