By C. CLAIBORNE
RAY
Q. Why
would my doctor prescribe expensive brand-name niacin for my cholesterol rather than generic
supplements?
A. Your doctor is probably
tailoring both dosage and delivery form to maximize niacin’s positive effects
and minimize negative side effects. Also, pharmaceutical-grade niacin is more
reliable in purity and potency, and it is covered by many insurance plans.
Niacin (nicotinic acid) is a B
vitamin at doses in the milligrams, said Dr. Sheldon S. Hendler, co-editor of
The Physicians’ Desk Reference for Nutritional Supplements. But at doses in the
grams, it is a potent drug that has a favorable effect on all kinds of
cholesterol, raising levels of “good” HDL cholesterol and lowering levels of LDL cholesterol, triglycerides and total cholesterol. Doses high enough to have a
pharmaceutical effect also have potent adverse effects, Dr. Hendler said,
especially “niacin flush,” which is common, and liver toxicity, which is less
so.
There are three delivery forms for
pharmaceutical niacin, Dr. Hendler said: immediate-release (crystalline)
niacin, an intermediate (extended-release) form and a sustained-release, or
slow-release, form.
“Flushing
is most severe with the immediate-release form,” which is the cheapest, he
said, “while the sustained-release form is the one most likely to be associated
with gastrointestinal and liver problems.” The intermediate-release form is
less likely to be associated with these adverse effects and is generally better
tolerated, he said, but it is also much more expensive than the generic niacin
formulations that can be obtained over the counter