Slo-Niacin vs Niaspan

Discussion in 'Upsher Smith Labs' started by Anonymous, Nov 28, 2007 at 6:31 PM.

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  1. Anonymous

    Anonymous Guest

    ..patient switched to Slo-Niacin / Upsher-Smith...,liver function test

    Rechallenge with crystalline niacin after drug-induced hepatitis from sustained-release niacin.
    Yaakov Henkin, Karen C. Johnson, Jere P. Segrest
    JAMA, The Journal of the American Medical Association
    July 11, 1990

    Niacin (nicotinic acid), a drug used to regulate blood lipid (fat) levels, is associated with side effects that are harmful to the liver. The drug is available in several forms, including a crystalline form and sustained-release (SR) capsules. The case studies of three patients who developed hepatitis while taking SR niacin are presented.

    One, a 62-year-old man, had been treated with crystalline niacin for high levels of low-density lipoprotein cholesterol (one form in which cholesterol is stored). He received the drug in this form for five months, then changed to SR niacin. After five days, the patient became nauseated, and fainted after drinking a glass of champagne. Tests for liver function were abnormal, and niacin was withheld. The patient recovered and resumed taking crystalline niacin.

    The second patient, a 50-year-old woman with familial hypercholesterolemia (high blood cholesterol), took SR niacin and developed impaired liver function. However, she was able to take the crystalline form.

    Crystalline niacin was prescribed for the third patient, a 47-year-old man, because of elevated cholesterol, but, based on his pharmacist's advice, he changed to the SR form. This led to abnormal liver functions tests and symptoms which disappeared when the crystalline form was re-instituted.

    In summary, it is likely that niacin will be prescribed more frequently in the future, since the National Cholesterol Education Program calls for aggressive treatment of high cholesterol levels.

    The cause of niacin-induced hepatitis is not known. However, the ease of access to SR preparations, which do not require a prescription, is cause for concern. (Consumer Summary produced by Reliance Medical Information, Inc.) Rechallenge With Crystalline Niacin After Drug-Induced Hepatitis From Sustained-Release Niacin (nicotinic acid) is available in several forms, including crystalline preparations and various types of sustained-release preparations.

    Evidence exists that sustained-release niacin, with respect to both dosage and severity, is more hepatotoxic than crystalline niacin. Three patients who developed hepatitis during treatment with sustained-release niacin were rechallenged with equivalent or higher doses of crystalline niacin, with no evidence of recurring hepatocellular damage.

    Although the mechanism for niacin-induced hepatitis is unknown, these cases support previous observations that crystalline niacin may be less hepatotoxic than sustained-release preparations in certain patients. NIACIN (nicotinic acid) is an effective hypolipidemic agent available in several forms, including crystalline preparations ("regular" niacin) and various forms of sustained-release (or slow-release SR) capsules and caplets.

    Hepatotoxic effects are an uncommon but well-documented complication of niacin therapy. Cholestatic and hepatocellular reactions have been described clinically, with liver biopsy findings of parenchymal necrosis and centrilobular cholestasis in most patients. Although the mechanism by which niacin or one of its metabolites induces hepatic injury is unknown, evidence exists to suggest a dose-related, direct toxic effect rather than an idiosyncratic drug reaction.

    Although all forms of niacin have shown efficacy in modifying serum lipid levels, differences exist in their side effect profiles. Sustained-release niacins produce less cutaneous flushing, but a greater frequency and severity of hepatic and gastrointestinal side effects have been observed. Although most cases of hepatotoxic reactions are mild and reversible, fulminant hepatic failure has been reported, occurring within days of switching a patient from crystalline to SR niacin.

    We describe the experience of three patients who developed hepatitis while receiving SR niacin therapy. These patients were rechallenged with equivalent (or higher) doses of crystalline niacin, and they maintained normal liver function test results after 6 to 10 months of therapy.



