Anti-hyperlipidemia ( Niacin )
Mechanism of action:
1- in adipose tissues: Niacin works by inhibiting the process of converting triglycerides into fatty acids in the adipose tissues of the body.
2- in the liver: Niacin works in the liver to reduce the level of free fatty acids, which in turn reduces the level of triglycerides, which ultimately leads to a decrease in the concentration of both low density lipoprotein and very low density lipoprotein (As shown in the picture above)
Pharmacological action:
1- Decrease the concentration of low density lipoprotein-C in plasma (decrease LDL-C).
2- Niacin reduces the level of triglycerides in the liver.
3- Increase the level of high density lipoprotein-C that is beneficial to the body
Uses:
Niacin is used with other anti-hyperlipidemia such as statins groups to treat cases of severe hypercholesterolemias, and it is taken three times daily in a dose of 1-2 grams at a rate of 8 grams per day.
Side effect:
1- flushing
2- pruritus
3- gout
4- hyperuricemia
5- hepatotoxicity
6- abdominal pain
7- impaired glucose tolerance
Contraindications:
Niacin should not be used in patients with gout, as this increases hyperuricemia.
To reduce both flush and pruritus caused by niacin, we use aspirin before giving niacin because it is an anti-inflammatory (aspirin reduces prostaglandins).