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Varying Cost and Free Nicotinic Acid Content in Over-the-Counter Niacin Preparations for Dyslipidemia

C. Daniel Meyers, MD; Molly C. Carr, MD; Sang Park, PhD; and John D. Brunzell, MD
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From University of Washington School of Medicine, Seattle, Washington.

Acknowledgments: The authors thank Tara J. Meyers for her assistance in preparing and editing of the manuscript.

Grant Support: By the National Institutes of Health (grants HL30086 and K23 RR16067).

Potential Financial Conflicts of Interest: Dr. Meyers currently works at the Veterans Affairs Medical Center in Long Beach, California. The head of the laboratory at which he works has received grants from Kos Pharmaceuticals (makers of Niaspan), and the basic science work Dr. Meyers conducts is funded in part by these grants.

Requests for Single Reprints: C. Daniel Meyers, MD, Veterans Affairs Medical Center, 5901 East Seventh Street (11/111I), Long Beach, CA 90822; daniel.meyers@med.va.gov.

Current Author Addresses: Dr. Meyers: Veterans Affairs Medical Center, 5901 East Seventh Street (11/111I), Long Beach, CA 90822.

Drs. Carr and Brunzell: University of Washington Medical Center, 1959 Northeast Pacific Street, Box 356426, Seattle, WA 98195-6426.

Dr. Park: University of Washington Medical Center, 1959 Northeast Pacific Street, Box 356540, Seattle, WA 98195.

Ann Intern Med. 2003;139(12):996-1002. doi:10.7326/0003-4819-139-12-200312160-00009
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Background: 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.

Objective: 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.

Data Sources: 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.

Measurements: 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.

Data Synthesis: 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.

Conclusions: 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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Figure 1.
Cost and content of over-the-counter niacin preparations.Top.PBottom.

Monthly cost (in U.S. dollars per month) for 2000 mg of over-the-counter niacin per day (* < 0.001 for both immediate-release and sustained-release compared with no-flush niacin). Content of free nicotinic acid (in milligrams per pill) in over-the-counter niacin preparations. Free nicotinic acid was measured by using high-performance liquid chromatography.

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Figure 2.
Patient information for initiation of immediate-release niacin therapy.
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