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Nicotinic acid for lowering cholesterol:
too many drawbacks

Short- or long-acting nicotinic acid causes too many adverse effects to be used as a treatment for high cholesterol.

Long-acting nicotinic acid is coming onto the market as a treatment for high cholesterol in some circumstances. In a study of around 5,000 patients monitored for an average of 15 years, short-acting nicotinic acid was not shown to have any effect on patients' survival rates. The adverse effects of short-acting nicotinic acid are very frequent and sometimes severe, ranging from hot flushes to digestive and visual disorders and hepatic toxicity. They are the reason for treatment being halted in around 50% of cases.

The effectiveness of long-acting nicotinic acid has not been evaluated using clinical criteria. The frequency of its adverse effects is similar to that of the short-acting form.

In practice, if an appropriate dietary regime alone does not lower cholesterol levels sufficiently, the best drugs are those in the statin family, starting with pravastatin and simvastatin, which have a proven benefit in reducing mortality. When the effect of these drugs seems insufficient and combined drug therapy is being considered, gemfibrozil or cholestyramin should be suggested, under close supervision, given the increased muscular risks.

©Prescrire September 2006

Source: "Acide nicotinique-Niaspan°LP. Libération prolongée ou pas : trop de risques pour un intérêt clinique non démontré" Rev Prescrire 2006 ; 26 (275) : 567.

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