Slo-Niacin vs Niaspan

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

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  1. Edterry

    Edterry Guest

    I've taken immediate-release niacin for over 7 years at a dose of 3.5 to 5 grams a day. When I divide the daily dose into two doses, I never experience elevated liver enzymes. However, when I split the daily into three doses, I always get slightly elevated liver enzymes.

    I've also never experienced hyperglycemia with niacin.

    Twice a day dosing also increases my HDL more than three times a day dosing. It's also reduced by LDL particle number from 2,100 to under a thousand and increased my LDL particle size from Pattern B to A.

    Back when I was a pharmacist (1980's), drug sales reps were actually pharmacists. That is no longer true today. They're mainly marketing reps who are fed their company's mis-information.

    Doctor's tend to prescribe the sustained- or timed-release form of niacin because of better patient compliance. Many patients lack the patience to develop a tolerance to the flushing effect of immediate-release niacin.
     

  2. Anonymous

    Anonymous Guest


    William Peter Castelli MD A Conversation with the Editor Wm Clifford Roberts The American Journal of Cardiology Vol 94 Sept 1st 2004‏


    Read Dr. Castelli [Framingham Study] interview w the editor, Am J Cardiol - Sept. 1st 2004
    "1st pass effect with niacin" HDL increases more robustly with longer trough times. He skipped every other day & his tot-HDL went from 70's to 90's. The more hours/day you have serum levels of nicotinic acid,.. the greater the incidence of elevtaed LFT's on labs. That is why SR has the greatest problem there,.. and IR [what your taking] has the least,.. except when you take 3-4 doses/day.

    The Chaun
     
  3. T Polacek

    T Polacek Guest

    Re: Slo-Niacin vs Niaspan - my experience

    What a bunch of misleading information! Do you know you are disingenuous or just regurgitating corporate crap? Why hasn't anyone pointed out the obvious?

    First, according to Poon et al, Niaspan has the slowest release of 7 non-prescription extended release preparations tested. Thats right, the authors labeled them ER preparations!
    American Journal of Health-System Pharmacists Vol 63, Nov1,2006
    Anyone trying to differentiate SR and ER niacin is ignorant or worse.

    Second, the reason therefore, that SR and ER preparations have different effect on HDL is DOSING REGIMEN, not dissolution time. As was referred to in the Wm Castelli interview, longer trough times enable greater HDL response. This also reduces the liklihood of liver enzyme elevation, due to the "washout" period for the liver. Twice daily dosing of an SR/ER preparation mazimizes patient tolerance, and LDL response, but has a narrower therapeutic range, limiting the dose to 1500mg -2000mg daily for most individuals. Same is true for Ed Terry's post #41.

    The cases of hepatotoxicity leading to fulminate liver failure in the literature are extremely rare as compared to stain rhabdos. they all occurred from patients either switching from IR to SR at doses of 4-6gms daily, or patients with preexisting liver disease. Other reports of hepatotoxicity in the literature are from overdosing as well - my favorite is the James McKenney study with forced titration to 3gms daily of an SR preparation when they KNEW doses over 2gms daily led to enzyme elevation. JAMA March 2, 1994. (To this day, no source of funding has been disclosed for this study. Statin company anyone?).

    Incidentally, these patients rapidly return to normal and can still use niacin with no hepatocellular injury. The best authority on this is the late William Parsons JR, THE pioneering investigator of niacin use for cholesterol in the 50s, and had 5 decades of experience with niacin before retiring. Read his book "Cholesterol Control Without Diet - The Niacin Solution.

    The one thing most physicians agree on is this: If you are going to use a non-prescription extended release niacin, it needs to be a preparation that has "objectively shown to be safe and effective in controlled clinical trials", (CD Meyers et al. Annals of Internal medicine, Vol 139,Dec 16 2003.) and "over-the-counter compounds that should be recommended are Slo-Niacin and Enduracin. (MK Ito et al, Pharmacotherapy Vol 26 Number 7, 2006)

    regardless of the preparation, niacin therapy has to be physician monitored. Rarely, some patients are very poor metabolizers of niacin, and careful titration (downward) will find a dose as low as 500mg daily that both keeps LFTs normal AND provides a tremendous lipid response.
     