    Report Cases
    CASE 1.--A 62-year-old man with a medical history of a cardiac arrest and subsequent coronary artery bypass graft was referred to the Atherosclerosis Detection and Prevention Clinic for evaluation of his condition. His lipoprotein profile showed an elevated level of low-density lipoprotein cholesterol with a mildly decreased level of high-density lipoprotein cholesterol. A low-fat diet was started and a gradually increasing dose of crystalline niacin was given to the patient. On reevaluation at 4 months, the patient was tolerating well a niacin dose of 3000 mg/d, with normal results of liver function tests and an improved lipoprotein profile. He was advised to increase his daily niacin dose gradually to 4000 mg during the following month.

    Four weeks later, the patient purchased an SR niacin capsule preparation (Major Pharmaceuticals, Chicago Ill) at a health food store and substituted it for his prescribed crystalline niacin. After ingesting SR niacin for 5 days (1000 mg four times daily) he began to experience nausea. Two days later, after drinking a glass of champagne on an empty stomach, the patient experienced a brief syncopal episode and was taken to the hospital.

    On admission to the hospital, the patient was noted to be alert and oriented, with a blood pressure of 110/68 mm Hg and a pulse rate of 73 beats per minute. The results of physical examination were normal, except for orthostatic hypotension. Admission laboratory tests were remarkable for the following values: aspartate aminotransferase, 323 U/L; alanine aminotransferase, 210 U/L; albumin, 33 g/L; total bilirubin, 7 micromol/L; alkaline phosphatase, 66 U/L; lactate dehydrogenase, 360 U/L; and prothrombin time, 24s. The patient denied recent exposure to hepatotoxins; no serologic evidence of present or past viral hepatitis infection was noted. Myocardial infarction was ruled out. Niacin was withheld and the patient was treated with parenteral vitamin K. Maximal liver aminotransferase level elevations occurred 2 days after hospitalization and gradually declined to normal during the following 4 weeks.

    At the patient's reevaluation 1 month later, crystalline niacin was readministered and the dosage was gradually raised back to 4000 mg/d. After more than 6 months at this dosage, there were minimal side effects, a greatly improved lipoprotein profile, and normal results of liver function tests.

    CASE 2.--A 50-year-old woman with a medical history of hypertension, mitral valve prolapse, and coronary heart disease had a coronary artery bypass graft at the age of 45 years. familial hypercholesterolemia was diagnosed based on the lipoprotein profile, the presence of Achilles tendinous xanthomas, and a strong family history of hyperlipidemia and premature coronary heart disease. The patient was a heavy smoker and drank a glass of wine daily. Her medications included verapamil and hydrochlorothiazide. Treatment with SR niacin (Nicobid; USV Pharmaceutical Corp, Tarrytown, NY) was started at a dose of 1500 mg/d but was discontinued twice (after 5 months of therapy and again 4 months after readministration) because of elevations of the aspartate aminotransferase level to 111 and 177 U/L, respectively. Because of its effectiveness is modifying the patient's lipoprotein profile, SR niacin was readministered both times after normalization of the serum aminotransferase levels.

    Six months after reinitiation of SR niacin therapy (several weeks after increasing her daily dose to 1000 ng twice daily), the patient came to the hospital with atypical chest pain. On admission to the hospital she was found to be icteric, with a blood pressure of 120/92 mm Hg and a pulse of 88 beats per minute. Results of physical examination were otherwise normal, except for a cardiac murmur consistent with mitral regurgitation and bruits over the carotid, femoral, and rental arteries. Laboratory tests were remarkable for the following values: alanine aminotransferase, 241 U/L; aspartate aminotransferase, 227 U/L; alkaline phosphatase, 2325 U/L; y-glutamyltransferase, 870 U/L; direct bilirubin, 80 micromol/L; indirect bilirubin, 41 micromol/L; lactase dehydrogenase, 278 U/L; partial thromboplastin time, 38 s; and prothrombin time, 24 s. No evidence of acute myocardial infarction was noted; results of serologic tests for viral hepatitis were negative. Niacin therapy was discontinued; the liver function test results gradually improved and normalized within 6 weeks.

