Starting Niacin Today

[Lou-ah-vull]

In the never ending battle against my high triglycerides (around 450) and low HDL (31) cholesterol, my doctor took me off zocor today and started me on niacin.  For the first week, I take one a day preceded by one aspirin a half-hour before.  Next week, assuming no side effects, two and two.  Finally, the third week, three and three.  The big side effect is flushing (not really quite sure what that entails.)

Has anyone had any experience with niacin therapy?  I have been unsuccessful with lopid and with tricor and now with full strength zocor.  Thankfully, my other heart indicators are all good. 

I am still taking two pharmaceutical grade fish oil (1360 mg. each) daily.

Curious if anyone has any thoughts about this therapy.  As you can see below, I have been on Atripla for over three years now with great success in managing HIV.

Gary

[aztecan]

Hey Gary,

Are you taking OTC or prescription niacin?

I have been taking Niaspan, the prescription type, for a while now. The doctor just upped my prescription from 500 mgs to 750 mgs.

The flushing is like having a wave of heat cover you, then itching, or at least mine is like that.

Actually, it doesn't happen often any more, just once in a while.

The aspirin will help a lot, as long as you remember to take it before you take the niacin.

I also take fish oil, 6,000 mgs (or 6 grams) a day.

Between the two, they have dropped the triglycerides to 111, which is good. The LDL is still too high, though.

Since I can't take statins, I have to do it with niacin, fish oil, vegetarian meals, exercise and weight loss. I have dropped 15 pounds so far.

Let me know how this works for you.

HUGS,

Mark

[Lou-ah-vull]

I am taking Niacor 500 mg.  Can't tell if prescription or OTC.  I took a prescription form to Walgreens.  I had to get it behind the counter, but that does not mean it is prescription.  I bought a big bottle of enteric coated aspirin (not used to aspirin...I have used iburprofin for years.)

[tednlou2]

My partner took the kind you buy over-the-counter.  He had to stop taking it due to that flushing effect.  It made him feel like he was having some allergic reaction.

[Lou-ah-vull]

The label says "flush free" niacin...but I can't imagine that is any kind of guarantee.  I am building up to 3 a day.  1 a day this week, 2 a day next week, then 3 a day assuming I tolerate it.  No problem with tonight's first dose.

[Lou-ah-vull]

No flushing yet!  I am curious about the wisdom of taking so much aspirin.  One aspirin a half hour before each dose of niacin.  On Friday, I increase to two doses and next Friday up to three doses.  I guess I won't mind if this finally nudges my triglycerides down and my good cholesterol up.

Gary

[eric48]

Hi,

If you would like to see your HDL go up and TG go down, you may want to try Viramune + Truvada

Viramune extended release is to be approved as a once daily. It is known to improve HDL quite a bit. Mine went from 35 to 66 under viramune + Kivexa.

Not everyone can viramune but if Efavirenz had worked for you, viramune should be OK, and if not you could come back. I suggest that you consider this as it could yield interesting results.

Especially since high TG is not THAT bad if you HDL is high (the HDL protective effect superseeds that of TG)

read this for reference:

http://www.iasusa.org/pub/topics/2010/issue3/112.pdf

HDL is the most difficult parameter to up modulate. Actually the is not medicine (except viramune which is primarily an anti HIV and therefore not prescribed to HIV negs) that can up regulate HDL . The most promising is anacetrapib which is in phase III and showing good (it is not an HIV med, it will be for everyone)

Viramune and anacetrapib have in common that their are both CETP inhibitors. Whether inhibiting CETP in order to increase HDL is a good strategy in order to reduce CVD is still being discussed

http://www.ncbi.nlm.nih.gov/pubmed/20645987

Once anacetrapib is approved it is poised to become a blockbuster. The most ironic would be that HIVers get prescribed anacetrapib once it is approved, whereas they could get the same effect with already approved viramune.

Just my 2 cents, since it worked for me...

Better diet and exercise will do marvel too !!!

Give Viramune a chance (if you can) and let us know...

Cheers Eric

[denb45]

My partner took the kind you buy over-the-counter.  He had to stop taking it due to that flushing effect.  It made him feel like he was having some allergic reaction.

I took Niaspan for about 2 yrs. then I started having this horrible  allergic reaction, I just wanted to pull all the skin off my body, had to go to the ER via Ambulance to get 2 shots of Diphenhydram, the next day my ID Doctor took me off the Niaspan for good   and replaced it with Tricor & Zocor....yep I'm now on both of
them   and all is well

[J.R.E.]