  4. crunchy37

    crunchy37 Guest

    I have been on Niaspan for several years due to low HDL. When I went on a couple of other high cost drugs, Bennecar, Lipitor, and insulin, the cost became a major factor. Two friends of mine suggested Slo-Niacin to me, as had been suggested to them by their doctors as an alternative to Niaspan. I told my Dr. and he said "give it a try and see if it works for you". I did. Have seen very little difference in HDL with Slo-Niacin vs Niaspan. So, I stay with Slo-Niacin.

    Several years ago someone came up with a generic version of Niaspan that received FDA approval. Kos sued them at first for patent violations but finally paid them off to NOT bring their generic to market until 2012 and gave them rights to distribute Niaspan in the meantime. Don't know the current status since Kos was bought by Abbot. Notices Abbot going the high price route of intense advertising on TV -- adding even more to the cost..

    Another reason typical of why our drugs are SO high.
     
  5. chevyo

    chevyo Guest

    Personally...I've taken Niaspan for over 10 years with excellent results on both Tryglycerides and Cholesterol AND no bad effects whatsoever! Now, is a few bucks saved more important than being safe? We have NO idea where these vitamin OTC Slo-Niacin are made, whether they are correct active ingredients or whatever. I'm not willing to take a chance. Two links, one to a Research Study by the Department of Veterans Affairs who found Slo-Niacin too much of a safety risk in comparison to Niaspan: (scroll down to CONCLUSIONS) http://www.pbm.va.gov/reviews/niacinreview.pdf and the American Heart Asc says PLAINLY do NOT substitute the unregulated OTC for the FDA approved and regulated real product: (scroll to Niacin at bottom) http://www.americanheart.org/presenter.jhtml?identifier=3044771 I think a Liver transplant or Liver failure is just not worth the risk to me.
     
  6. Anonymous

    Anonymous Guest

    Well whatever the answer, I know that when my wife was hospitalized her Niaspan 500 mg was switched to niacin until released (oops, meant discharged). I guess we can alternate?
     
  7. Anonymous

    Anonymous Guest

    I take 3000mg of immediate release niacin, 3 1000mg caps per day and I started out with 250mg and I rarely if ever get flushing anymore, and my total chol when from 228 to 130.

    The key with immediate release is to take it after a meal, and you won't get flushing, if you take it on a empty stomach you are asking for trouble.

    The only niacin that really works is the immediate release, any slow or timed release does not have the same effect
     
  8. Anonymous

    Anonymous Guest

    What is the real reason for elevated ldl? Certainly it is not a niacin deficiency, though this is a better answer than statin drugs. Elevated ldl, a fraction of Syndrome X comes from straying from our ancestral diet of vegetation, vegetation fed animal meat, nuts, insects, lots of exercises and sunshine (to make adequate levels of vitamin D). I suggest reading Dr. Loren Cordain, Ph.D. @ www.thepaleodiet.com. Our genes adapted to a hunter-gatherer lifestyle for 150,000 generations, our diet now consists of foods that have been in our diet for only 4 (concentrated seed oils, high sugar, trans fats) to 300 (grains, grain-fed animal meat, beans, nightshades) generations. Give it a month and not only will your ldl decrease, but your aches and pains will gradually diminish as well.

    High TGL and fine particle ldl is linked to diets high in simple carbohydrates, i.e. starches and sugars found in modern diet.

    Incidentally, look for inositol-hexanicotinate, slowly metabolized with niacin reaching peak levels at 10 hours, non flushing and effective.

    Look for Niacin-Hex from Vitamer Labs, made under pharmaceutical conditions and available as private label in many health food stores.
     
  9. Anonymous

    Anonymous Guest

    Wow! This thread is almost three years old and still active. Maybe I can help someone by sharing my journey through the niacin jungle since late 2005.

    I had a heart attack in 2005, but was very lucky and only ended up with two stents. Two months later my cardiologist did a complete workup and pronounced me well with no discernable damage to my heart. Blood test showed HDL about 30 and LDL about 110. I found out about niacin and started self-treatment with 1200 mg/day of an OTC no-flush product. HDL cholesterol was essentially unchanged 90 days later. My opinion is that no-flush equals no-niacin and is a complete waste of time and money. I immediately switched to OTC IR niacin from GNC, building up over about three months to 1500mg/day which I took all at once at night. Next blood test showed HDL rose from 30 to 40 and LDL still about 110. My doc added 10mg/day simvastatin and switched me to 1500mg/day of Niacor. He told me to expect good things with that combo. Three months later blood test showed HDL 50 and LDL 70! Definitely a synergistic effect. I added more animal protein (and cholesterol) to my diet to gain some weight. My last blood test showed HDL 50 and LDL 69.

