Class: Antilipemic Agents, Miscellaneous
ATC Class: A11HA01
VA Class: VT103
CAS Number: 59-67-6
Brands: Advicor, Niacor, Niaspan, Nicotinex, Nico-400, Slo-Niacin
Introduction
Water-soluble, B complex vitamin.a Prescription-only preparations are FDA-labeled for use as antilipemic agents.a
Do not use dietary supplement preparations and prescription-only preparations interchangeably.178 191 (See Substitution of Different Niacin Preparations under Cautions.)
Uses for Niacin
Prevention of Cardiovascular Events
Adjunct to dietary therapy in patients with a history of MI and hypercholesterolemia to reduce the risk of recurrent nonfatal MI.160
Adjunct to bile acid sequestrant therapy in patients with CHD and hypercholesterolemia to slow progression or promote regression of atherosclerosis.134 157 158 160
Dyslipidemias
Adjunct to dietary therapy to decrease elevated serum total cholesterol, LDL-cholesterol, apolipoprotein B (apo B), and triglyceride concentrations, and to increase HDL-cholesterol concentrations in the management of primary hypercholesterolemia and mixed dyslipidemia, including heterozygous familial hypercholesterolemia and other causes of hypercholesterolemia (e.g., polygenic hypercholesterolemia).107 120 121 122 124 156 160 161 163 181 Fixed combination of extended-release niacin and lovastatin (Advicor) should not be used as initial antilipemic therapy.188
Adjunctive therapy in the management of severe hypertriglyceridemia in patients at risk of developing pancreatitis (typically those with serum triglyceride concentrations >2000 mg/dL and elevated concentrations of VLDL-cholesterol and fasting chylomicrons) who do not respond adequately to dietary management.160 161
Also may be used in patients with triglyceride concentrations of 1000–2000 mg/dL who have a history of pancreatitis or of recurrent abdominal pain typical of pancreatitis.160 161
Efficacy in patients with type IV hyperlipoproteinemia and triglyceride concentrations <1000 mg/dL who exhibit type V patterns subsequent to dietary or alcoholic indiscretion not adequately studied.160
Not indicated for use in patients with type I hyperlipoproteinemia who have elevated triglyceride and chylomicron concentrations but normal VLDL-cholesterol concentrations.160 161
Dietary Requirements
Adequate intake of niacin needed to prevent niacin deficiency and pellagra.a
In the US, niacin is principally obtained from fish, meat, or poultry, and niacin-enriched or niacin-fortified food (e.g., enriched and whole grain breads and bread products). Conversion of dietary tryptophan to niacin also contributes to niacin intake.
Niacin Deficiency and Pellagra
Prevention of niacin deficiency.a
Treatment of pellagra.a Niacinamide preferred by some clinicians due to its lack of vasodilating effects.a
Niacin Dosage and Administration
General
Dietary supplements containing niacin are not FDA-labeled for prevention of cardiovascular events or management of dyslipidemias; use prescription-only preparations for these indications.191
Do not use different formulations (i.e., immediate-release, extended-release) interchangeably since pharmacokinetics (e.g., metabolism) may vary.160 161 (See Substitution of Different Niacin Preparations under Cautions.)
Minimize flushing, pruritus, and GI distress by initiating therapy at low dosages, increasing dosage gradually, and avoiding administration on an empty stomach.160 161 186 188 May also administer a prostaglandin-synthesis inhibitor (e.g., aspirin 325 mg, ibuprofen 200 mg) 30 minutes prior to administration of niacin to reduce flushing.104 105 106 107 118 124 151 160 161 186 188
Administration
Oral Administration
Immediate-release niacin (e.g., Niacor): Administer orally with meals.161
Extended-release niacin (Niaspan) or extended-release niacin/lovastatin fixed combination (Advicor): Administer orally at bedtime following a low-fat snack.160 188 Take tablets whole; do not break, crush, or chew.160 188 Do not administer Advicor with grapefruit juice due to increased risk of myopathy associated with lovastatin component.188
To minimize risk of flushing or pruritus, avoid administering concomitantly with alcohol or hot drinks.160 161 188
Dosage
Commercially available as dietary supplements and as prescription-only preparations.160 161 188 Do not use these preparations interchangeably.190 191 (See Substitution of Different Niacin Preparations under Cautions.)
Pediatric Patients
Dietary Requirements
Recommended Daily Allowance (RDA) generally expressed in terms of niacin equivalents (NE).a NE is calculated as follows: 1 mg of NE = 1 mg of niacin = 60 mg of tryptophan.