    Subsequently the patient was referred for evaluation at the Atherosclerosis Detection and Prevention Clinic. Treatment with 80 mg/d of lovastatin (Mevacor) caused a 16% reduction in the level of serum low-density lipoprotein cholesterol. As this response was considered to be insufficient, crystalline niacin was cautiously added (250 mg/d). The daily dose was gradually increased by 250 mg each week and finally maintained at 2500 mg. The patient tolerated this combination of lovastatin and crystalline niacin for more than 10 months with minimal side effects, normal results of liver function tests, and a much improved lipoprotein profile (Tabel).

    CASE 3.--One year after a myocardial infarction and subsequent coronary angioplasty, a 47-year-old man was referred to the Atherosclerosis Detection and Prevention Clinic for evaluation. His medications included dipyridamole, diltiazem hydrochloride, and low-dose aspirin. Results of thyroid and liver function tests were normal. Lipoprotein analysis revealed mild elevations in levels of low-density lipoprotein cholesterol, intermediate-density lipoprotein cholesterol, and very-low-density lipoprotein cholesterol, with moderately reduced levels of high-density lipoprotein cholesterol. In light of the patient's premature coronary heart disease and syslipidemia, crystalline niacin was prescribed. He was instructed to begin with 250 mg/d and to increase the daily dose by 250 mg every week, up to a dose of 2000 mg/d. During the first 2 weeks he experienced pronounced flushing, and on his pharmacist's advice the patient switched to SR niacin (Slo-Niacin caplets, Upsher-Smith Laboratory Inc. Minneapolis, Minn), which he took according to the previously prescribed schedule.

    On reevaluation 2 months later, just after increasing the daily niacin dose to 500 mg four times daily, the patient's liver function tests revealed the following levels: alanine aminotransferase, 160 U/L; aspartate aminotransferase, 155 U/L; alkaline phosphatase, 85 U/L; and total bilirubin, 9 micromol/L. Treatment with SR niacin was promptly discontinued, and treatment with crystalline niacin was reinstated at a daily dose of 1000 mg, which was gradually increased to 4000 mg/d with careful monitoring of liver function. After 6 months, the patient was tolerating crystalline niacin well and had normal results of liver function tests.



    Comment
    The National Cholesterol Education Program guidelines and recent studies suggesting regression of atherosclerotic plaques after aggressive hypolipidemic therapy have aroused an increased interest in the diagnosis and treatment of hyperlipidemia. Because niacin is inexpensive, and particularly because it is most effective in raising high-density lipoprotein cholesterol levels, its use can be expected to increase.

    The mechanism of niacin-induced hepatitis is unknown. It has been speculated that SR niacin affects the liver enzyme systems for longer periods than does crystalline niacin, resulting in shorter recovery periods and thus more severe toxic effects. Another possibility is that different gastrointestinal tract absorption sites influence the metabolism and action of the preparations.

    In our patients, the diagnosis of niacin-induced hepatitis was made on clinical grounds, as no evidence of viral hepatitis or exposure to other hepatotoxic agents was noted. Furthermore, all clinical and biochemical abnormalities resolved on withdrawal of the drug. Patient 2 exhibited serum aminotransferase abnormalities on three occasions during SR niacin treatment that resolved each time the drug was withdrawn. Patient 1, on the other hand, experienced a syncopal episode that could have resulted in ischemic hepatitis. However, most cases of ischemic hepatitis are characterized by a rapid rise and fall of serum aminotransferase levels, marked elevations in the serum level of lactate dehydrogenase, mild hyperbilirubinemia, and normal prothrombin time and serum albumin level. In contrast, our patient exhibited a rather gradual decline in serum aminotransferase levels, markedly abnormal prothrombin time and serum albumin level, only mildly elevated serum lactate dehydrogenase level, and no hyperbilirubinemia.

    The time course for the development of niacin-induced hepatitis is unpredictable; although hepatitis may develop many months after beginning niacin therapy, much shorter intervals have also been documented with SR preparations, as illustrated by our patients 1 and 3.

    Our data support previous observations that SR niacin preparations may be more hepatotoxic in certain patients. Concern must be expressed over the accessibility of such preparations without a prescription and the potential for individuals to ingest large doses in an unmonitored manner.
     