    I also should mention that I have been popping mega-vitamins for over 10 years. For the last few years I have added 3600mg/day of fish oil. When I started the simvastatin, on my own I began taking 30mg/day of CoQ-10. And, every liver test has been negative.

    Curiously, at my last visit my doc suggested I switch to Niaspan and told me about how it is better than slo-niacin products regarding liver toxicity. Sounds like he must have had a visit from the Niaspan rep! I told him I was happy with the Niacor and saw no reason to switch.

    Now, about cost. I am on Medicare and have Humana supplemental. My opinion is that a good OTC IR niacin is as good as Niacor and costs about $15/month. Because of weird Medicare/Humana rules it turns out that I can get Niacor prescription for $0 per month through the Humana online pharmacy. So, I chose free. I have no intention to do so, but if I switched to Niaspan it would cost about $21/month.

    Lastly, about the flushing. No-flush niacin does not cause flushing, but it doesn't raise HDL cholesterol either. I have no experience with Niaspan and don't intend to. My opinion is that it is more risky than Niacor or any good IR niacin, so flushing with it is not important to me. I had moderate to strong flushing with Niacor and IR niacin every night for several months as I increased dosage. Once I discovered how well it was working I learned to like the flush. I just thought of it as proof that those little molecules were in there building good cholesterol and scrubbing away at all that bad cholesterol. After many months at 1500mg/day I get little or no flushing.

    For what it's worth, I take the niacin at night mostly because of business. I used to take it in the morning. I was on an important sales call and the customer was being difficult and negative. At the height of our discussion a major niacin flush came on me that lit my face up like a stop light. I had to run out of the room to find a drinking fountain, figuring that the customer was thinking that I was mad or having a heart attack or something. A bit later I returned to the room and began to explain about high dose niacin, flushing and so forth. He stopped me to reveal that he knew all about that because he was taking 5000mg/day. I didn't ask him why such a high dose, but I decided right then that in the future I would restrict my niacin flushes to night time with my wife.
     
  10. JimWOmahaNE

    JimWOmahaNE Guest

    My Dad got a letter from the VA a couple of weeks ago, telling him his Niaspan prescription will now be filled with SLO-Niacin! I assume this will be VA wide.
     
  11. Anonymous

    Anonymous Guest

    Is this true about the VA ? Just curious as a veteran who currently takes slo niacin anyways
     
  12. Anonymous

    Anonymous Guest

    You may want to carry a foil-pack of Alka-Seltzer,.. it will reverse the flush in 15 minutes.
     
  13. Anonymous

    Anonymous Guest

    you are essentially taking a placebo,.. no flush = no benefit. Watch your blood labs do ZERO. Find this journal article,.. " No Flush No Benefit Norris RB Prevent Cardiol Jan 6th 2006 "
     
  14. Anonymous

    Anonymous Guest

    Re: Slo-Niacin vs Niaspan - my experience

    And on Slo-Niacin your HDL went down. Brilliant,..
     
  15. Anonymous

    Anonymous Guest

    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
     
  16. chevyo

    chevyo Guest

    Yes...even though Niaspan is still on the VA Formulary. I gave in and tried the Slo-Niacin for a month and was naseous all month...could not get over 1000mg daily without extreme flushing, also had some upset stomach, finally just bought my own Niaspan. I plan on appealing to Secretary of Veterans Affairs. Ischemic Heart Disese was found to be a Presumptive Disease of exposure to Agent Orange and chemicals in Nam and I was HEAVILY exposed. Niaspan and Tricor are treatments that are affective in slowing buildup of plaque and hence Ischemic Heart Disease. The ONLY reason the VA gave me for the switch was the same reason they switched and denied to continue to pay for medicines for other service-connected conditions..."it's cheaper". Kind of gives vets an idea where our government stands on treatment for combat war veterans!
     
