In this issue of The JOURNAL, McKenney et al1 report their experience with two different preparations of niacin in the treatment of hypercholesterolemia. One version was an immediate-release (IR) preparation and the other a sustained-release (SR) preparation. The treatments differed significantly with regard to both safety and efficacy. While the SR and IR preparations had similar effects on serum triglyceride levels, SR niacin was better at reducing total serum cholesterol and low-density lipoprotein cholesterol, but IR was better at increasing high-density lipoprotein cholesterol. The explanation for these differences is not readily apparent.
In terms of patient tolerance, both preparations left a lot to be desired. Many patients withdrew from the study because of adverse drug reactions, abnormal laboratory test results, or both. Only 22% of the SR patients and 61% of the IR group completed the study. Although abnormal liver test results were common in the SR group, no
Lasagna L. Over-the-Counter Niacin. JAMA. 1994;271(9):709-710. doi:10.1001/jama.1994.03510330087041