  2. Anonymous

    Anonymous Guest

    Re: Slo-Niacin vs Niaspan - my experience

    Seems to me this board is dominated by the Niaspan sales force, but I have actual experience with both Niaspan and Slo-Niacin. I am 68, male, healthy but with a history of high cholesterol. I started Zocor in about 1992 and have been on Lipitor since about 1997. About 2001, my doctor added Niaspan to my regime with the idea of boosting HDL. It worked. Because of my relatively high co-pay for the Niaspan, I asked him if I could try Slo-Niacin available at Costco for about $10 a month. He was dubious, but agreed I could try it if I did a follow up liver and lipid study in 3 months. So, in early 2002 I switched from 1000 MG Niaspan to 2 500 MG Slo-Niacin taken at the same time before bed. I take my Lipitor in the morning. I have been on the regime ever since. Regular monitoring of liver -- no problem. Total cholesterol level is below 170 with excellent ratio. Never a problem at all.
     
  3. Anonymous

    Anonymous Guest

    Re: Slo-Niacin vs Niaspan - my experience

    See the SLIM study/Upsher-Smith slo-Niacin. HORRIBLE HDL response. ALL of the SR niacins have POOR HDL response vs ER [Niaspan] & IR/plain. This is just fact. The less the formulation flushes,.. the longer the release time,.. the longer the serum level stays up & the worse the HDL response is. It is NOT about your TC/total cholesterol,.. that is NOT what niacin is used for.
     
  4. Anonymous

    Anonymous Guest

    So I am about to reach 65 and about to go on Medicare.

    I am a type II diabetic with cholesterol and triglyceride issues, so I take several meds, and see an endocrinologist and have blood tests every 3-4 months.

    In researching the Medicare prescription options I have discovered that, due to the so-called "donut hole" in the Medicare Part D prescription drug coverage, the difference between the cost of insurance plus drugs with and without Niaspan is nearly $3000 per year.

    So I talked to my Endo about Slo-Niacin. He had no problem with my trying it to see if it works as well for me. I take 3 750mg tabs per day. He suggested that we start slowly, substituting ine tab of Slo-Niacin for one of Niaspan, and checking me after a few months to see the effect. We would then do 2, etc.

    So we will see how it works .. perhaps in 6 months I will be totally off this ridiculously expensive drug. Wish me luck.
     
  5. Anonymous

    Anonymous Guest

    Again,.. [ad infinitum, ad nauseum],.. there are 4 distinctly different formulations of niacin,.. with 4 distinctly profiles for: safety, efficacy, tolerability & tolerability.
    IR, ER, SR & NO FLUSH.

    "NO FLUSH"
    "NO FLUSH" results in NO NIACIN detected in the blood, therefore it is USELESS, but safe & tolerable. Not of any clinical use for CAD, lipids.

    S.R./Slow Release niacins
    SR aka LOW Flush aka SR aka Time-release aka SLO-Niacin.
    Good effects on LDL, Trigs & Lp(a)
    More GI vs IR or ER, LESS flushing than ER [maybe], but much less flushing than IR. POOR HDL effects, sometimes HDL drops [see SLIM study compare to any ER or IR study. So you want great HDL increases,..? Use IR or ER. Way too many types/brands, with NO standardization of formulation re: release characteristics. So,.. caveat emptor !! It is YOUR liver. Cheaper than ER, more expesive than IR. And, YES, there has been liver issues documented with Upsher-Smith Slo-Niacin.

    IR Niacin\IR = Immediate Release
    Oldest form, the "gold standard", also the cheapest: $10-15 / month, some times even <$10 / month.
    Safe, effective, and,.... annoying. Once you are on a stable dose for 4 weeks,.. it is actually easy. getting from day 1 to that point is the trick: And, there are many great tricks/tips to get there. Need to take 3 divided doses / day. At 3 months a 2-dose a day regimen can work as well. VERY low HDL, take once EVERY OTHER DAY. that is also published [Castelli, Wm. et al Am J Cardilogy "Interview with the Editor" 2005] aka known as the "1st pass effect" which explains why slo-release / SR niacins have shitty HDL benefits.