Oral
Recommended Dietary Allowance (RDA) is nutrient recommendation from National Academy of Sciences (NAS) for children and adults. The RDA for a given nutrient is the goal for dietary intake in individuals.
Adequate Intake (AI) is nutrient recommendation from NAS for infants ≤12 months of age; used when data are insufficient or too controversial to establish an RDA. AI set for infants ≤6 months of age is based on the observed mean niacin intake of infants fed principally human milk. AI set for infants 6–12 months of age is based on the AI for younger infants and data from adults.
Age | RDA | AI |
|---|---|---|
0–6 months |
| 2 mg of preformed niacin (0.3 mg/kg) daily |
6–12 months |
| 4 mg of NE (0.4 mg/kg) daily |
1–3 years | 6 mg of NE daily |
|
4–8 years | 8 mg of NE daily |
|
9–13 years | 12 mg of NE daily |
|
14–18 years | Boys: 16 mg of NE daily |
|
Niacin Deficiency
Pellagra
Oral
Niacin or niacinamide: 100–300 mg daily in divided doses.a
Adults
Prevention of Cardiovascular Events
Oral
Extended-release niacin (Niaspan): Initially, 500 mg once daily at bedtime.160 If response is inadequate, increase dosage by no more than 500 mg at 4-week intervals until desired effect is observed or maximum daily dosage of 2 g is reached.160
Usual maintenance dosage is 1–2 g once daily at bedtime.160
In patients previously treated with immediate-release preparations or in those who have discontinued extended-release niacin (Niaspan) therapy for an extended period, titrate dosage as with initial therapy.160
Dyslipidemias
Oral
Immediate-release preparations: Initially, 100–500 mg 3 times daily.b Increase dosage gradually (e.g., 300 mg daily at 4- to 7-day intervals) until desired effect is achieved.b Usual maintenance dosage is 1.5–3 g daily given in 2 or 3 divided doses.187
Initial dosage of 250 mg daily following the evening meal recommended by manufacturer of Niacor (immediate-release preparation).161 Increase dosage of Niacor at 4- to 7-day intervals until desired effect is achieved or dosage of 1.5–2 g daily is reached.161 If adequate response is not achieved after 2 months, may then increase dosage at 2- to 4-week intervals to 3 g daily (1 g 3 times daily).161 Manufacturer of Niacor states that higher doses (up to 6 g daily) occasionally may be required in patients with marked lipid abnormalities.161 Usual maintenance dosage recommended by manufacturer of Niacor is 1–2 g daily given in 2 or 3 divided doses.161
Extended-release niacin (Niaspan): Initially, 500 mg once daily at bedtime.160 If adequate response is not achieved after 4 weeks, increase dosage by no more than 500 mg at 4-week intervals until desired effect is observed.160 Usual maintenance dosage is 1–2 g once daily at bedtime.160 Titrate Niaspan dosage as with initial therapy in patients previously treated with immediate-release niacin preparations or in those in whom therapy with extended-release niacin (Niaspan) has been discontinued for a prolonged period.160
Extended-release niacin (Niaspan) and lovastatin combination therapy: In patients already receiving a stable dosage of lovastatin, add Niaspan (using recommended titration schedule).160 In patients already receiving a stable dosage of Niaspan, add lovastatin (at initial dosage of 20 mg once daily).160 Adjust dosage at 4-week intervals.160
Fixed combination of extended-release niacin and lovastatin (Advicor): Use only in patients already receiving a stable dosage of Niaspan; in patients currently receiving niacin preparations other than Niaspan, discontinue current niacin therapy and switch to Niaspan.188 Once a stable Niaspan dosage is reached, switch to Advicor at the same niacin-equivalent dosage as Niaspan.188 In patients currently receiving a stable dosage of lovastatin, add Niaspan (using the recommended titration schedule) until a stable dosage has been reached, then switch to Advicor at the same niacin-equivalent dosage as Niaspan.188 Increase Advicor dosage by no more than 500 mg (of the niacin component) at 4-week intervals.188 Usual maintenance dosage ranges from 500 mg of extended-release niacin and 20 mg of lovastatin to 2 g of extended-release niacin and 40 mg of lovastatin once daily.188 If Advicor therapy has been discontinued for >7 days, reinstitute at the lowest available dosage.188 Because of differences in bioavailability, do not substitute 1 tablet of Advicor 1 g/40 mg for 2 tablets of Advicor 500 mg/20 mg, or vice versa.188
Dietary Requirements
RDA generally expressed in terms of NE.a NE is calculated as follows: 1 mg of NE = 1 mg of niacin = 60 mg of tryptophan.
