To the Editor.
—The study by Dr McKenney and colleagues1 is described by the authors as a "well-designed clinical trial." We would concur with that description if the authors would make more explicit the intention of the study, namely, that it was clearly designed to maximize the potential for niacin intolerance and toxicity. Despite their obvious familiarity with the clinical literature, they chose a peculiarly unphysiologic twice-daily dosing schedule. Similarly, they intentionally escalated both the immediate-release (IR) nicotinic acid and sustained-release (SR) nicotinic acid to a total dose of 3000 mg (1500 mg twice daily), whether or not the patient had demonstrated an adequate lipid response at a lower dose.
Keenan JM, Ripsin CM, Huang Z, McCaffrey DJ. Safety and Side Effects of Sustained-Release Niacin. JAMA. 1994;272(7):513. doi:10.1001/jama.1994.03520070031015