Alternative Cholesterol Medication (Niacin)

[hbert]

I have read in previous threads on this board that Niacin might be a viable alternative to the commonly used cholesterol lowering drugs.

I am currently using Crestor but would be interested in Niacin since I get a few of the mild symptoms of side effects (joint pain, rashes).

I would be interested in using Niacin instead but how do I best approach my doctor?

The start: I have read on Internet that Niacin..etc. etc. might not be the best way to get your doctors full attention.

Any suggestions highly appreciated.

[Naam]

have you tried Lipitor?

[Genericnic]

hbert,

I take niacin but it is only an adjunct to the Lipitor. Niacin alone may bring the serum cholesterol down a bit but change of diet is the best line of defense. If you can find a copy, I highly recommend "<a href="http://www.amazon.com/8-Week-Cholesterol-Cure-Percent-Deprivation/dp/006109773X/ref=sr_1_28?ie=UTF8&s=books&qid=1278296037&sr=1-28">The 8 Week Cholesterol Cure</a>." This is the original edition, which I find better written than the new version. It gives some very good guidance to changing the diet first with the addition of time-release niacin. Incorportate statins if it doesn't come down enough. The diet/niacin part brought mine down quite a bit and if it wasn't for the hereditary high cholesterol, that would probably have been enough.

By the way, the time release niacin made by <a href="http://www.endur.com/index.cfm?fuseaction=shopping.display&subcatid=2&parentid=1&parentpage=0">Endurance Products</a> is excellent if you get flushing from the niacin. Most of the folks I know that take the Endur-Acin 500mg tablets get no flushing at all. I've been using them for well over 10 years.  (no, they don't pay me to say that)

Good luck with it and stay on top of it. Better to head off the problem than to try to correct it later.

David

Edited July 5, 2010 by Genericnic

[george]

You may try Supralip NT 145mg. A tad expensive but for me no side effects at all.

[hbert]

I have not used Lipitor. Does Lipitor have less side effects?

I have changed lifestyle and eating habits after my by-pass operation.

I exercise regularly one hour per day and I do really try to eat healthy.

Thanks "Genericnic" for the reading material, I might order it.

My Cholesterol values are now down so the Crestor medication and lifestyle changes seems to do its job.

My only concern now is the mild symptoms of side effects and also a slightly low HDL value (~40 mg/dL).

So my question still remain.

How to bring up an alternative treatment plan to my doctor, which I do respect, and consider very knowledgeable, without getting on the wrong side of him?

[hhgz]

"How to bring up an alternative treatment plan to my doctor..."

Just as you did with the TV forum. "I've read that niacin might be effective in lowering my cholesterol..." It is just that simple. Doctors like to treat patients that are educated and engaged with their health care. If you approach the doctor (as some TVers have), "Hey, doc, I know that you're trying to cheat me, and that you get a kickback on any medications that you prescribe...", you might find the doctor less likely to listen to your perspective.

[Sheryl]

Lipitor and Crestor are bot statins, same class of drugs and same side effects. Some people tolerate these drugs just fine but others do indeed experience problems such as muscle pain and poor memory. If you are having problems with Crestor odds are you'll have the same with Lipitor.

Suprlip is a fibrate, different class of drug than statin and different mode of action. But fibrates also have significant side effects in some people.

In some cases both a fibrate and statin are used although such combination therapy also carries a greater risk of serious side effects.

Niacin is not totally without adverse effects, either, although other than hot flashes/flush (dealt with by taking a sustained release formulation at bedtime so you sleep through it), they are not that common. But can happen.

All 3 types (niacion, fibratem, statin) are metabolized in the liver and can have adverse effects on the liver and this people on any of them need check liver enzymes (AST/ALT) before starting and then periodically thereafter.

In short there is no magic drug free of side effects. Also need to understand that not all hyperlipedemias are the same and that some types respond better to certain drugs than to others. That said, I do agree that the statins have been very aggressively hyped by the drug companies and that this has unduly influenced prescribing patterns, and that Niacin is underutilized. Some doctors are not even aware that a sustained release formulation (Niaspan) is available which gets around some of the earlier disadvantages to niacin therapy.

Suggest you tell your doctor you are not tolerating the statin well and wish to switch to a different class of drug, and then ask specifically about sustained release Niaspan. If the doctor does not take kindly to such questioning, personally, I'd change doctors. This is a chronic health problem in which the patient must take an active role in management.

Of course, diet and exercise are important and if it is possible to obtain adequate control with these alone it is better than taking medication. Some people however cannot, even with optimal diet and exercise they still need a lipid lowering agent.

[hhgz]

"You may try Supralip NT 145mg. A tad expensive but for me no side effects at all."

Lipanthyl is the same drug, and it is substantially cheaper.

[hbert]

Thank you all for your advice.

I will talk with my doctor regarding the sustained release Niaspan.

My side effects are not so great on Crestor but they are a irritating part of the medication which I hope that I can avoid with an alternative.

Whatever I am going to do, is in all case going to be coordinated/discussed with my doctor so that correct tests (liver values etc.) will be carried out.

I will have my half yearly check-up now in the end of the month and I will let you know the outcome of the discussion.