Oral
RDA for healthy men: 16 mg of NE daily.
RDA for healthy women: 14 mg of NE daily.
RDA for pregnant women: 18 mg of NE daily. Higher dosages required in women pregnant with >1 fetus.
RDA for lactating women: 17 mg of NE daily. Higher dosages required in mothers nursing >1 infant.
Higher dosages required in patients with Hartnup disease, liver cirrhosis, carcinoid syndrome, malabsorption syndrome, or in individuals receiving long-term isoniazid therapy or undergoing hemodialysis or peritoneal dialysis.
Niacin Deficiency
Pellagra
Oral
Niacin or niacinamide: 300–500 mg daily in divided doses.a
Hartnup Disease
Oral
Niacin: 50–200 mg daily.a
Prescribing Limits
Adults
Prevention of Cardiovascular Events
Oral
Extended-release niacin (Niaspan): Maximum 2 g daily.160
Dyslipidemias
Oral
Immediate-release preparations: Maximum 4.5 g daily;187 manufacturer of Niacor states that maximum of 6 g daily generally should not be exceeded.161
Extended-release niacin (Niaspan): Maximum 2 g daily.160 When used in combination with lovastatin, maximum 2 g of Niaspan and 40 mg of lovastatin daily.160
Fixed combination of extended-release niacin and lovastatin (Advicor): Maximum 2 g of extended-release niacin and 40 mg of lovastatin daily.188
Cautions for Niacin
Contraindications
Known hypersensitivity to niacin or any ingredient in the formulation.160 161 188
Active liver disease or unexplained persistent elevations of serum transaminases, active peptic ulcer disease, or arterial bleeding.160 161 188
Extended-release niacin in fixed combination with lovastatin (Advicor) contraindicated in pregnant or lactating women.188
Warnings/Precautions
Warnings
Substitution of Different Niacin Preparations
Do not use dietary supplement preparations and prescription-only preparations interchangeably.178 191 Do not use different formulations (i.e., immediate-release, extended-release) interchangeably.141 160 161 178 Severe hepatic toxicity (e.g., fulminant hepatic necrosis) reported in some individuals who substituted certain sustained-release niacin preparations for immediate-release niacin at equivalent dosages.140 143 160 161 178 c d
Hepatic Effects
Abnormal liver function test results160 161 162 163 188 (e.g., increased serum bilirubin, AST, ALT, and LDH concentrations), hypoalbuminemia, cholelithiasis, jaundice,160 161 162 188 hepatitis,181 188 e chronic liver damage,160 161 and hepatic failure140 143 162 reported.
Perform liver function tests before initiation of therapy, every 6–12 weeks for the remainder of the first year, and periodically thereafter (e.g., semiannually).160 161 188
If increased serum AST/ALT concentrations or manifestations of liver disease occur, perform second liver function evaluation to confirm findings and continue monitoring liver function until abnormalities return to normal.160 161 188 If increases in AST or ALT concentrations of ≥3 times the ULN persist, or if associated with nausea, fever, and/or malaise, discontinue therapy.160 161 188 Consider performing liver biopsy if elevations persist after discontinuance of therapy.161
Musculoskeletal Effects
Elevations in serum creatine kinase (CK, creatine phosphokinase, CPK),163 myalgia,188 myopathy,160 163 188 and rhabdomyolysis reported with niacin alone152 or in combination with other antilipemic agents (e.g., gemfibrozil,152 various statins).134 135 136 137 147 160
Carefully monitor patients for signs and symptoms of muscle pain, tenderness, or weakness, especially early in the course of therapy or during upward titration.160 161 188 Consider periodic monitoring of serum CK and potassium concentrations in patients exhibiting such symptoms;160 161 no assurance that such monitoring will prevent occurrence of severe myopathy.160 161 188
Fixed-combination Preparation (Advicor)
When using the fixed-combination preparation containing lovastatin, consider the cautions, precautions, and contraindications associated with lovastatin.188
Sensitivity Reactions
Hypersensitivity Reactions
Hypersensitivity reactions (e.g., anaphylaxis, angioedema, urticaria, flushing, dyspnea, tongue edema, laryngeal edema, facial edema, peripheral edema, laryngismus, vesiculobullous rash) reported rarely.160
Major Toxicities
Effects on Glucose Tolerance
Decreased glucose tolerance, hyperglycemia, and glycosuria reported.160 161 a Closely observe patients with (or those at risk of developing) diabetes mellitus.160 Monitor blood glucose concentrations periodically (especially early in the course of therapy) and adjust dosages of niacin and/or antidiabetic agents as appropriate.160 167 188
Hematologic Effects
Increased PT and decreased platelet count reported.160 188 Use with caution in patients undergoing surgery.160 188 Closely monitor PT and platelet count in patients receiving niacin concomitantly with anticoagulants.160
