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  #1  
Old 11-28-2007, 06:31 PM
Anonymous
 
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Default Slo-Niacin vs Niaspan

I currently on Niaspan though the doc said that if I wanted to save money slo-niacin was "the best of the worst". Does it really caus liver toxicity problems like some posters say(and a KOS rep friend). It seems to me that they both have the same Polygel release system
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  #2  
Old 11-28-2007, 10:15 PM
Anonymous
 
Posts: n/a
Default Re: Slo-Niacin vs Niaspan

niaspan and slo-niacin are both slow release niacin (b3). the release system is not the same - USL has a patented release technology. as for liver toxicity, any person taking any niacin product, rx or otc, needs to have regular lft's checked. there are "safer" niacin type prodcuts "no-flush" for example, but they don't have the positive effects on TG or HDL. If you're on niaspan, you're simply paying way too much for vitamin B3. switch to slo-niacin but maintain the same check ups you would with niaspan. and fyi -i don't work for USL, but i did study and sell this product years ago. it's worth switching, there is no beneift to paying sooo much more.
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  #3  
Old 11-28-2007, 11:15 PM
Anonymous
 
Posts: n/a
Default Re: Slo-Niacin vs Niaspan

There is a major difference between the safety of Niaspan and any form of dietary supplement slow niacin including the one offered from Upsher Smith. Don't make a decision based on what you read on this board. Do your own research and start with the FDA as well as organizations such as the American Heart Association that state "dietary supplement niacin must not be used ..." Slo-Niacin is a dietary supplement that would never pass the safety requirments of the FDA needed to become an approved prescription product.

Anyone that thinks there is no difference between Niaspan and Slo-Niacin is not up to date with their understanding of niacin.
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  #4  
Old 11-29-2007, 10:28 PM
Anonymous
 
Posts: n/a
Default Re: Slo-Niacin vs Niaspan

niaspan is only a prescription product because that was the route the manufacturer chose. there is no benefit to a rx version, it only adds cost to the patient. and as for quality - why has niaspan used a study to promote its product when slo-niacin was the product used. yes, i'm talking about HATS? don't take my word, or your trainers for that matter - ask an informed doc - niacin is pretty much niacin. should be taken carefully, and with proper monitoring. and niaspan isn't a breakthrough, superior product...just more costly. sorry, it's true. and i'm willing to bet my medical degree on it.
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  #5  
Old 11-30-2007, 08:07 AM
Anonymous
 
Posts: n/a
Default Re: Slo-Niacin vs Niaspan

Hey Mr. "I'll bet my medical degree on it"- as a former Kos rep that sold Niaspan, go back and read the HATS study. Patients were switched to IR niacin in the study from slo-niacin because it had minimal lipid effects. Say what you want about Niaspan, but it works and it is the safest alternative of any niacin product.
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  #6  
Old 12-01-2007, 09:02 PM
Anonymous
 
Posts: n/a
Default Re: Slo-Niacin vs Niaspan

I can see why the good doctor is so willing to "bet his medical degree" as it appears his degree may be flawed as he seems to have missed the section on understanding the differences between the various forms of nicotinic acid. Here are a couple quotes from the NCEP ATP III Full Report available on the NIH website:

"The sustained-release preparations usually increase HDL cholesterol levels by only 10-15% with the exception of Niaspan which retains the HDL -raising potential of the crystalline form."

"The risk of hepatotoxicity appears to be greater with the sustained-release preparations, although not with Niaspan"

"Niaspan is an extended-release preparation; however, its more rapid-release than sustained-release preparation appears to reduce the risk of hepatotoxicity. Niaspan also is associated with less flushing than with crystalline nicotinic acid."


If you are looking to save money on niacin therapy - use an immediate release form. It is safe and it works. The downside is that you need to take it 3 or 4 times a day and the flushing side effects are terrible even if you follow a complicated 45 day dose titration schedule. But ... if you can tolerate it you might be able to save money if you pay cash for your meds. If you have good Rx insurance coverage use Niaspan without a doubt. If you pay cash, try IMMEDIATE RELEASE with Niaspan as a second option. If you need meaningful HDL elevations and you value your liver do not use any form of dietary supplement slow release niacin.
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  #7  
Old 01-24-2008, 10:01 PM
Anonymous
 
Posts: n/a
Smile Re: Slo-Niacin vs Niaspan

I used all three and the I.R. 500 mg 3x = am noon pm had the greatest in in hdl....don't need to read study's ...I practice on my self....no insurance and pay cash for everything.
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  #8  
Old 10-24-2008, 07:33 PM
Anonymous
 
