Slo-Niacin vs Niaspan

Thanks for the great information. My doctor put me on Enduracin 8 months ago and we've both been very pleased with the results of my labs and tolerability. I was on Niaspan before but the flushing was brutal. My copay with BC/BS for Niaspan 1500mg a day was $35.00 /month. The Enduracin is about $6-$7 / month.

 

FWIW, here's a summary of a recent (2010) VA study
regarding the switch from Niaspan to SLO-Niacin.

http://www.ajhp.org/content/67/23/2038.abstract

Personally, I don't know what to believe, but I plan to
stick with ($40/quarter private insurance) Niaspan for
at least another 90 days -- to get another TG and HDL
data point before (maybe) considering a switch.

 

This lipidologist sees no problem with Slo-Niacin. The SLIM Study: Slo-Niacin(R) and Atorvastatin Treatment of Lipoproteins and Inflammatory Markers in Combined Hyperlipidemia (J Clin Lipidol. 2009;3(3):167-178). Slo-Niacin twice daily did very well and there were essentially no adverse effects. Works even better when added to a statin. http://www.ncbi.nlm.nih.gov/pubmed?term=slim%20slo-niacin

 

Thanks for your useful info. It appears to me from reading the literature that the best HDL elevation with minimal liver impact appears to result from a spike in niacin with, say, 8-12 hours between doses, is there a sound argument (or data) to say that a low dose of IR niacin on an empty stomach would have the same effect as a higher dose after consuming a meal? Isn't the recommendation to take IR niacin after a meal (to minimize flushing) just a technique to spread its metabolism over time, somewhat defeating the mechanism you describe occurring in the liver and thereby requiring a higher dose to achieve the desired result?

 

My goal is to raise HDL from 29 and lower trigs from 219 using IR Niacin.

I can tolerate 3g all at once. Should I take that all at once or 1.5g every 12 hours?

 

Niaspan is the pharmaceutical industry's concession that they cannot create an effective HDL reduction ethical drug that does not have dangerous side effects. All the major firms have tried to come up with an HDL-lowering drug but during their trials problems have cropped up. It drives them crazy that niacin works so well and is so cheap that they have "invented" Niaspan which is nothing but niacin with a different slow release mechanism. You can buy a thousand 500mg tablets of regular niacin (not slow release) for $21 on Amazon (2.1 cents per tablet) while Niaspan costs about $250 for the same amount and dosage - almost twelve times as much. If you buy it in 30-day or 90-day quantities, Niaspan is considerably more expensive per tablet. While the high price of most drugs is attributed to the cost of development and trials, this is clearly not the case for Niaspan since the formula and structure of the niacin is well-known and the slow release system borrowed from other ethical drugs. In short, Niaspan is one of the great rip-offs of the pharma industry. If your doctor prescribes it in lieu of regular niacin or slow-release niacin, I suggest you change doctors.

 

You don't mention how much Niaspan or Slo-niacin you were taking. My research suggest that raising my triglycerides goal should be less than 60 and to raise the HDL to greater than 60. My understanding is to lower your triglycerides you should be getting omega 3s (fish oil). With Slo=Niacin I raised my HDL from 28 (when I received a quad by-pass Jan 2009) to 66 last month. My triglycerides were 156 then and are now are at 53. Again niacin is for raising HLD and fish oil for lowering triglycerides. FYI the formula for LDL is TC less HDL = A, divide triglycerides by 5 = B, then subtract A from B = LDL.

 

Actually, the LDL from your formula is what we call "derivative," which means that we assume that the LDL is what remains after subtracting the rest. For a truly accurate measurement of LDL (there are at least two types of LDL, by the way), ask your doctor to write a Rx for a "direct measurement," which utilizes a more complex (and expensive) quantitative analysis. This measures the true, aggregate low-density lipoprotein floating around in the blood.

 

I thought the study just came out that proved Niaspan doesn't do anything?

 

I have been researching this topic extensively for the last couple days since I have to find a reasonably priced alternative to Niaspan. I flat out can't afford it since I no longer have health insurance coverage.

There is a recent study that puts this debate to rest... http://www.ncbi.nlm.nih.gov/pubmed/21098376

To make a long story short, the study summed it up nicely... CONCLUSION: Formulary conversion from Niaspan to Slo-Niacin resulted in a small but significant increase in HDL cholesterol concentration and no significant change in ALT or AST level.