Metabolic Effects
Hyperuricemia reported; use with caution in patients predisposed to gout.160 161 188
Reductions in phosphorus concentrations reported;160 monitor phosphorus concentrations periodically in patients at risk for developing hypophosphatemia.160 188
General Precautions
Role as Adjunct Therapy
Prior to institution of antilipemic therapy, vigorously attempt to control serum cholesterol by appropriate dietary regimens, weight reduction, exercise, and treatment of any underlying disorder that might be the cause of lipid abnormality.160 161
Concomitant Illnesses
Use with caution in patients with unstable angina, AMI, or CHD, particularly when these patients also are receiving vasoactive drugs such as nitrates, calcium-channel blockers, or adrenergic-blocking agents.160 161 188
Use with caution and closely observe patients with history of jaundice, hepatobiliary disease, or peptic ulcer disease.160
Use with caution in patients with renal or hepatic impairment; lack of data in such patients.160 (See Specific Populations under Cautions.)
Specific Populations
Pregnancy
Category C.160 If used for primary hypercholesterolemia, discontinue therapy when patient becomes pregnant.160 161 188 If used for hypertriglyceridemia, assess benefits and risks of continued therapy.160 161 188
Fixed combination of extended-release niacin and lovastatin (Advicor): Category X (due to lovastatin component).188
Lactation
Distributed into milk.160 188 Discontinue nursing or the drug.160 161
Advicor should not be used in nursing women.188
Pediatric Use
Safety and efficacy not established in children or adolescents161 ≤16 years of age.160
Extended-release niacin (Niaspan): Safety and efficacy not evaluated in patients <21 years of age.160
Fixed combination of extended-release niacin and lovastatin (Advicor): Safety and efficacy not evaluated in patients <18 years of age.188 Manufacturer states that use of Advicor not currently recommended in patients <18 years of age.188
Geriatric Use
Extended-release niacin (Niaspan): No overall differences in safety and efficacy relative to younger adults, but increased sensitivity cannot be ruled out.160
Fixed combination of extended-release niacin and lovastatin (Advicor): No substantial differences in safety and efficacy relative to younger adults; however, higher serum amylase concentrations observed in geriatric patients.188
Hepatic Impairment
Use with caution in patients who consume substantial amounts of alcohol and/or have a history of liver disease.160
Renal Impairment
Use with caution.160 188
Common Adverse Effects
Flushing (e.g., warmth, redness, itching and/or tingling), headache, pain, abdominal pain, diarrhea, dyspepsia, nausea, vomiting, rhinitis, pruritus, rash.160 161 188
Interactions for Niacin
Ganglionic Blocking and Vasoactive Drugs
Potentiation of hypotensive effects, resulting in postural hypotension.160 161 188
Specific Drugs and Laboratory Tests
Drug or Test | Interaction | Comments |
|---|---|---|
Anticoagulants, coumarin | Potential additive anticoagulant effect (increased PT and decreased platelet count reported with niacin alone or combined with lovastatin)160 188 | Closely monitor PT and platelet count.160 In patients receiving fixed combination of extended-release niacin and lovastatin (Advicor), closely monitor PT upon initiation of such therapy or dosage adjustment; when stabilized, monitor PT at intervals recommended for patients receiving coumarin anticoagulants188 |
Antihypertensive agents (e.g., ganglionic blocking drugs, vasoactive agents) | Possible potentiation of hypotensive effects160 161 188 | |
Aspirin | Decreased niacin metabolic clearance160 161 188 | Clinical relevance not fully elucidated160 160 188 |
Bile acid sequestrants (cholestyramine, colestipol) | Decreased niacin bioavailability due to binding of niacin to bile acid sequestrant160 188 | Administer niacin and bile acid sequestrant at least 4–6 hours apart160 188 |
HMG-CoA reductase inhibitors (statins) | Possible increased risk of myopathy and rhabdomyolysis when used concomitantly with niacin dosages >1 g daily;134 135 136 137 160 161 rhabdomyolysis not reported in clinical studies of up to 2 years’ duration with Niaspan-statin combination or with Advicor160 188 | Carefully weigh potential benefits and risks of combined therapy; advise patients of risks if such therapy is employed160 161 |
Isoniazid, long-term therapy | Possible interference with conversion of dietary tryptophan to niacin. Possible increased niacin requirement | |
Vitamins or nutritional supplements containing large doses of niacin or nicotinamide | Potentiation of niacin adverse effects160 | |
