To the Editor.
—We read with interest the recent article by Dr McKenney and colleagues,1 which reported a strikingly high rate of adverse effects, especially hepatotoxicity, in patients treated with niacin, particularly those treated with one brand of SR niacin. Although we believe that their study has some merit, their conclusion that "the SR form of niacin is hepatotoxic and should be restricted from use" is unwarranted and may only be applicable to the particular agent that they studied. The authors state that many SR preparations can cause hepatotoxicity, but also mentioned that other investigators have found few cases of hepatotoxicity with SR niacin, thus suggesting that the prevalence of this problem may be different with various SR preparations. This has certainly been our experience with one preparation, Slo-Niacin (Upsher-Smith Laboratories, Minneapolis, Minn). In a 3-month study of 36 patients (average dose, 2400 mg/d), only one patient (3%) had
Lavie CJ, Milani RV. Safety and Side Effects of Sustained-Release Niacin. JAMA. 1994;272(7):513-514. doi:10.1001/jama.1994.03520070031016