I've only taken the over the counter Niacin, and yes, I would flush about 5 minutes after taking it, and it would last for about 10 minutes or so. I would get reddish from the neck up, just about at the shoulder line, I would also get red from the elbow down to the wrist.  It was tingling, and somewhat itchy feeling, and a feeling of being hot.  But, as I said, it only lasted less than 10 minutes, then back to normal.

Good luck, hope things work out for you---Ray

[sharkdiver]

My Dr had prescribed me over the counter Niacin and not Niaspan or non-flushing type. Apparently for me, Niaspan and and the non flushing are bad for my liver.

 I did a stepping up process starting at 50 mg 3x a day for a week, then 100 mg for a week then 200 building up every week to 500mg. My body adjusted to that and the flushing effects weren't so severe.   


 

[aztecan]

Hi,

If you would like to see your HDL go up and TG go down, you may want to try Viramune + Truvada
. . .

Give Viramune a chance (if you can) and let us know...

Cheers Eric

There is a problem with starting Viramune with a CD4 in excess of 450 in men and 250 in women.

http://www.aidsmeds.com/archive/Viramune_1616.shtml

The side effect can be serious problems with the liver.

Like all of the meds, whether this will happen is unknown and very individual.

Hey Gary, just wondering, did you have problems with the Zocor? After my last experience with statins, my doc won't go near them with me.

Just curious.

HUGS,

Mark

[Lou-ah-vull]

No problems at all with zocor (and I took the strongest kind) but my regular doctor did not like the interaction data on zocor and atripla and my ID doctor agreed with him.  I should add however, I was not getting a reduction in TGs or an increase in good cholesterol with zocor.

[eric48]

There is a problem with starting Viramune with a CD4 in excess of 450 in men and 250 in women.

I quote :

http://www.aidsmeds.com/archive/Viramune_1616.shtml

---

In its treatment guidelines, the DHHS points out that there is an increased risk of liver problems in certain people using Viramune when starting HIV treatment for the first time

---

for the first time ...

One certainly would have to do a bit more research into the original study and cause for this restriction (which by the way is 400 and not 450 for males) before looking at that option. A bit more monitoring is also needed with this med (liver...)

Other guidelines (Europe) say that docs should weight the pro and cons if over that cd4 limit.

I started meds with Viramune (despite being over 400 ...), I was not too happy with that idea, I must admit. But since I could pass the initial side effects period and could see the benefits on HDL, I feel better about it now... I hope the HDL effect will last ... It has been reported in various studies, so I am quite hopeful.

Cheers! Eric

[joemutt]

sorry. double post.

[joemutt]

There is a problem with starting Viramune with a CD4 in excess of 450 in men and 250 in women.

I'm sorry if this goes a bit off topic, but I also started viramune at a high cd 4 level  (hig 900's)  without any complications. Now I'm on truvada + viramune, my cholesterol is 187 and my HDL 39. I take a very low-dose statin (simvastatin) @ 10 (ten) mg.

[Jeff64]

Me and friends used to take niacin before a high school class!
Usually would be excused for the rest of the day...

My triglycerides were a sky high 980 last week, my Dr. added a trig lowering rx which name escapes me.
I tale simvistatin 80mg a day. My ldl is good.

I am going to ask my Dr. if taking extra niacin will be beneficial to me.

Jeff

[Lou-ah-vull]

I finally received the blood work this morning...my triglycerides have increased to 524.  Sheesh!

Everything else is in range, except my good cholesterol which has been 31 for as long as it has been measured.  I am starting my second week of niacin today (increasing to two doses a day today and three per day starting next week.)  Recheck lipids in two months.

I am relieved all of my other indicators are so good, but I have to wonder if the Atripla is causing this.  I have had such good virus control with Atripla (and no side effects at all) that I would be hesitant to switch, but I will read up and consider the relevant advice these next several months.  Like Aztecan has suggested I am trying the modifications with diet and exercise as well.

Gary

[eric48]

 Hi,

I just got my latest cholesterol results a few minutes ago...

I am on combo that is not very different from yours

where you take Efavirenz, I take its cousin viramune

where you take truvada, I take its cousin Kivaxa (Epzicom)

I know my pre infection numbers, my post infection numbers ans post meds numbers.

I have had always been carefull on diet and I do lots of low energy exercise (walking), no smoke.

This combo is virologically very close to yours. But (please kindly excuse me if I sound a bit insistant)

1- My TG (had never been elevated) are down from 80 to ... 50
2- my baseline HDL was 35 and is now 77 ! !
3- my LDL at 130 (a bit lower than prefinfection)

(even after taking into account my age, HIV infection and Abacavir (part of epzicom) my 5 years firmingham risk is 0.3 %

I could not be happier.

