Nicotinic acid

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Nicotinic acid (pyridine-3-carboxylate), while being a B group vitamin (niacin, vitamin B3), has different therapeutic activity to nicotinamide and is used therapeutically to treat hyperlipidaemia. It has a low therapeutic index in this indication causing symptoms due to vasodilation and activation of prostagladins. It may be combined with a statin or used alone, but use with other agents used to lower cholesterol has a poor evidence base. Indeed the AIM-HIGH trial was terminated early in 2011 when an high dose, extended-release nicotinic acid preparation that was added to standard statin treatment in those with cardiovascular disease, did not reduce the risk of cardiovascular events, including heart attacks and stroke. In due course when fuller results from the study became available in 2013 the modified release nicotinic acid (1000 mg) and laropiprant (20 mg) preparations (Tredaptive®, Pelzont® or Trevaclyn®)were recommended to be removed from the European market[1].

References

  1. [http://www.ema.europa.eu/docs/en_GB/document_library/Referrals_document/Tredaptive_20/Recommendation_provided_by_Pharmacovigilance_Risk_Assessment_Committee/WC500137124.pdf EMEA Q&A PRAC considers that benefit-risk balance of Tredaptive, Pelzont and Trevaclyn (nicotinic acid/laropiprant) is negative 10 Jan 2013
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