Varying cost and free nicotinic acid content in over-the-counter niacin preparations for dyslipidemia.
BACKGROUND
Nicotinic acid is an effective treatment for dyslipidemia, but the content of over-the-counter niacin is not federally regulated. As a result, patients may use preparations of over-the-counter niacin that do not contain free nicotinic acid.


OBJECTIVE
To characterize the types, costs, and free nicotinic acid content of over-the-counter niacin preparations and to review literature on the use of over-the-counter niacin for dyslipidemia.


METHODS
Commonly used over-the-counter niacin preparations (500-mg tablets or capsules) from the 3 categories of immediate-release, sustained-release, and no-flush were purchased at health food stores and pharmacies and from Internet-based vitamin companies. Pertinent literature on the use of over-the-counter niacin was obtained by searching PubMed.


METHODS
For each preparation studied, the monthly cost of therapy (at 2000 mg/d) and the free nicotinic acid content (quantified by high-performance liquid chromatography) were reported.


RESULTS
On average, immediate-release niacin preparations cost 7.10 dollars per month, sustained-release preparations cost 9.75 dollars per month, and no-flush preparations cost 21.70 dollars per month. The average content of free nicotinic acid was 520.4 mg for immediate-release niacin, 502.6 mg for sustained-release niacin, and 0 for no-flush niacin.


CONCLUSIONS
No-flush preparations of over-the-counter niacin contain no free nicotinic acid and should not be used to treat dyslipidemia. Over-the-counter sustained-release niacin contains free nicotinic acid, but some brands are hepatotoxic. Immediate-release niacin contains free nicotinic acid and is the least expensive form of over-the-counter niacin.
Meyers
C Daniel
CD
University of Washington School of Medicine, Seattle, Washington, USA. daniel.meyers@med.va.gov
Carr
Molly C
MC
Park
Sang
S
Brunzell
John D
JD
D002851:Chromatography, High Pressure Liquid; D004304:Dosage Forms; D005252:Fees, Pharmaceutical; D006801:Humans; D006949:Hyperlipidemias / Q000188:drug therapy*; D009525:Niacin / Q000008:administration & dosage / Q000032:analysis* / Q000737:chemistry* / Q000191:economics*; D004366:Nonprescription Drugs / Q000008:administration & dosage / Q000737:chemistry* / Q000191:economics*
D004304:Dosage Forms; D004366:Nonprescription Drugs; D009525:Niacin