Posts: n/a
Smile Re: Slo-Niacin vs Niaspan

I used to take 1000 mg of Niaspan which btw still produces some flushing. Now I take a nonflush vitamin distributor version. The improvements to my HDL remained in effect. I also take some low dose statin drug.
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  #9  
Old 11-05-2008, 03:55 PM
Anonymous
 
Posts: n/a
Default Re: Slo-Niacin vs Niaspan

Typical dumbass KOS rep. You need to go back and read the HATS trial! Patients were only switched to IR niacin (NIACOR - USL product) if a specific patient didn't reach a certain threshhold. It was a small % of patients. Also, dumbass KOS rep, Slo-Niacin was the first extended-release niacin on the market and its release formula was virtually copied by KOS to create Niaspan. You pussies then went around claiming to be the niacin used in the HATS trial. I know because I had a lot of pissed off cardiologists when I showed them the Slo-Niacin name of the first page of the study. Kudos to KOS corporate for making it RX. But don't tell people that Niaspan is superior to Slo-Niacin. Liver issues only occur when physicians fail to warn patients about the dangers of taking more than 2000mg per day. If a patient took more than 2000mg of Niaspan, the same liver toxicities would take place. If you want to make claims that Niaspan is "safer" and that Slo-Niacin kills people, then put it in writing and have KOS endorse that statement. I'll be happy to bring it up with the FDA...stupid fuck!
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  #10  
Old 11-09-2008, 08:38 PM
Anonymous
 
Posts: n/a
Rolleyes Re: Slo-Niacin vs Niaspan

Get your facts straight. KOS has not been around for over 2 years. Abbott now owns and promotes niaspan.

Slo-niasin is just one more example of USL's inability to make anything out of this poor excuse of a pharma company.

KOS and their dum ass rep's laughed all the way to the bank when Abbott bought them out.
You have no clue do you.
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  #11  
Old 02-09-2009, 07:40 PM
Anonymous
 
Posts: n/a
Nervous Re: Slo-Niacin vs Niaspan

If you want the closest to the "truth" here it is. People try to make things black and white when it is not. First of all Slo-Niacin is a controlled or timed release OTC version of niacin, Niaspan is an extended release Rx version of niacin (there is a difference b/t controlled and extended release but I will spare you the details). The active ingredient is the same, that is obvious. The fact that Slo-Niacin is OTC shows that the product has to be proven SAFE and chemically pure to the product labeling, but it not as closely monitored as Rx products (which have to be proven effective). However, that does NOT mean Slo-Niacin will not be effective. Slo-Niacin DOES have a higher risk/potential for hepatoxicity (liver toxicity) this is partly due to some people going over the recommended max. amount of 2,000 mg/day, partly because they may not get normal liver function tests (LFTs) as they should for this drug and yes, partly because of the drug delivery system of Slo-Niacin (controlled release) has been associated with hepatoxicity (I know people will want to argue this last part). The fact is the controlled release is actually a slower/constant (zero-order) release than the Niaspan which you may think is a good thing, but in fact is bad because it keeps "artificially" elevated levels of niacin (meaning from the pill) in the body for a much longer time (it is better to have a shorter spike of niacin than a long, slow gently descending curve of niacin blood levels for liver safety). It is sort of "scary", if you will, to have this as an OTC product that could potentially have some very bad side effects without proper monitoring (and that is excluding the flushing that can occur, which can be helped by taking aspirin beforehand). If you go OTC, Niacor or immediate-release niacin is actually safer taking 50-100 mg twice daily to three time daily and increasing to slowly to 1,500 mg/day to 3,000 mg/day over several weeks, however, the relative difference in safety is not a HUGE amount, but as a pharmacist I do not recommend Slo-Niacin. Any OTC product it is also important to buy a product labeled with a USP or NSF symbol showing that their manufacturing process is actually monitored by someone. You would be amazed what has been found in some OTC drugs, dont always assume all products out there are equal... I know some will want to argue with this, but that is all the truth. Bottom line, Niaspan IS safer, however, I would not say by a huge margin, and I would talk to your doctor regarding safety of this drug anyway, just because its "OTC" doesn't mean its 100% safe for you.

