Current Atherosclerosis Reports

, Volume 2, Issue 1, pp 64–71 | Cite as

Niacin dosing: Relationship to benefits and adverse effects

  • David M. Capuzzi
  • John M. Morgan
  • Osvaldo A. BruscoJr.
  • Charles M. Intenzo


Because of the original observation by Altschul et al. [1], that nicotinic acid (niacin), not nicotinamide, in pharmacologic doses lowered human serum cholesterol levels, an avalanche of reports have been published over the past 45 years on the plasma lipid-regulating properties of this drug and its beneficial cardiovascular effects. A myriad of studies that have examined efficacy, safety, adverse effects, and pharmacologic properties of niacin rendered convincing evidence that niacin, used alone or combined with other agents, has favorable effects on serum lipoprotein regulation and on containment of atherothrombotic cardiovascular diseases. However, because of the unusual side effect profile of niacin and the availability of various formulations of this drug, niacin must be used prudently and with careful instruction and monitoring of patients. This review summarizes the pertinent and recent literature on niacin that impacts its therapeutic use. We also discuss some controversial issues and personal clinical experience and opinions on this topic.


Niacin Pravastatin Lovastatin Fluvastatin Colestipol 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Altschul R, Hoffer A, Stephen JD: Influence of nicotinic acid on cholesterol in man. Arch Biochem 1955, 54:558–559.PubMedCrossRefGoogle Scholar
  2. 2.
    McKenney JM, Proctor JD, Harris S, et al.: A comparison of the efficacy and toxic effects of sustained-vs immediate-release niacin in hypercholesterolemic patients. JAMA 1994, 271:672–677.PubMedCrossRefGoogle Scholar
  3. 3.
    Knopp, RH: Drug treatment of lipid disorders. N Engl J Med 1999, 341:498–510.PubMedCrossRefGoogle Scholar
  4. 4.
    Brown BG, Bardsley J, Poulin D: Moderate dose three drug therapy with niacin, lovastatin, and colestipol to reduce low density lipoprotein cholesterol less than 100 mg/dL in patients with hyperlipidemia and coronary artery disease. Am J Card 1997, 80:111–115.PubMedCrossRefGoogle Scholar
  5. 5.
    Tornvall P, Hamsten A, Johanson J, et al.: Normalisation of the composition of very low-density lipoprotein in hypertriglyceridemia by nicatinic acid. Atherosclerosis 1990, 84:219–227.PubMedCrossRefGoogle Scholar
  6. 6.
    Superko HR, Krauser RM: Differential effects of nicotinic acid in subjects with different LDL subclass patterns. Atherosclerosis 1992, 95:68–76.CrossRefGoogle Scholar
  7. 7.
    Blankenhorn DH, Nessim SA, Johnson RL, et al.: Beneficial effects of combined colestipol-niacin therapy of coronary atherosclerosis and coronary venous bypass grafts. JAMA 1987, 257:3233–3240.PubMedCrossRefGoogle Scholar
  8. 8.
    Cashin-Hemphil J, Mack W, Pogoda M, et al.: Beneficial effects of colestipol-niacin on coronary atherosclerosis: a 4-year follow-up. JAMA 1990, 64:3013–3017.CrossRefGoogle Scholar
  9. 9.
    Blankenhorn DH, Selzer RH, Crawford DW, et al.: Beneficial effects of colestipol-niacin therapy on the common carotid artery. Circulation 1993, 88:20–28.PubMedGoogle Scholar
  10. 10.
    Blankenhorn DH, Azen SP, Crawford DW, et al.: Effects of colestipol-niacin therapy on human femoral atherosclerosis. Circulation 1991, 83:438–447.PubMedGoogle Scholar
  11. 11.
    Olsson AG, Ruhn G, et al.: The effect of serum lipid regulation on the development of femoral atherosclersis in hyperlipidemia: a randomized controlled study. J Intern Med 1990, 227:381–390.PubMedCrossRefGoogle Scholar
  12. 12.
    The Coronary Drug Project Research Group: Clofibrate and niacin in coronary heart disease. JAMA 1975, 231:360–381.CrossRefGoogle Scholar
  13. 13.
    Canner PL, Berge KG, Wenger NK, et al.: Fifteen-year mortality in coronary artery drug project patients long-term benefit with niacin. J Am Coll Cardiol. 1986, 8:1245–1255.PubMedCrossRefGoogle Scholar
  14. 14.
    DiPalma JR, Thayer WS: Use of niacin as a drug. Ann Rev Nutr 1991, 11:169–187.CrossRefGoogle Scholar
  15. 15.
    Kashyap ML: Mechanistic studies of high-density lipoproteins. Am J Card 1998, 82:12A.Google Scholar
  16. 16.
    Packard CJ, Stewart JM, Third JLHC, et al.: Effects of nicotinic acid therapy on high-density lipoprotein metabolism in type II and type IV hyperlipoproteinemia. Biochim Biophys Acta 1980, 618:53–62.PubMedGoogle Scholar
  17. 17.
    Gotto AM Jr, Pownall HJ: Management of lipid and lipoprotein disorders. In Manual of lipid disorders. Edited by Gotto AM Jr, Pownall HJ. Baltimore: Williams & Wilkins, 1992.Google Scholar
  18. 18.
    Rubins HB, et al.: N Eng J Med. 1999, 341:410–418.CrossRefGoogle Scholar
  19. 19.
