| Nicotinic acid: new/old drug. Immediate or sustained release: too risky for a drug with no proven benefit. | |
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MedLine Citation:
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PMID: 17165243 Owner: HSR Status: MEDLINE |
Abstract/OtherAbstract:
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(1) For patients with hypercholesterolaemia requiring primary or secondary prevention, pravastatin, simvastatin and atorvastatin have a proven benefit in terms of mortality and/or morbidity. Gemfibrozil and cholestyramine have a proven impact on morbidity. (2) The lipid-lowering properties of immediate-release nicotinic acid have been known for about 50 years, as have its frequent and sometimes severe adverse effects. About 70% of patients experience cutaneous flushing, and 20-30% develop gastrointestinal adverse effects. Hepatotoxic effects occur in about 2% of patients, especially in those using high daily doses or sustained-release formulations. (3) The clinical evaluation of immediate-release nicotinic acid is mainly based on two comparative placebo-controlled trials. One, involving 5000 patients monitored on average for 15 years, showed no effect on survival. One trial suggested that immediate-release nicotinic acid reduced the risk of recurrent myocardial infarction. (4) Sustained-release nicotinic acid has not been evaluated in terms of its effect on morbidity or mortality. It has been shown to lower LDL cholesterol and triglyceride levels and to raise the HDL cholesterol level. (5) This new pharmaceutical formulation has a profile and frequency of known adverse effects similar to those of immediate-release nicotinic acid. (6) When hypercholesterolaemia persists despite an appropriate diet, it is best to use one drug with a proven preventive impact on mortality and/or morbidity. This is not the case for sustained-release nicotinic acid. (7) When statin therapy is inadequate, it remains to be shown whether adding another cholesterol-lowering drug is beneficial in terms of morbidity and mortality. If, in rare cases, combination with a statin is envisaged, it is best to use gemfibrozil or cholestyramine. Note that gemfibrozil should only be combined with a statin with the greatest caution. |
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Authors:
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Publication Detail:
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Type: Comparative Study; Journal Article |
Journal Detail:
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Title: Prescrire international Volume: 15 ISSN: 1167-7422 ISO Abbreviation: Prescrire Int Publication Date: 2006 Dec |
Date Detail:
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Created Date: 2006-12-13 Completed Date: 2006-12-27 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 9439295 Medline TA: Prescrire Int Country: France |
Other Details:
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Languages: eng Pagination: 213-6 Citation Subset: T |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Anticholesteremic Agents
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administration & dosage,
adverse effects,
therapeutic use Cardiovascular Diseases / mortality Cost-Benefit Analysis Drug Therapy, Combination France Humans Hydroxymethylglutaryl-CoA Reductase Inhibitors / administration & dosage, adverse effects, therapeutic use Hypercholesterolemia / drug therapy* Lipoproteins, HDL / drug effects Lipoproteins, LDL / drug effects Nicotinic Acids / administration & dosage, adverse effects, therapeutic use* Randomized Controlled Trials as Topic Treatment Outcome |
| Chemical | |
Reg. No./Substance:
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0/Anticholesteremic Agents; 0/Hydroxymethylglutaryl-CoA Reductase Inhibitors; 0/Lipoproteins, HDL; 0/Lipoproteins, LDL; 0/Nicotinic Acids |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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