Tests for catecholamines | Possible false elevations in some fluorometric determinations of plasma or urinary catecholamines160 | |
Tests for urine glucose | Possible false-positive reactions with cupric sulfate solution (Benedict’s reagent)160 |
Niacin Pharmacokinetics
Absorption
Bioavailability
Rapidly and extensively (60–76% of dose) absorbed following oral administration.160 161 166
Peak plasma concentrations attained within 30–60 minutes or 4–5 hours following oral administration of immediate-release niacin (Niacor) or extended-release niacin (Niaspan), respectively.160 161 162 163 166
Bioavailability of 1 tablet containing 1 g of extended-release niacin in fixed combination with 40 mg of lovastatin (Advicor 1 g/40 mg) differs from that of 2 tablets each containing 500 mg of extended-release niacin in fixed combination with 20 mg of lovastatin (Advicor 500 mg/20 mg).188 (See Adults: Dyslipidemias under Dosage and Administration.)
Onset
Reductions in triglyceride concentrations apparent within 1–4 days.162 Reductions in LDL-cholesterol concentrations achieved within 3–5 weeks.162
In the treatment of pellagra, redness and swelling of the tongue disappear within 24–72 hours, mental symptoms and infections of the mouth and other mucous membranes clear rapidly, and GI symptoms disappear within 24 hours.a
Special Populations
Peak plasma concentrations following oral administration of Niaspan appear to be slightly higher in women than in men, possibly because of differences in metabolism.160 166
Distribution
Extent
Distributed mainly to the liver, kidney, and adipose tissue.160
Distributed into milk.160
Elimination
Metabolism
Rapidly metabolized; undergoes extensive first-pass metabolism.160
Converted to several metabolites, including nicotinuric acid (NUA), nicotinamide, and nicotinamide adenine dinucleotide (NAD).160 164 166 Nicotinamide does not appear to exert antilipemic effects;160 the activity of other metabolites on lipoprotein fractions currently unknown.160
Elimination Route
Niacin and metabolites are rapidly excreted in urine.160 161 162 163
Immediate-release niacin (e.g., Niacor): Approximately 88% of oral dose excreted in urine as unchanged drug and inactive metabolites.161
Extended-release niacin (Niaspan): Approximately 60–76% of oral dose excreted in urine as unchanged drug and inactive metabolites.160 166
Half-life
20–60 minutes.161 162 163
Stability
Storage
Oral
Tablets
Advicor or Niaspan: 20–25°C.160 188
Niacor: 15–30°C.161
ActionsActions
Niacinamide (formed from conversion of niacin) required for lipid metabolism, tissue respiration, and glycogenolysis.a
At daily dosages ≥1 g, niacin decreases serum total cholesterol, LDL-cholesterol, VLDL-cholesterol, and triglyceride concentrations, and increases serum HDL-cholesterol concentrations in patients with type II, III, IV, or V hyperlipoproteinemia.151 160 161 162 163 165 Mechanism of antilipemic effects independent of role as vitamin.160 161 162 Has no effect on cholesterol synthesis or fecal excretion of fats, sterols, or bile acids.162 Refractoriness to antilipemic effects of large niacin doses reported.b
Slows progression and promotes regression of coronary atherosclerotic lesions.160 161 129 157
Causes only cutaneous vasodilation at daily dosages of 300–800 mg.a May cause histamine release (resulting in increased gastric motility and acid secretion) and activate fibrinolytic system.a
Advice to Patients
Risk of flushing; may vary in severity, last for several hours, and likely occur during sleep if niacin taken at bedtime.160 161 Pretreatment with aspirin or other NSAIA (e.g., taken 30 minutes prior to extended-release niacin [Niaspan] dose) may minimize flushing.160 161 If awakened by flushing at night, patient should get up slowly, especially if flushing is accompanied by a feeling of dizziness or fainting, or if patient is receiving antihypertensive therapy.160
Importance of informing clinician if dizziness occurs.160
In patients with diabetes mellitus, importance of informing clinician of changes in blood glucose values.160
Importance of informing clinician if niacin therapy has been discontinued for an extended period of time (retitration of dosage is recommended in such cases).160
Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs and dietary or herbal supplements (especially those containing niacin or nicotinamide), as well as any concomitant illnesses.160
Importance of women informing their clinician if they are or plan to become pregnant or plan to breast-feed; necessity for clinicians to advise women to avoid pregnancy during therapy, advise pregnant women of risk to the fetus, and advise males to use effective contraception during therapy.
