Good-by Niaspan. Welcome back Immediate release niacin.


One of my clients who has been on Niaspan for 14 years informs me that he has experienced unsolicited advice from many would-be physicians as well as recently trained physicians about the inadvisability of the medication Niaspan. Now this patient had Familial Combined hyperlipidemia with total cholesterols in the 220 range and mildly elevated triglycerides. His ApoB was in the top 5%. For years his total LDL-P has been lowered in the 700 nmol per liter range (bottom 1%) and he has succeeded in reaching the age of 80 without an untoward cardiovascular event. Yet many unsolicited advisors have the chutzpah to make recommendations without benefit of a required medical degree and also physicians with an insufficient experience with this medication. It was noteworthy to hear that at least one of these would-be advisors did recommend particle numbers over the standard lipid panel.

Now the recent generation of physicians who read the flawed and fake AIM-HIGH or HPS Thrive II as if it were Gospel do not have the benefit of the experience nor can they recall the previous trials involving niacin prior to AIM-HIGH or HPS Thrive II, in which the use of niacin had beneficial effects. Now based on AIM-HIGH or HPS Thrive II, how many of you think I should have discontinued niacin in this patient. I know Lipidology lecturers who did exactly that to the point of discontinuing their own Niaspan even though there was not one untoward reaction. After all in reality niacin is nothing but a vitamin. 

It is amazing at National Lipid Association( NLA) meetings to hear the contrast between how old-timers who have had experience with niacin and today’s new generations describe this medication. It is amazing how the pharmaceutical companies with its arm twister, the so-called evidence based medicine trials which apply to very  few in the clinical world, can control the thinking process of the great majority of today’s recently trained physicians and even some old-timers.

Recently the price of Niaspan has shot out of sight reaching up to $700 or more for a 30 day supply of 1000 mg  which is directly an abuse perpetrated by our pharmaceutical corporations and their control of the medical delivery system. On the brighter side with regard to Nisapan, there is a much cheaper alternative i’e. Immediate release niacin costing a little over $8. for #100 500 mg tabs. Because of the gouging by the pharmaceutical industry allowed by our medical delivery system, I am in process of switching the majority of my clients from Niaspan to immediate release niacin and I have no intention to write any further Niaspan prescriptions, or to be a further unwitting or witting accomplice to the pharmaceutical industriy in the fleecing of America. 

I have been successful in minimizing the cost of many of the other anti-cholesterol medications to an affordable level for the vast majority of my clients. Looking into the future, I do not envision, except for the ASO for ApoCIII,  a meditation that should be a clear rival for niacin but if anything this meditation because of the profit motive, similar to PCSK9 inhibitors with its excessive cost, injudicious indications and really unknown future side effects will probably be financially unavailable to many of the US citizens who could benefit. 

For those who now still benefit and will continue to benefit from niacin in the future, I say, Thank God for immediate release niacin.

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