Niacin (Nicotinic Acid) -- The Old Drug Is Making a Comeback With A New Act

Linda Brookes, MSc


June 12, 2007

In This Article


Niacin (nicotinic acid) is well known as the most effective drug currently available for raising levels of high-density lipoprotein (HDL) cholesterol, raising it by 25% to 35% at the highest doses. The extended-release (ER) formulation of niacin is safe and as effective as the immediate-release version, but it is better tolerated. However, despite the availability of the ER form, niacin is still not optimally utilized because of the cutaneous flushing and the patient resistance and nonadherence that are associated with its use.

Because of the importance of addressing low levels of HDL cholesterol in patients at risk, and because the flushing side effect is such an impediment to acceptance of niacin, a great deal of research has been targeted at addressing or ameliorating this effect. A series of reports on this topic were presented at the 2007 American College of Cardiology (ACC) 56th Annual Scientific Session meeting held in New Orleans, Louisiana. The first assessed to what extent flushing leads to patient nonadherence or discontinuation of niacin therapy. The second study used measurement of carotid artery intima media thickness (CIMT) to assess progression of atherosclerosis in patients with metabolic syndrome. Lastly, the third report used magnetic resonance imaging (MRI) to compare the effects of a niacin-plus-simvastatin combination vs high-dose simvastatin as protection against clinical end points.