    ER Niacin aka Niaspan [also, Advicor, Simcor] NO other ER niacin exists.
    Same efficacy, safety as IR, but it is an on=patent Rx medicine. Expensive, un;ess you have insurance. Then it is a co-pay. No direct substitute,.. but gram for gram same as IR. The bonus is less flushing vs. IR, less GI vs. SR,... and ONCE DAILY at bedtime.


    The Chaun, now I be gone,...
     
  6. Anonymous

    Anonymous Guest

    Extra tip:
    Get CarlsonLabs dot com [CarlsonLabs.com] IR Niacin. $10 / month for a 1 gm [1000 mg] dose per day as 2 500 mg tabs,.. 1 early in day one late in day. For easier transition through the "break-in" period [to avoid a bad flush],.. buy 2-3 bottles of the 50 mg IR niacin, and titrate from 50 mg 3X daily up to a point where you can switch to the 50`s. After titrating for 8-12 weeks, most patients never have another sever flush again. Gotta take every day though.
     
  7. Anonymous

    Anonymous Guest

    Man sues pharmacist for negligence over supplement Slo-Niacin

    Man sues pharmacist for negligence over supplement
    Sharon Dunn, (Bio) sdunn@greeleytrib.com
    July 16, 2005


    A Greeley man who had high cholesterol is suing a local pharmacist and Safeway Inc. for urging him to buy the wrong supplement, which quickly put him in the hospital. Joseph Gerber of Greeley filed the negligence lawsuit in late June in Weld District Court against pharmacist Paul Rotunno and his employer, Safeway Inc. Rotunno works at the Safeway store at 3526 10th St. Gerber is seeking compensatory and punitive damages, including almost $13,000 for his hospital bills and lost wages for the potentially deadly mistake.
    In the complaint, Gerber reports he was diagnosed with high cholesterol in early 2004.
    His doctor recommended a form of niacin called inositol hexanicotinate, which is known as the safest of three forms. Niacin, part of the vitamin B complex, is a natural remedy and an alternative to prescription cholesterol medicine. It can, however, cause liver damage if taken for long periods of time or in large doses, according to WholehealthMD.com , an alternative medicine Web site. "Inositol hexaniacinate is the safest form available, causing no skin flushing and posing considerably less risk of liver damage," the Web site states. Gerber went to Safeway to get the vitamin on March 6, 2004. "After finding what he thought was the correct bottle of niacin, he took it to the pharmacy and spoke with Rotunno to obtain professional advice about whether he had selected the correct medication," the complaint states. "Rotunno told (him) he had selected the wrong kind of niacin." The complaint states that Rotunno selected a different brand of niacin, a timed-release form, and stated "this is what you need," without giving any further instructions. Gerber took the niacin as his doctor prescribed, two a day. Two weeks later, the complaint said Gerber awoke with shortness of breath, tightness in his chest and nausea. His wife rushed him to North Colorado Medical Center, where doctors performed a variety of tests. The tests revealed he had swelling of the liver and pancreas.
    Gerber eventually recovered. The lawsuit also claims Safeway failed to train Rotunno adequately. Attorneys on both sides, as well as Rotunno, did not return calls for comment.
     
  8. Anonymous

    Anonymous Guest

    CostCo offers 150 tabs of Slo-Niacin 500mg for $13.89. Niaspan ER 500mg runs $75.45 for 30 tabs at CostCo. That makes Niaspan more than 25 times as expensive as Slo-Niacin.
     
  9. Anonymous

    Anonymous Guest

    Re: Man sues pharmacist for negligence over supplement Slo-Niacin

    Saturday, September 16, 2006
    Pharmacist cleared in negligence case

    A Greeley jury this week cleared a local pharmacist in a case where he was accused of urging a man to buy a supplement that put him in the hospital two years ago.

    While Safeway pharmacist Paul Rotunno said he was relieved after the four-day trial and two-year ordeal, the case also may serve as an eye-opener for residents relying on over-the-the counter health supplements.