    Knopp RH, Alagona P, Davidson M, et al.: Equivalent efficacy of a time release form of niacin (niaspan) given once-a-night versus plain niacin in the management of hyperlipidemia. Metabolism 1998, 47:1097–1104.PubMedCrossRefGoogle Scholar
  20. 20.
    Capuzzi DM, Guyton JR, Morgan JM, et al.: Efficacy and safety of an extended-release niacin (niaspan):a long-term study. Am J Card 1998, 82:12A.Google Scholar
  21. 21.
    Morgan JM, Capuzzi DM, Guyton JR, et al.: Treatment effect of niaspan, a controlled-release niacin, in patients with hypercholesterolemia:a placebo controlled trial. J Cardiovasc Pharmacol Therapeut 1996, 1:195–202.Google Scholar
  22. 22.
    Morgan JM, Capuzzi DM, Guyton JR, et al.: Treatment effect of niaspan, a controlled-release niacin, in patients with hypercholesterolemia:a placebo controlled trial. J Cardiovasc Pharmacol Therapeut 1996, 1:195–202.Google Scholar
  23. 23.
    Gotto AM Jr,: Results of recent large cholesterol-lowering trials and implications for clinical management. Am J Cardiol 1997, 79:1663–1666.PubMedCrossRefGoogle Scholar
  24. 24.
    Kuriterovich, PO Jr: State of the art update and review: clinical trials of lipid-lowering. Am J Cardiol 1998, 82:3U-17U.CrossRefGoogle Scholar
  25. 25.
    Carlson LA, Rosenhamer G: Reduction in mortality in the Stockholm Ischaemic Heart Disease Secondary Prevention Study by combined treatment with clofibrate and nicotinic acid. Acta Med Scand 1988, 223:405–414.PubMedCrossRefGoogle Scholar
  26. 26.
    Brown BG, Albers JJ, Fisher LD, et al.: Regression of coronary artery disease as a result of intensive lipid-lowering therapy in men with high levels of apolipoprotein B. N Engl J Med 1990, 323:1289–1298.PubMedCrossRefGoogle Scholar
  27. 27.
    Malloy MJ, Kand JP, Kunitake ST, et al.: Complementarity of colestipol, niacin, and lovastatin in treatment of severe familial hypercholesterolemia. Ann Intern Med 1987, 107:616–623.PubMedGoogle Scholar
  28. 28.
    Kane JP, Malloy MJ, Ports TA, et al.: Regression of coronary atherosclerosis during treatment of familial hypercholesterolemia with combined drug regimens. JAMA 1990, 264:3007–3012.PubMedCrossRefGoogle Scholar
  29. 29.
    Brusco OA, Capuzzi DM, Morgan, JM, et al.: Incidence of primary lipoprotein abnormalities and lipoprotein (a) excess in referred out-patients with premature CHD. CA J Invest Med 1995, 43 (Suppl 2):390A.Google Scholar
  30. 30.
    Guyton JR, Capuzzi DM: Treatment of hyperlipidemia with combined niacin-statin regimens. Am J Cardiol 1998, 82:82U-84U.PubMedCrossRefGoogle Scholar
  31. 31.
    Davignon J, Roederer G, Montigny M, et al.: Comparative efficacy and safety of pravastatin, nicotinic acid and the two combined in patients with hypercholesterolemia. Am J Cardiol 1994, 73:339–345.PubMedCrossRefGoogle Scholar
  32. 32.
    Gardner SF, Schneider EF, Granberry MC, et al.: Combination therapy with low-dose lovastatin and niacin is as effective as higher-dose lovastatin. Pharmacotherapy 1996, 16:419–423.PubMedGoogle Scholar
  33. 33.
    Gardner SF, Marx MA, White LM, et al.: Combination of low-dose niacin and pravastatin improves the lipid profile in diabetic patients without compromising glycemic control. Ann Pharmacother 1997, 31:677–682.PubMedGoogle Scholar
  34. 34.
    Jacobson TA, Chin MM, Fromell GJ, et al.: Fluvastatin with and without niacin for hypercholesterolemia. Am J Cardiol 1994, 74:149–154.PubMedCrossRefGoogle Scholar
  35. 35.
    Vacek JL, Dittmeier G, Chiarelli T, et al.: Comparison of lovastatin (20mg) and nicotinic acid (1.2g) with either drug alone for type II hyperlipoproteinemia. Am J Cardiol 1995, 76:182–186.PubMedCrossRefGoogle Scholar
  36. 36.
    Reaven P, Witztum JL: Lovastatin, nicotinic acid, and rhabdomyolysis. Ann Intern Med 1988, 109:597–598.PubMedGoogle Scholar
  37. 37.
    Illingworth NDJ, Munson J, Hsenpud J: Myolysis and acute renal failure in a heart-transplant recipient receiving lovastatin. [letter]. N Engl J Med 1988, 318:46–47.PubMedCrossRefGoogle Scholar
  38. 38.
    Bank WJ, DiMauro S, Bonilla E, et al.: A Disorder of muscle lipid metabolism and myoglobinuria. N Engl J Med 1975, 292:443–449.PubMedCrossRefGoogle Scholar
  39. 39.
    Pasternak RC, Brown LE, Stone PH, et al.: Effect of combination therapy with lipid-reducing drugs in patients with coronary heart disease and “normal” cholesterol levels. Ann Intern Med 1996, 125:529–540.PubMedGoogle Scholar
  40. 40.
    O’Keefe JH, Harris WS, Nelson J, et al.: Effects of Pravastatin with niacin or magnesium on lipid levels and postprandial lipemia. Am J Cardiol 1995, 76:480–484.PubMedCrossRefGoogle Scholar

Copyright information

© Current Science Inc 2000

Authors and Affiliations

  • David M. Capuzzi
    • 1
  • John M. Morgan
    • 1
  • Osvaldo A. BruscoJr.
    • 1
  • Charles M. Intenzo
    • 1
  1. 1.Cardiovascular Disease Prevention CenterDepartment of Medicine, Thomas Jefferson UniversityPhiladelphiaUSA

Personalised recommendations