Nicotinic acid in treatment of low HDL cholesterol levels – adapted from the American Journal of Medicine 1995;99:378-85 – Tips from Other Journals
Nicotinic acid is useful for raising low levels of high-density lipoprotein (HDL) cholesterol. Unfortunately, side effects often limit its use. Gibbons and colleagues sought to determine the side effects of nicotinic acid and the rate at which patients were forced to discontinue the drug because of the side effects.
One hundred ten patients who were seen at a single clinic and were between 24 and 84 years of age were assigned to receive either regular or sustained-release nicotinic acid. Healthy patients received nicotinic acid if their HDL cholesterol level was below 30 mg per dL, and patients with coronary artery disease or multiple risk factors for coronary artery disease received nicotinic acid if their HDL level was below 35 mg per dL. Each patient was given instructions about how to take the medication. Spontaneous complaints (either made in person or by phone call) about the side effects of nicotinic add were recorded; no questionnaire about side effects was administered.
Of the 110 patients reviewed, six were lost to follow-up. The remaining patients took 133 separate trials of a preparation of nicotinic add. Some of these trials occurred in the same individual. That is, some patients started with regular nicotinic acid and then switched to the sustained-release preparation. Patients in both groups reported flushing, abdominal pain, nausea or vomiting as the primary side effects requiring discontinuation. Both groups also had abnormal liver function tests and elevated serum glucose levels, and those who received the regular preparation also had elevated uric acid levels more often than those who received sustained-release nicotinic acid. Of the 63 patients who took regular nicotinic acid, nearly half (43 percent) discontinued the drug because of side effects. These patients were, however, able to take the medication for an average of 16.7 months before they stopped taking it. Similarly, 42 percent of patients given sustained-release nicotinic add were forced to discontinue the medication, with 14.9 months being the average time before discontinuation occurred.
The authors conclude that both regular and sustained-release formulations of nicotinic acid are often associated with untoward side effects. The patients in this study demonstrated many of the same side effects that patients in previous studies have shown, although this study may have more closely replicated actual practice conditions. The authors suggest that even though patients are able to tolerate nicotinic acid for an extended period of time, they will not necessarily be able to tolerate this lipid-lowering treatment indefinitely, and thus, they should continue to be monitored closely while receiving nicotinic acid. (Gibbons LW, et al. The prevalence of side effects with regular and sustained-release nicotinic acid. Am J Med 1995;99:378-85.)
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