Thanks again

hbert

[chiang mai]

I've been taking 10mg Crestor for three years although I did take a six month break from it to see if some side effects would abate and relied solely on exercise and life style changes in the meantime. I just completed my annual health check at Bumrungrad and for the first time was shown the year on year graph of my cholesterol levels which show a steady decline (improvement) to a now near ideal level. I've convinced myself that such things can be controlled through exercise alone and will stay off statins for another six months and monitor progress, a far better approach in my book if you can manage it.

[BEENTHEREDONETHAT]

I was prescribed Lipitor about 18 months ago. Within 30 days I was experiencing severe muscle pain. Can't remember if there was any memory loss.

So for some of us the statins cause more problems than they do good. Things returned to normal after quitting for a couple of weeks.

[chiang mai]

I was prescribed Lipitor about 18 months ago. Within 30 days I was experiencing severe muscle pain. Can't remember if there was any memory loss.

So for some of us the statins cause more problems than they do good. Things returned to normal after quitting for a couple of weeks.

[geriatrickid]

Crestor and Lipitor have different product monographs. Bear in mind that a pharmaceutical company cannot make a claim unless it has the clinical evidence to bak up the claim.

Here is what the main differences are;

................................................................................ DRUG IS APPROVED FOR USE

PROBLEM ................................................................ CRESTOR .................LIPITOR

slows the progression of atherosclerosis....................... Yes .......................... No

For subjects with heart disease,prevention

regime for heart attack, stroke, plaquing blockage........... No .......................... Yes

more effective at lower doses for most subjects................Yes...........................No

Here are some things people may not be aware of and it is important;

- Lipitor comes off patent protection in Q3 this year, while Crestor will be protected until 2016. The benefit is that the cost of lipitor's generic version will be a fraction of Crestor's cost.

(If you are going to buy the generic version be sure to purchase it from a manufacturer that has purchased the exact formula from Pfizer. It will be a basic rebranding, whereas a general generic will not necessarily manufacture the active molecule in the same manner. Bioavailability and Bioequivalence clinical trials do not guarantee that the drug will achieve 100% of the proprietary drug. You can have all the benefits of a generic drug price reduction if you just purchase it from the manufacturer that will manufacture using the proprietary specs.)

The reason Crestor is not "approved" for the heart disease preventative treatment is NOT because of an absence of clinical data. Rather, Asttra Zeneca could not have its trials pass the the ethical review board because it would mean taking away an already proven treatment regime to determine if another one was just as good or better. More specifically, a clinical trial would have meant that heart disease patients would have been given placebos in the trial. It is forbidden to do that because it is unethical and would have opened Astra Zeneca to multi billion dollar class action litigation, and regulatory censure.

As an aside, some people that do not respond to Crestor will respond better to Lipitor. Don't know why, but active ingredients work differently on some people.

There is an interesting study that is supposed to be wrapping up at the same time Lipitor comes off patent protection. Code Name: Saturn. 1300 patients followed over 24 months in a randomized trial of a 40mg Crestor dose vs. an 80mg Lipitor dose to determine which one was more effective in reducing artery plaque. It's an incredibly exciting trial because it offers hope to people with artherosclerosis.

Personal opinion: Avoid statins with fibric acid derivatives. More adverse reactions are reported with fibrate compounds than lipitor or crestor alone. There are demonstrated cases of serious muscle damage. If one is prescribed a fibrate, it is because the need is serious. You have to be in bad shape to get a script like that. Change your &lt;deleted&gt; diet.

Edited July 8, 2010 by geriatrickid

[gf286]

is niacin available in pattaya?

[Sheryl]

Naicin per se is available all over the place. But if you are referring to treatment of elevated blood lipids what you need is a high dose sustained release forumulation specifically for that purpose, called Niaspan.

Not so widely available, but can get it at Facsino's.

As with any medication, read up on contraindications and side effects.

[gf286]

Thanks

[hbert]

Hi All,

I have now stopped Crestor and been on Niaspan 500mg at bedtime for a week.

So far no side effects and it in all case feels like some of the Crestor side effects are going away.

The Niaspan dose will be increased to 750mg after one more week and then to 1000mg later on.

So far so good....

[tdcollins1]

Where can I find Endur-Acin and how does it compare with Niaspan price-wise? Niaspan is 500-600 THB for a box of 28 500mg tablets. Since I take 1000mg daily, I am getting tired of shelling out that much.

And I read in one post that niacin is available all over. I beg to differ. I have been to a couple or smaller pharmacies and to Boots, and none have niacin (or even act like they know what it is.)

Thanks much for your help!

Edited August 9, 2010 by tdcollins1

[Sheryl]

Endur-acin is not licensed in Thailand.

There are two locally made Thai brands of nicotinic acid (niacin) that I know of: Nicotabs and Nictoinic Acid Greater Pharma. Both are in only 50 mg dose. I am not aware of any alternative to Niaspan when it comes to sustained release niacin in the dosage range necessary for treatment of dyslipedemia.

If you ever get to cambodia, Niaspan (like all other impoirted pharmaceuticals) is considerably less expensive there. I just bought 28 tabs for $24.