-From the doc, haha, although, I'll never bet my degree on anything, studies done constantly change the field of medicine and the best therapies for a given condition
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  #12  
Old 02-20-2009, 04:38 PM
Anonymous
 
Posts: n/a
Default Re: Slo-Niacin vs Niaspan

Pretty exciting exchange! At the end of the day, Doctors can make their decisions based on their own interpretation of the tradeoffs on safety, efficacy and cost. As an Rx product promoted by a major pharma company, Niaspan will continue to be dominant, and Slo-Niacin will get a small piece of the pie. On a relative basis, both are productive products for the respective companies. There's plenty of room for both products in the market and each offers benefits that can help different types of patients.
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  #13  
Old 03-21-2009, 08:31 AM
Anonymous
 
Posts: n/a
Default Re: Slo-Niacin vs Niaspan

Quote:
Originally Posted by Anonymous View Post
If you want the closest to the "truth" here it is. People try to make things black and white when it is not. First of all Slo-Niacin is a controlled or timed release OTC version of niacin, Niaspan is an extended release Rx version of niacin (there is a difference b/t controlled and extended release but I will spare you the details). The active ingredient is the same, that is obvious. The fact that Slo-Niacin is OTC shows that the product has to be proven SAFE and chemically pure to the product labeling, but it not as closely monitored as Rx products (which have to be proven effective). However, that does NOT mean Slo-Niacin will not be effective. Slo-Niacin DOES have a higher risk/potential for hepatoxicity (liver toxicity) this is partly due to some people going over the recommended max. amount of 2,000 mg/day, partly because they may not get normal liver function tests (LFTs) as they should for this drug and yes, partly because of the drug delivery system of Slo-Niacin (controlled release) has been associated with hepatoxicity (I know people will want to argue this last part). The fact is the controlled release is actually a slower/constant (zero-order) release than the Niaspan which you may think is a good thing, but in fact is bad because it keeps "artificially" elevated levels of niacin (meaning from the pill) in the body for a much longer time (it is better to have a shorter spike of niacin than a long, slow gently descending curve of niacin blood levels for liver safety). It is sort of "scary", if you will, to have this as an OTC product that could potentially have some very bad side effects without proper monitoring (and that is excluding the flushing that can occur, which can be helped by taking aspirin beforehand). If you go OTC, Niacor or immediate-release niacin is actually safer taking 50-100 mg twice daily to three time daily and increasing to slowly to 1,500 mg/day to 3,000 mg/day over several weeks, however, the relative difference in safety is not a HUGE amount, but as a pharmacist I do not recommend Slo-Niacin. Any OTC product it is also important to buy a product labeled with a USP or NSF symbol showing that their manufacturing process is actually monitored by someone. You would be amazed what has been found in some OTC drugs, dont always assume all products out there are equal... I know some will want to argue with this, but that is all the truth. Bottom line, Niaspan IS safer, however, I would not say by a huge margin, and I would talk to your doctor regarding safety of this drug anyway, just because its "OTC" doesn't mean its 100% safe for you.

-From the doc, haha, although, I'll never bet my degree on anything, studies done constantly change the field of medicine and the best therapies for a given condition

I would not trust anything with the NSF marking on it. National Santitation Foundation's monitoring program is just a step above a Good Housekeeping Seal.
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  #14  
Old 07-01-2009, 03:53 PM
Anonymous
 
Posts: n/a
Banghead Re: Slo-Niacin vs Niaspan

I don't care if this reference is six years old or not.... http://www.fda.gov/ICECI/Enforcement.../ucm147897.htm

Kos were cited for bad quality control. Big deal, so now they're owned by Abbot. Bottom line is this:
1. ANYTHING that comes out of Florida has SCAM attached to it by default
2. The pharmaceutical industry are the biggest perpetrators of human misery in USA with their outrageous pricing to support shareholder returns and fat-cat corporate officers. It's disgusting, but there it is. In fact the entire health care industry sucks - BIG TIME.

Funny how people in other countries seem to do pretty well without FDA regulation on their OTC and generic drugs!!!!!

Wake up America. Stop the SCAMMING. The Federal Government is a wholly owned subsidiary of the pharmaceutical industry. You are being robbed and pillaged. Tell your doctor or health care provider that unless he/she can prescribe an alternative to a name brand drug, you'll find someone who can. Start a groundswell of resistance to these thugs.
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  #15  
Old 07-06-2009, 08:05 PM
Anonymous
 
Posts: n/a
Jester Re: Slo-Niacin vs Niaspan

Thats all well and good, but if there is no one left to make the product, test the product, or sell the product how can people take the product?