  17. Anonymous

    Anonymous Guest

    I had been prescribed Niaspan 6 -7 years ago. After the first 90 tablets, I found out about about Slo-Niacin at Costco. I asked my MD if I could use that and he told me I could try it but in his experience, it probably wouldn't work for me. It didn't.My triglycerides went up. I joined the VA because Niaspan was in their formulary. I've been with the VA for 6 years now, and in March or April 2010, I was told that they were no longer dispensing Niaspan, but instead the Upsher-Smith, slo-niasin. I explained to them that it did not work on me and they insisted that I use it. After asking the PA for an immediate blood test for the triglycerides they showed a result of 160 mg/dl. After suffering thru the slo-niasin for about 5 weeks along with an upset stomach and continuous diahrea, I called and said I couldn't take the side effects any longer. I asked for another blood test for the triglycerides to see how the slo=niacin had effected me. The PA went along with my idea. In a period of 5 weeks they had gone from 160 which was only slightly high to 213 which was up 53 points and considerably out of the normal range. After having my request for the Niaspan rejected 3 times by the VA, I was finally able to show them that not only wasn't it working on me, but it was having a bad effect. My personal MD switched me back to the Niaspan at my own expense and I asked the VA to give me a new blood test ,and after 5 weeks on Niaspan, the triglycerides were down to 129.
    I had convinced them that IN MY BODY, the SLO-NIACIN was not working and that , in my case I needed the Niaspan. They reluctently have given me the Niaspan which does cost them more. I was willing to pay them more for it but there are no provisions to do that. THE MORAL OF THIS STORY IS THAT SOME PRODUCTS WORK BETTER ON SOME PEOPLE THAN OTHERS. THAT IS WHY YOU CAN BUY DOZENS OF DIFFERENT PRODUCTS FOR HEADACHES.ALL SIMILAR, BUT SOME WORK BETTER FOR SOME PEOPLE THAN OTHERS AND YOU NEED TO FIND OUT WHAT WORKS FOR YOU. So, for the people that say that Niaspan and slo-niasin are the same and why spend the additional money, I say that if the less expensive one works fine in your case, that's wonderful, but sometimes the other product can give you a better and a safer result. If you go back and read one of the previous articles that mentions a VA study to click on, that study shows that the VA found that Niaspan was the drug of choice about 5 years ago and not to use the slo-niasin due to some of the side effects. Unfortunately due to cost cutting, they have eliminated the drug and you can only get it if you are able to get an exception by showing it is doing harm to you. I have just joined a drug plan, Medicare, so that when the VA deceides they won't supply me with the Niaspan, I'll at least have a back up plan.
     
  18. Anonymous

    Anonymous Guest

    I've tried slo-niacin and niaspan and had flushing with them. I found this product called endur-acin from Endurance Products company. This has been the best of the 3 products for me. It has a wax matrix release which has caused almost no flushing and my labwork is the best in my life.

    I went on the companies website www.endur.com and they have a research page which shows all of the studies that were done with this product. The best part, it only costs around $7- 10 / month, depending on what bottle size is purchased. Good luck to all!
     
  19. Anonymous

    Anonymous Guest

    I understand that to detoxify the liver, an early morning drink of water laced with half a lemon (juice only) and drank will cleanse this organ. Do not use bottled only fresh from the lemon juice.
     
  20. Anonymous

    Anonymous Guest

    Thought I would add my 2 cents (I must confess that I am not a Pharma employee but rather a physician board-certified in clincal lipidology). Let me also disclaim that this offering is not an attemp to diagnose or treat, but strictly for informational purposes.

    To gain an understanding of niacin's therapeutic and adverse effects one must first understand its metabolism. The liver can metabolize niacin in two different ways, one path is a low affinity high capacity system producing compounds that may cause flushing through the release of prostaglandin D2 (the first path also gives us most of the therapeutic benefit). The second pathway is a high affinity low capacity system producing compounds that can cause hepatotoxicity.

    IR naicin floods the second system quickly and is therefore primarily metabolized through the first system causing a definite therapeutic effect but also significant flushing. True ER niacin (such as slo-niacin) is preferentially metabolized through the second system with a higher risk of hepatotoxicity. In a class of their own are Niaspan and Enduracin, which chemically are glycoprotein or wax matrix controlled-release IR niacin and tend to favor the first pathway (but are metabolized in much smaller dose increments over a 6-8 hour period lessening side effects).

    No-flush niacin (typically niacinamide or hexose inositol) does not seem to have an effect on lipid parameters.

    In my practice I tend to use a lot of Niaspan and Enduracin, some IR niacin (depending on the goal of therapy), and essentially no slo-niacin or No-flush niacin.

    Hopefully that helps.