C. Daniel Meyers, MD; Molly C. Carr, MD; Sang Park, PhD; John D. Brunzell, MD
Meyers CD, Carr MC, Park S, Brunzell JD. Varying Cost and Free Nicotinic Acid Content in Over-the-Counter Niacin Preparations for Dyslipidemia. Ann Intern Med. 2003;139:996-1002. doi: 10.7326/0003-4819-139-12-200312160-00009
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Published: Ann Intern Med. 2003;139(12):996-1002.
Nicotinic acid is an effective treatment for dyslipidemia, but the content of over-the-counter niacin is not federally regulated. As a result, patients may use preparations of over-the-counter niacin that do not contain free nicotinic acid.
To characterize the types, costs, and free nicotinic acid content of over-the-counter niacin preparations and to review literature on the use of over-the-counter niacin for dyslipidemia.
Commonly used over-the-counter niacin preparations (500-mg tablets or capsules) from the 3 categories of immediate-release, sustained-release, and no-flush were purchased at health food stores and pharmacies and from Internet-based vitamin companies. Pertinent literature on the use of over-the-counter niacin was obtained by searching PubMed.
For each preparation studied, the monthly cost of therapy (at 2000 mg/d) and the free nicotinic acid content (quantified by high-performance liquid chromatography) were reported.
On average, immediate-release niacin preparations cost $7.10 per month, sustained-release preparations cost $9.75 per month, and no-flush preparations cost $21.70 per month. The average content of free nicotinic acid was 520.4 mg for immediate-release niacin, 502.6 mg for sustained-release niacin, and 0 for no-flush niacin.
No-flush preparations of over-the-counter niacin contain no free nicotinic acid and should not be used to treat dyslipidemia. Over-the-counter sustained-release niacin contains free nicotinic acid, but some brands are hepatotoxic. Immediate-release niacin contains free nicotinic acid and is the least expensive form of over-the-counter niacin.
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Cardiology, Dyslipidemia, Coronary Risk Factors.
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