    "We have to have respect for the chemicals we ingest, and we have to take responsibility for them and make sure everyone is on the same page before we proceed so there are no bad consequences," said Rotunno, who still works at the Safeway pharmacy at 2526 10th St.

    Gerber could not be reached for comment.

    The case surfaced in July 2005, when Greeley resident Joseph Gerber claimed that Rotunno had urged him to take the wrong supplement for a cholesterol problem, which put him in the hospital for two days. He incurred $13,000 in medical bills.

    According to Gerber's complaint, he was diagnosed with high cholesterol in early 2004. His doctor recommended a form of niacin. Niacin, part of the vitamin B complex, is a natural remedy and an alternative to prescription cholesterol medicine. It can, however, cause liver damage if taken for long periods of time or in large doses.

    The complaint states Rotunno suggested a time-release form of niacin and didn't give any instructions. Gerber's complaint said he took the supplement twice a day, and two weeks later, awoke with shortness of breath and tightness in his chest. Hospital tests revealed swelling of the liver and pancreas, and he eventually recovered.

    Rotunno said Gerber failed to communicate with him about all the medications he would be taking for the condition and also Gerber and his doctor probably didn't communicate well. He said Gerber's doctor's directions were contrary to the directions of the niacin supplement.

    "The typical thing we recommend in pharmacy with this drug is start low and go slow, and that's not what happened here," Rotunno said. "In the prescription arena, these things in incorrect doses can cause trauma. If there's a question and the doctor has written something for you to obtain, you've got to give it to the pharmacists."

    Gerber's complaint also claimed Safeway was negligent, but a jury also cleared the company of that claim.
     
  10. Anonymous

    Anonymous Guest


    This is an excellent, informative post.

    One question: Of the four different types you metioned, is Niaspan the only one that you need a prescription for?

    Does the drug Niacor fall into any of these categories? I think you need a prescription if you want to take Niacor.

    I had horrible digestive side effects taking Niaspan ER 500 mg every other day. I'm wondering if Niacor would wreak less havoc on my system.
     
  11. Anonymous

    Anonymous Guest

    Niacor is prescription IR/Immediate Release niacin.

    No insurance,..?
    Just want to save money,..?

    Go to CarlsonLabs.com order a $3 bottle [100 pills] of the 50 mg PLAIN,.. IR niacin,.. AND,.. a botlle of same,.. only as 500 mg. Take one 50 mg w each meal,.. bump up as you feel brave,..
    Once you are taking 3-4 w each meal [= 150 mg-200 mg each meal = 450mg to 600 mg total a day],.. switch over to 1 500 mg / twice daily [BID]. $10/month
    You will need to have a bit more "hard bark" on ya to get past the 1st 30-days,.. but,.. $10/month vs. Niaspan $150/month cash ??

    The Chaun
     
  12. Anonymous

    Anonymous Guest

    1st, before quitting ER,.. make sure you have a high-fiber snack on-board,.. 3 TBS apllesauce,...

    The Chaun

    PS Happy Trails !
     
  13. Anonymous

    Anonymous Guest

    It appears that money may play a part in the competitive marketing rhetoric for both these products. That's a shame. At all times and in all things, everything medical should have one goal, and one goal only: the best possible outcome for the patient. Profit margins for competing pharmaceutical companies should never enter the equation. When they do, fines should be imposed.

    Any time an industry involved with health care shows a sign that their marketing ploys are based on profit motive rather than patient wellness, the FDA should fine them. After so many fines for such offenses, the company in question should be shut down.

    That said, we should never hear that a prescription form of Niacin is better than the OTC form based on the writings of people on the payroll of the company that makes the prescription product. That would constitute a conflict of interest. It's appalling that such a thing even might be occurring in the debate about these products.

    A long time ago there used to be a concept known as integrity ...
     
  14. Anonymous

    Anonymous Guest

    Former USL employee here, now moved outside of the industry.

    If you are a pt looking for info on Cafepharma, please look elsewhere. It's obviously filled with industry reps, and both KOS/Abbott and USL are absolute sleaze. They will both only discuss the advantages of their product and pretend the disadvantages are non-existant.