 

I'm sure its as good a Niaspan if not better. Despite that ......... it probably doesn't even sell ten million a year. Niaspan now sells close to a billion !!!!!!!

 

I have an HSA as well and I am willing to bet make double or more than your income. Do not attack somebody over the type of insurance they have and comment about getting areal job. If we all had HSAs the insurance costs would not rise near as rapidly. By the way I'll bet th other poster that was on an HSA makes more $$ than you do as well by a significant margin. Your intelligent remarks are a dead give away of your IQ and your great insurance plan making $11/hr in some government job sucking the life out of the real tax paying workforce.

 

Yes -- I saw that study as well, and, along with the information below from the Kaiser-Permanente website, therefore decided to switch to Slo-Niacin for the same reason you did.

This is cut-and-pasted from their site (easily found by Googling "difference between Niaspan and Slo-Niacin"):

"Your doctor may have approved a change in your niacin medicine from Niaspan to Slo-Niacin tablets. Niaspan and Slo-Niacin are both slow-release forms of niacin. They work the same way in your body to lower cholesterol levels and have similar side effects."

The same page goes on to describe the different co-pays for the "generic" Slo-Niacin and the "brand name" Niaspan and a few cautions about switching, etc. I was a Niaspan user for around ten years but lost my health insurance. My local Save-Mart pharmacy charges $180 for 60 tablets. That's $3.00 per pill vs. 9 cents for the Slo-Niacin.

I also consulted this board during my search and really appreciate everyone's contributions.

 

I been taking Slo-Niacin for 1 1/2 years. HDL was 36 when I started and is now at 50.. LDL-P particicle test was extremely high but has basicly cut in half since taking Slo-niacin. I purchase Slo-Niacin at COSTCO. 150 tablets, 500MG for under $15.00. Every few months it goes on sale for about ten bucks. Can't beat it. I take 1500 mg daiy in three doses of 500mg each.

 

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

 

Re: Slo-Niacin vs Niaspan - Both present danger!

Metabolism of Niacin

The rate of release of the various niacin formulations determines the metabolic pathway that is predominantly used and as a result, the likelihood of certain adverse events associated with niacin. Niacin is metabolized by either the conjugative pathway, in which it is conjugated with glycine to form nicotinuric acid, or the amidation pathway, in which it goes through a series of oxidation-reduction reactions that produce nicatinamide and ultimately pyrimidine metabolites. The amidation pathway is a high-affinity, low-capacity pathway whereas the conjugation pathway is a low-affinity, high-capacity pathway.

The rapid absorption time of IR niacin results in quick saturation of the low-capacity amidation pathway, and the conjugation pathway, which is associated with flushing, dominates its metabolism. Conversely, the slow absorption of ER niacin results in most of the product being metabolized by the high-affinity amidation pathway, which increases the risk of hepatotoxicity.

All extended release Niacin presents the risk of liver damage over time. There is zero evidence of this negative effect with IR release. Currently I'm grinding up Nisapan into a fine powder making it in essence IR and taking just enough per dose to result in a mild flush.

 

Re: Slo-Niacin vs Niaspan - Both present danger!

 

That study had to do with using Niaspan IN CONJUNCTION WITH Zocor (simvastatin). Using Niaspan alone has been shown to halt and possibly even reverse alterial plaque, which statins cannot do. The study in question showed higher stroke risk, etc., but that may have been because of the combination of the two drugs.

 

Well, here is my experience. I asked my doctor about the difference, and he said it would depend on how my body uses the medications. So we did a nine month test with me to see which I would respond best to.

Niaspan ER 500 x 2 taken at night. 90 days.

Original HDL: 25
90 day Niaspan HDL: 32

Off Niaspan for 90 days.

Slo-Niacin 500 x 2 taken at night. 90 days

Original HDL: 28
90 day Slo-Niacin HDL: 38

So an improvement using Slo-Niacin in my case over that of Niaspan. Cheaper cost too. $13.99 (retail) over $30 (insurance).

Flushing is easily prevented with 81 mg of asprin.

Now I do not have Kaiser Permanente insurance, but they are saying at www.permanente.net/kaiser/pdf/62664.pdf that they are bioequavalent.

The AJHP also noted that a study done in 2010/2011 had a conclusion that "Formulary conversion from Niaspan to Slo-Niacin resulted in a small but significant increase in HDL cholesterol concentration and no significant change in ALT or AST level."
http://www.ajhp.org/content/67/23/2038.short

 

niaspan has more MG of niacin