TYPES OF OVER THE COUNTER PREPARATIONS:

No-flush niacin (inositol hexaniacinate)

• Also called “zero-flush” or “flush-free”
• Does not contain niacin, but gets broken down to niacin in the body but at much lower levels than other forms of niacin
• Effects on lipids are not as well studied as other forms of niacin
• Patients do not have flushing with inositol hexaniacinate
• Most expensive form of over the counter niacin
• Doses of 2000-3000 mg daily are needed to be effective and then only works well in about half of patients so close monitoring of effect is needed

Sustained-release

• Also called “controlled-release” or “timed-release”
• Cause less flushing than immediate release preparations
• Several formulations have been shown to be more likely to cause liver
• Toxicity than the immediate release
• Examples:  Slo-Niacin and Enduracin

Immediate release

·         Also called “crystalline” or “plain” niacin

·         Absorbed within 1 hour of ingestion

·         Used safely for > 40 years

·         Least expensive form of niacin

·         Usually more flushing than above forms and must take 3 times a day

o   Flushing can be reduced by taking after meals, taking an 81 mg aspirin 30 minutes prior to niacin, and avoiding hot drinks, spicy foods, and alcohol with niacin

Sample Titration Schedule for Immediate Release Niacin—100 mg tablets

Week	Breakfast	Lunch	Dinner
1	1 tablet	1 tablet	1 tablet
2	2 tablets	2 tablets	2 tablets
3	3 tablets	3 tablets	3 tablets
4	4 tablets	4 tablets	4 tablets
5	5 tablets	5 tablets	5 tablets