Thankfully there will still be people here to manage the product... poorly
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  #16  
Old 09-12-2009, 07:41 PM
Anonymous
 
Posts: n/a
Default Re: Slo-Niacin vs Niaspan

Bottom Line! Niaspan was $120.00/month (with my insurance)......Slo-Niacin was $12.50......you do the math!
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  #17  
Old 10-02-2009, 04:29 PM
Anonymous
 
Posts: n/a
Default Re: Slo-Niacin vs Niaspan

Quote:
Originally Posted by Anonymous View Post
Bottom Line! Niaspan was $120.00/month (with my insurance)......Slo-Niacin was $12.50......you do the math!
$120??? What kind of absolute shit insurance do you have? Niaspan is pretty much preferred across the board. My BCBS has it for only $25 a month. Besides, if your shitty insurance has that bad of a pharmacy benefit, I'd forget about Niaspan altogether and quit pissing away my insurance premium dollars. So get off your ass, quit playing on the computer and go get a real job, with decent benefits you douchebag!
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  #18  
Old 10-30-2009, 03:06 PM
Anonymous
 
Posts: n/a
Default Re: Slo-Niacin vs Niaspan

As a small business owner, I have a Health Savings Plan. If you are aware of the stipulations of a HSA, you must pay for 100% of benefits until you reach your deductible. This includes Rx. So, it is not whether someone has a "bad" vs "good" Rx plan. People need to take into consideration all the aspects.

As far as the comment about "playing on the computer, getting a real job" and the other very classy language you use. I don't know why anyone would not listen to your gems of wisdom.
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  #19  
Old 11-16-2009, 01:00 PM
Anonymous
 
Posts: n/a
Default Re: Slo-Niacin vs Niaspan

I was on Niaspan for 6 months. The side effects are so severe I can't imagine the FDA approving this drug. The sad part is I put myself through that for nothing. After 6 months I saw no improvement in cholesterol,triglycerides or HDL. Not only is Niaspan extremely expensive I can't see that it's very effective. I am currently taking Gemfibrozil which is a generic version of a drug that has been around forever. Not only is it cheap wthout the side effects of Niaspan it appears to be much more effective.
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  #20  
Old 11-16-2009, 01:36 PM
Anonymous
 
Posts: n/a
Default Re: Slo-Niacin vs Niaspan

My husband has been on Niapsan for 4 years now. We pay $50 a month, which seems to be a bargain compared to some. The 2 months we were without insurance, it was $184!!! I begged some samples from the doctor's office. It has made a remarkable difference. When he started taking the Niaspan, his HDL was 4...no, that's not a typo. Now his HDL has been maintained in a normal range. Yes, it is a good drug, but I don't understand why it has to be SO expensive. OTC niacin is not an option for him. Our doc said he would have to take so much (he is on the max dose of 2000mg of Niaspan)that the savings would be nullified, and that there would be no guarantee that it would work.
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  #21  
Old 11-17-2009, 11:56 PM
Anonymous
 
Posts: n/a
Lightbulb ..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.
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  #22  
Old 11-23-2009, 08:03 PM
Anonymous
 
Posts: n/a
Default 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.
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  #23  
Old 11-28-2009, 11:38 PM
Anonymous
 
Posts: n/a
Lightbulb Re: Slo-Niacin vs Niaspan - my experience

Quote:
Originally Posted by Anonymous View Post
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.
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.
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  #24  
Old 12-04-2009, 08:51 PM
Anonymous
 
Posts: n/a
Default Re: Slo-Niacin vs Niaspan

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.
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  #25  
Old 01-08-2010, 03:57 PM
Anonymous
 
Posts: n/a
Exclamation Re: Slo-Niacin vs Niaspan

Quote:
Originally Posted by Anonymous View Post
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.
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,...
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  #26  
Old 01-08-2010, 04:02 PM
Anonymous
 
Posts: n/a
Smile Re: Slo-Niacin vs Niaspan

Quote:
Originally Posted by Anonymous View Post
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.
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.
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  #27  
Old 02-07-2010, 05:59 PM
Anonymous
 
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Lightbulb 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.
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  #28  
Old 02-07-2010, 07:19 PM
Anonymous
 
Posts: n/a
Default Re: Slo-Niacin vs Niaspan

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.
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  #29  
Old 02-21-2010, 03:26 AM
Anonymous
 
Posts: n/a
Default Re: Man sues pharmacist for negligence over supplement Slo-Niacin

Quote:
Originally Posted by Anonymous View Post
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.
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.
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  #30  
Old 02-23-2010, 04:29 PM
Anonymous
 
Posts: n/a
Default Re: Slo-Niacin vs Niaspan

Quote:
Originally Posted by Anonymous View Post
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,...

