Sustained release niacin at 500 mg daily for 4 weeks followed by 1000 mg daily for 4 weeks resulted in compliance of over 90%, increased HDL by 17%, LDL decreased by 11%, and did not result in any significant transaminase elevations (64). Sustained release niacin dose should therefore be limited to 1000 mg daily because it is tolerated well and has less hepatotoxicity than higher doses (64).
Immediate release niacin:
The ADMIT study (Arterial Disease Multiple Intervention Trial), evaluated immediate release niacin at a dose escalation up to 3000 mg daily in a large study group for 48 weeks and found the following results (65):
- Significant lowering of total cholesterol, LDL, and triglycerides.
- Significant increase in HDL.
Niacin and homocysteine:
Niacin administration is associated with increased plasma homocysteine levels in patients who have peripheral arterial disease (PAD, plaque build-up in the arteries), report the authors of this study of 55 participants from a randomized, placebo-controlled study. Niacin, increased daily from 100 mg to 1000 mg, was associated with a 17% increase in average homocysteine level. After 18 weeks on treatment, average homocysteine level in the niacin group had increased by 55% but in the placebo group the average level had decreased by 7%. This group difference was still present after 48 weeks of follow-up. (66)
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