Importance of informing patients of other important precautionary information. (See Cautions.)
Preparations
Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.
* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name
Routes | Dosage Forms | Strengths | Brand Names | Manufacturer |
|---|---|---|---|---|
Bulk | Powder* | |||
Oral | Capsules, extended-release | 125 mg* | ||
250 mg* | ||||
400 mg* | Nico-400 | King | ||
500 mg* | ||||
Elixir | 50 mg/5 mL | Nicotinex (with alcohol 14%) | Fleming | |
Tablets | 50 mg* | |||
100 mg* | ||||
250 mg* | ||||
500 mg* | Niacor (scored) | Upsher-Smith | ||
Tablets, extended-release | 250 mg* | Slo-Niacin | Upsher-Smith | |
500 mg* | Niaspan | Kos | ||
Slo-Niacin | Upsher-Smith | |||
750 mg* | Niaspan | Kos | ||
Slo-Niacin | Upsher-Smith | |||
1000 mg | Niaspan | Kos |
Routes | Dosage Forms | Strengths | Brand Names | Manufacturer |
|---|---|---|---|---|
Oral | Tablets, extended-release | 500 mg with Lovastatin 20 mg | Advicor (with povidone) | Kos |
750 mg with Lovastatin 20 mg | Advicor (with povidone) | Kos | ||
1 g with Lovastatin 20 mg | Advicor (with povidone) | Kos | ||
1 g with Lovastatin 40 mg | Advicor (with povidone) | Kos |
Niacin and niacinamide are also commercially available in combination with other vitamins, minerals, cerebral stimulants, sedatives, antacids, amino acids, hormones, infant formulas, vasodilators, antihistamines, local anesthetics, expectorants, enzymes, and laxatives.a For IV infusion, niacinamide is commercially available in combination with other vitamins in caloric and electrolyte solutions.a
Comparative Pricing
This pricing information is subject to change at the sole discretion of DS Pharmacy. This pricing information was updated 03/2011. Actual costs to patients will vary depending on the use of specific retail or mail-order locations and health insurance copays.
Advicor 1000-20MG 24-hr Tablets (ABBOTT): 60/$257.99 or 180/$740.96
Advicor 1000-40MG 24-hr Tablets (ABBOTT): 90/$433.97 or 180/$863.95
Advicor 500-20MG 24-hr Tablets (ABBOTT): 90/$330.98 or 180/$650.97
Advicor 750-20MG 24-hr Tablets (ABBOTT): 60/$264.98 or 180/$772.93
Niacin 500MG Tablets (RUGBY): 100/$11.99 or 200/$16.96
Niaspan 1000MG Controlled-release Tablets (ABBOTT): 30/$149.99 or 90/$432.97
Niaspan 500MG Controlled-release Tablets (ABBOTT): 30/$87.99 or 90/$240.97
Niaspan 750MG Controlled-release Tablets (ABBOTT): 30/$119.99 or 90/$332.98
Slo-Niacin 500MG Controlled-release Tablets (UPSHER-SMITH): 100/$25.99 or 200/$41.97
Disclaimer
This report on medications is for your information only, and is not considered individual patient advice. Because of the changing nature of drug information, please consult your physician or pharmacist about specific clinical use.
The American Society of Health-System Pharmacists, Inc. and Drugs.com represent that the information provided hereunder was formulated with a reasonable standard of care, and in conformity with professional standards in the field. The American Society of Health-System Pharmacists, Inc. and Drugs.com make no representations or warranties, express or implied, including, but not limited to, any implied warranty of merchantability and/or fitness for a particular purpose, with respect to such information and specifically disclaims all such warranties. Users are advised that decisions regarding drug therapy are complex medical decisions requiring the independent, informed decision of an appropriate health care professional, and the information is provided for informational purposes only. The entire monograph for a drug should be reviewed for a thorough understanding of the drug's actions, uses and side effects. The American Society of Health-System Pharmacists, Inc. and Drugs.com do not endorse or recommend the use of any drug. The information is not a substitute for medical care.
AHFS Drug Information. © Copyright, 1959-2011, Selected Revisions June 2006. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.
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