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Extended-release wax-matrix nicotinic acid: a cost-effective option for cholesterol and lipid health, study shows


  • Effective niacin therapy (2 g/day) can be inexpensive ($7-10/month)
  • “No-flush” inositol hexaniacinate products fail to contain free nicotinic acid, yet are comparatively expensive ($22/month)
  • “No-flush” inositol hexaniacinate is an unproven therapy and should not be used to support cholesterol and lipid health


This study was designed to compare the cost and free nicotinic acid content of commonly used brands of niacin supplements for the treatment of dyslipidemia. Brands were identified from a survey of clinical lipidologists in the United States asking which brands they typically recommended to their patients as well as top-selling over-the-counter (OTC) niacin products based on national sales figures. Samples were purchased from health food stores, pharmacies and online. Only OTC preparations advertised as providing 500 mg of niacin per tablet or capsule were included, and products labeled as providing niacin as niacinamide (nicotinamide) were excluded.

The comparison included a total of 29 dietary supplements (10 immediate-release nicotinic acid, 9 sustained-release nicotinic acid, and 10 “no-flush” inositol hexaniacinate products). For each product studied, the monthly cost of therapy (at 2,000 mg/day) and the free nicotinic acid content as measured by high-performance liquid chromatography (HPLC) were reported.

The average monthly cost of niacin therapy was $7.10 for immediate-release products, $9.75 for sustained-release products, and $21.70 for no-flush products. The average content of free nicotinic acid was 520+13 mg (range, 457 to 570 mg) for immediate-release niacin products and 503+19 mg (range, 423 to 620 mg) for sustained-release niacin products. None of the no-flush niacin preparations (n=10) contained detectable free nicotinic acid, even when samples were dissolved by using a variety of solvents and acid-base conditions.

The authors note that since no-flush (inositol hexaniacinate) niacin supplements fail to contain free nicotinic acid, this form should not be used to treat dyslipidemia. Use of this product can be detrimental in two ways. First, patients waste resources on an unproven therapy. Second, patients miss an opportunity to take a niacin supplement in a form that has been objectively shown to be safe and effective such as extended-release wax-matrix nicotinic acid.


Meyers CD, Carr MC, Park S, Brunzell JD. Varying cost and free nicotinic acid content in over-the-counter niacin preparations for dyslipidemia. Ann Intern Med. 2003;139(12):996-1002.

PMID: 14678919