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.
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  #31  
Old 02-25-2010, 10:24 PM
Anonymous
 
Posts: n/a
Talking Re: Slo-Niacin vs Niaspan

Quote:
Originally Posted by Anonymous View Post
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.
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
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  #32  
Old 02-25-2010, 10:26 PM
Anonymous
 
Posts: n/a
Lightbulb Re: Slo-Niacin vs Niaspan

Quote:
Originally Posted by Anonymous View Post
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.
1st, before quitting ER,.. make sure you have a high-fiber snack on-board,.. 3 TBS apllesauce,...

The Chaun

PS Happy Trails !
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  #33  
Old 04-19-2010, 04:28 PM
Anonymous
 
Posts: n/a
Default Re: Slo-Niacin vs Niaspan

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 ...
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  #34  
Old 04-24-2010, 06:24 PM
Anonymous
 
Posts: n/a
Default Re: Slo-Niacin vs Niaspan

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.
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  #35  
Old 05-04-2010, 01:00 AM
Anonymous
 
Posts: n/a
Default Re: Slo-Niacin vs Niaspan

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.
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  #36  
Old 06-14-2010, 04:56 PM
Anonymous
 
Posts: n/a
Default Re: Slo-Niacin vs Niaspan

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!
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  #37  
Old 06-28-2010, 01:32 PM
Anonymous
 
Posts: n/a
Lol Re: Slo-Niacin vs Niaspan

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
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  #38  
Old 07-13-2010, 12:43 PM
Anonymous
 
Posts: n/a
Default Re: Slo-Niacin vs Niaspan

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)
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  #39  
Old 08-11-2010, 06:05 PM
Anonymous
 
Posts: n/a
Default Re: Slo-Niacin vs Niaspan

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.
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  #40  
Old 08-18-2010, 02:52 PM
Anonymous
 
Posts: n/a
Jester Re: Slo-Niacin vs Niaspan

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[s].


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

Chaun
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  #41  
Old 08-26-2010, 08:35 AM
Edterry
 
Posts: n/a
Default Re: Slo-Niacin vs Niaspan

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.
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  #42  
Old 08-26-2010, 02:27 PM
Anonymous
 
Posts: n/a
Lightbulb Re: Slo-Niacin vs Niaspan

Quote:
Originally Posted by Edterry View Post
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.

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
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  #43  
Old 09-15-2010, 06:00 PM
T Polacek
 
Posts: n/a
Default Re: Slo-Niacin vs Niaspan - my experience

Quote:
Originally Posted by Anonymous View Post
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.
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.
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  #44  
Old 09-21-2010, 04:43 PM
crunchy37
 
Posts: n/a
Default Re: Slo-Niacin vs Niaspan

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.
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  #45  
Old 09-25-2010, 01:52 PM
chevyo chevyo is offline
cafepharma newbie
 
Join Date: Sep 2010
Posts: 2
Default Re: Slo-Niacin vs Niaspan

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/present...tifier=3044771 I think a Liver transplant or Liver failure is just not worth the risk to me.
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  #46  
Old 09-28-2010, 10:57 PM
Anonymous
 
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Rolleyes Re: Slo-Niacin vs Niaspan

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?
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  #47  
Old 10-29-2010, 05:03 PM
Anonymous
 
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Default Re: Slo-Niacin vs Niaspan

Quote:
Originally Posted by Anonymous View Post
My husband has been on Niapsan for 4 years now. We pay $50 a month, which seems to be a bargain compared to some. The 2 months we were without insurance, it was $184!!! I begged some samples from the doctor's office. It has made a remarkable difference. When he started taking the Niaspan, his HDL was 4...no, that's not a typo. Now his HDL has been maintained in a normal range. Yes, it is a good drug, but I don't understand why it has to be SO expensive. OTC niacin is not an option for him. Our doc said he would have to take so much (he is on the max dose of 2000mg of Niaspan)that the savings would be nullified, and that there would be no guarantee that it would work.
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
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  #48  
Old 11-06-2010, 02:37 PM
Anonymous
 
Posts: n/a
Default Re: Slo-Niacin vs Niaspan

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.
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  #49  
Old 11-08-2010, 06:04 PM
Anonymous
 
Posts: n/a
Default Re: Slo-Niacin vs Niaspan

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.
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  #50  
Old 11-30-2010, 09:24 PM
JimWOmahaNE
 
Posts: n/a
Default Re: Slo-Niacin vs Niaspan

Quote:
Originally Posted by chevyo View Post
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/present...tifier=3044771 I think a Liver transplant or Liver failure is just not worth the risk to me.
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.
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