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Last post 02-17-2009 2:14 PM by cartoon. 0 replies.
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  • 02-17-2009 2:14 PM



    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

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