Even compared to preinfection numbers , this combo has IMPROVED my lipid profile.

I do not know how much aware you are about the benefits of having a HDL over 60 : it superseeds everything else.

HDL > 60 is the trump card of CVD risk.

So before you add more medication to your current regimen, why not give a try andchange your current EFV + truvada for its cousin
Viramunue + Epzicom (if they do not work for you, you can still come back to your original)

(note : V&K is 2 pills once a day, not very different from one pill once a day Atripla.)

I must insist that Viramune is the ONLY FDA approved medication that is proven to increase HDL. The ONLY one, the is no other.

Not only my 2 cents piece of advice, my 77 HDL piece...

Cheers!

Eric

[denb45]

Are you an ID-Doctor? if not, I really wouldn't tell others forum members what they should be taking and why? if your not a ID-Doctor, I'd be very careful with some of your posting in this forum 

[Hellraiser]

Are you an ID-Doctor? if not, I really wouldn't tell others forum members what they should be taking and why? if your not a ID-Doctor, I'd be very careful with some of your posting in this forum 

He's just talking about his experience I think.  Although Eric you could make a decent living as a salesperson for Viramune y'know

[eric48]

Hi,

With the choice of meds there is a fierce competition between manufacturers and studies (sponsored or not) on side effects, and other collateral events such as blood sugar and cholesterol.

It can be confusing. And they are all stats, we are individuals.

I like to read the forum and how personal experience matches (or not) what the 'science' says.

Cholesterol is a very big concerns of mine since a few family members suffered (and passed away) of this condition. I was surprised to learn about the HDL benefits of Viramune and I am only reporting that, as far as I am concerned, the claims on that aspect turned out true.

 have no vested interest and I am not advising any one to take this or that med. My earlier post in this thread merely pointed out to available publications, to my own experience and simply suggested to discuss with HIV specialist about a combo change as alternative to add more medicine.

The HDL up regulating by viramune is due to its ability to inhibit CETP. Other non-HIV CETP inhibitors are under development and will soon be on the market.

My comment is simply that it would be ironical to take an HIV NNRTI that is not a CETP inhibitor and add a non HIV CETP inhibitor to it when a HIV NNRTI that is a CETP inhibitor is already at hand...

I am just a retired millionaire living on his patents as a pharmaceutical scientist. I am not offended by opinions that may differ from mine, especially as I am carefull in not being offending myself.

Considering that MY cholesterol issue, is, as far as I am personally concerned, solved, I have no further intention to follow up on this thread.

Thanks.

Eric

[aztecan]

Hey Gary,

Now that the viramune topic has been sufficiently hashed, how are you doing on the niacin?

HUGS,

Mark

[Ann]

I finally received the blood work this morning...my triglycerides have increased to 524.  Sheesh!

Well, you have only been on the niacin for less than a week and at a low dosage at that. Hopefully the by the next time you have a blood draw, you'll find an improvement. These things can take a bit of time and it would be somewhat unusual to see results overnight. Good luck!

And by the way, people have been way off-base concerning the flushing. It's actually an uncontrollable urge to flush every toilet within a half-mile radius. Hope that's not been happening to you as it could cause your neighbours to think you're a little strange.  

[sharkdiver]

ask you doc about taking "Baby Aspirin"    Mine recommended it and it helped reduce some of the flushing when i went to higher dosing.


btw ...Silly Ann

[Lou-ah-vull]

Mark,

I am up to two per day, 500mg each.  No flushing so far at all. 

Ann,

I was 524 on trigs before I started niacin.  I retest in two months.  My numbers have been climbing despite taking lopid, tricor and zocor. 

My doctor insists on the regular aspirin, not baby aspirin or low dose.  As I understand it, if I can tolerate the full dose of three per day without flushing, I will be able to jettison the aspirin.

It would be nice to boost my good cholesterol which has been stuck for years at 31.

Will keep everyone posted.

Gary

[Lou-ah-vull]

Mark,

I am up to two per day, 500mg each.  No flushing so far at all. 

Ann,

I was 524 on trigs before I started niacin.  I retest in two months.  My numbers have been climbing despite taking lopid, tricor and zocor. 

My doctor insists on the regular aspirin, not baby aspirin or low dose.  As I understand it, if I can tolerate the full dose of three per day without flushing, I will be able to jettison the aspirin.

It would be nice to boost my good cholesterol which has been stuck for years at 31.

Will keep everyone posted.

Gary

[Lou-ah-vull]

I have no idea how I double posted.  I only have one computer!

Gary