Varying cost and free Nicotinic acid content in over-the-counter niacin preparations for dyslipidemia

• Published in: Annals of internal medicine Vol. 139; no. 12; pp. 996 - 1002
• Main Authors: MEYERS, C. Daniel, CARR, Molly C, PARK, Sang, BRUNZELL, John D
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA American College of Physicians 16-12-2003
• Subjects: Biological and medical sciences; Chromatography, High Pressure Liquid; Costs; Dosage Forms; Fees, Pharmaceutical; General and cellular metabolism. Vitamins; Humans; Hyperlipidemias - drug therapy; Lipids; Medical disorders; Medical sciences; Niacin - administration & dosage; Niacin - analysis; Niacin - chemistry; Niacin - economics; Nonprescription drugs; Nonprescription Drugs - administration & dosage; Nonprescription Drugs - chemistry; Nonprescription Drugs - economics; Pharmacology. Drug treatments; Vitamin B; Human; Prognosis; Controlled release form; Nicotinic acid; Metabolic diseases; Lipids; Chemotherapy; Treatment; Health economy; Cost analysis; Dyslipemia; Public health; Antilipemic agent
• ISSN: 0003-4819; 1539-3704
• DOI: 10.7326/0003-4819-139-12-200312160-00009

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.
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.
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.
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.
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.
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.