    If you have questions, find a doctor that does not see drug reps.
     
  15. Anonymous

    Anonymous Guest

    I agree. Physicians should make individual treatment decisions for each patient, based on their interpretation of the medical evidence, and not based on the marketing messages.

    Both of these niacin products have proven to work for thousands of patients. Both products were developed and are manufactured by reputable pharmaceutical companies. These pharmaceutical businesses do generate profits, but that does not mean they are "sleaze" operations. Both companies have developed additional innovative products that have benefited millions of patients.

    The posts on this board should not be used by patients for making treatment decisions, and it should not be used to judge the overall quality of a company. The perspective here is often very unbalanced. The comments on this site are useful if you want to read about some of the views, experiences and opinions of current and former sales representatives. Utilize additional professional reputable resources to find a balanced perspective on these businesses and these products.
     
  16. Anonymous

    Anonymous Guest

    I am so ashamed that I wasted my vote on George Warmonger Bush. What could I have been thinking? Why did I choose to ignore sound personal thinking when I stepped into that voting booth? Now my LDL / HDL ratio is totally off the scale as a result of the damage done to this nation by the GOP & Bush and his daddie's Cheney & Rove!
     
  17. Anonymous

    Anonymous Guest

    I'v asked three bona fide pharmacist today the difference between Niaspan and Slo-Niacin.

    Two of them literally said "Oh about $120 bucks..." Those tw maintained there was very very little difference between one over the other. They both said that way the drug is metabolized is slighty different but nothing neither would endanger my liver any more than the other. And they both suggesed I save my money and use Niaspan if my doctor is good with it.

    The third of the three pharmacist contended they were equally effective niacin products but that she had "heard" (not read) that Slo-niacin had a higher risk of liver damage. When I asked here where she "heard" this she promptly replied "An Abbott Labs sales man!" LOL LOL LOL
     
  18. Anonymous

    Anonymous Guest

    REF: Nialipin (B-3 T/R Niacin) (N) by Ecological Formulas/Cardiovascular Research 1-800-888-4585

    Has anyone heard of Nialipin? I found the following.

    This slow-release niacin product was created by the same individual who created Niaspan and is essentially equivalent, for a fraction of the cost.

    Nialipin rarely causes a "flush reaction" due
    to its unique composition and mechanism of ac-
    tion and is well tolerated by sensitive indi-
    viduals. The hard gelatin capsules may be
    pulled apart and the beadlets may be removed.
    INGREDIENTS:
    EACH CAPSULE CONTAINS:
    Niacin (Vitamin B-3)....................400 mg
    (time-release beadlets)
     
  19. Anonymous

    Anonymous Guest

    My heart doctor said he takes slo niacin and that Niaspan is not worth the extra money. The FDA warned the manufacturer about the misleading labels, lack of proper warning on the label, and also about the false claims made about their studies. ASK your heart doctor about the change to over the counter, make sure you get to his appointed tests and do not stop taking what you are taking until you talk to him. The biggest difference, is the difference between slo release and regular niacin and how they work on you.
     
  20. Anonymous

    Anonymous Guest

    ANY naicin formulation claiming less/lower flush is some "longer" release vs. plain/crystalline/IR-Immediate Release niacin. This can be a problem once the serum levels persist . 8 hours:
    - Less HDL efficacy, sometimes actually reducing/lowering HDL [please do your homework, read the literature],.. ER/Niaspan is below that threshold, UpsherSmith/SR is NOT. See the studies. At the same dose,.. less efficacy on HDL

    - hepatotoxicity: Although rare,.. almost always occurs with SR formulations,.. near zero with IR naicin & ER/Niaspan

    If you merely want to lower ApoB particles / LDL, VLDL, IDL, Lp(a),.. yes, SR is more potent for that,.. longer serum time. BUT,.. if you are tteating low HDL &/or concerned with liver issues,.. IR or Niaspan iare the better choice.


    That's science,.. not a rep yakking,..

    Chaun