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Lipid modification - primary and secondary CVD prevention - Management
Which nicotinic acid preparation is recommended?

  • Two nicotinic acid preparations are licensed in the UK: Niaspan® tablets (containing modified-release nicotinic acid) and Olbetam® capsules (containing acipimox — a derivative of nicotinic acid).
  • Of these, modified-release nicotinic acid tablets are preferred.
Basis for recommendation
  • The National Institute for Health and Clinical Excellence (NICE) does not recommend any particular nicotinic acid preparation for use in the primary or secondary prevention of cardiovascular disease (CVD) for people who can not tolerate a statin [National Collaborating Centre for Primary Care, 2008a; NICE, 2008a].
  • The NICE recommendation is based on trial evidence using immediate-release nicotinic acid preparations.
  • Currently, Two nicotinic acid preparations are licensed in the UK: Niaspan® tablets (containing modified-release nicotinic acid) and Olbetam® capsules (containing acipimox — a derivative of nicotinic acid).
  • CKS could find no trials for either product that reported health-related quality of life or clinical endpoints such as cardiovascular morbidity and mortality. Neither preparation is licensed for primary or secondary prevention of CVD.
  • Of the two, nicotinic acid modified-release tablets are preferred because:
    • There is indirect evidence using the immediate-release nicotinic acid preparation (see above).
    • Niaspan® is less expensive than acipimox.
  • Although it has been suggested that acipimox may be associated with fewer adverse effects than nicotinic acid [BNF 55, 2008], CKS found no strong evidence to support this.
    • CKS only identified one very small trial (n = 32) which found 22 people completed 6 months of treatment with acipimox without adverse effects (after 10 participants withdrew from the study) [Aronson, 2006b].

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