Indications and Purposes
| Indications And Usage I. Therapy With Lipid-Altering Agents Should Be Only One Component Of Multiple Risk Factor Intervention In Those Individuals At Significantly Increased Risk For Atherosclerotic Vascular Disease Due To Hypercholesterolemia. Nicotinic Acid, Alone Or In Combination With A Bile-Acid Binding Resin, Is Indicated As An Adjunct To Diet For The Reduction Of Elevated Total And Ldl Cholesterol Levels In Patients With Primary Hypercholesterolemia (Types Iia And Iib) † , When The Response To A Diet Restricted In Saturated Fat And Cholesterol And Other Nonpharmacologic Measures Alone Has Been Inadequate (See Also The Ncep Treatment Guidelines 6 ). Prior To Initiating Therapy With Nicotinic Acid, Secondary Causes For Hypercholesterolemia (E.g., Poorly Controlled Diabetes Mellitus, Hypothyroidism, Nephrotic Syndrome, Dysproteinemias, Obstructive Liver Disease, Other Drug Therapy, Alcoholism) Should Be Excluded, And A Lipid Profile Performed To Measure Total Cholesterol, Hdl Cholesterol, And Triglycerides. Ii. Nicotinic Acid Is Also Indicated As Adjunctive Therapy For The Treatment Of Adult Patients With Very High Serum Triglyceride Levels (Types Iv And V Hyperlipidemia) † Who Present A Risk Of Pancreatitis And Who Do Not Respond Adequately To A Determined Dietary Effort To Control Them. Such Patients Typically Have Serum Triglyceride Levels Over 2,000 Mg/dl And Have Elevations Of Vldl Cholesterol As Well As Fasting Chylomicrons (Type V Hyperlipidemia) † . Subjects Who Consistently Have Total Serum Or Plasma Triglycerides Below 1,000 Mg/dl Are Unlikely To Develop Pancreatitis. Therapy With Nicotinic Acid May Be Considered For Those Subjects With Triglyceride Elevations Between 1,000 And 2,000 Mg/dl Who Have A History Of Pancreatitis Or Of Recurrent Abdominal Pain Typical Of Pancreatitis. Some Type Iv Patients With Triglycerides Under 1,000 Mg/dl May, Through Dietary Or Alcoholic Indiscretion, Convert To A Type V Pattern With Massive Triglyceride Elevations Accompanying Fasting Chylomicronemia, But The Influence Of Nicotinic Acid Therapy On The Risk Of Pancreatitis In Such Situations Has Not Been Adequately Studied. Drug Therapy Is Not Indicated For Patients With Type I Hyperlipoproteinemia, Who Have Elevations Of Chylomicrons And Plasma Triglycerides, But Who Have Normal Levels Of Vldl. Inspection Of Plasma Refrigerated For 14 Hours Is Helpful In Distinguishing Types I, Iv, And V Hyperlipoproteinemia 7 . † Classification Of Hyperlipoproteinemias Lipoproteins Lipid Elevations Type Elevated Major Minor C = Cholesterol, Tg = Triglycerides Ldl = Low-Density Lipoprotein Vldl = Very Low-Density Lipoprotein Idl = Intermediate-Density Lipoprotein I (Rare) Chylomicrons Tg ↑→ C Iia Ldl C ..... Iib Ldl, Vldl C Tg Iii (Rare) Idl C/tg ..... Iv Vldl Tg ↑→ C V (Rare) Chylomicrons, Vldl Tg ↑→ C |
All Formulated Excipients (0 Total)
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