Nicotinic acid acts as an antilipolytic agent in adipose tissue, reducing the supply of free fatty acids and hence the availability of substrate for hepatic triglyceride synthesis and the secretion of VLDL. Nicotinic acid lowers plasma triglyceride and cholesterol concentrations, and raises HDL-cholesterol. Flushing of the skin (preventable by low-dose aspirin) and gastrointestinal upset commonly occur; the unpleasantness may be diminished by gradually building up the oral dose over 6 weeks and in time tolerance develops. Rarely there is major disturbance of liver function.
Acipimox is better tolerated than nicotinic acid, has a longer duration of action but is less effective. Unlike nicotinic acid, it does not reduce circulating
9 Stephens N G et al 1996 Randomised controlled trial of vitamin E in patients with coronary disease: Cambridge heart antioxidant study. Lancet 347: 781-786.
levels of Lp(a), the modest reduction of which (achieved by nicotinic acid) may contribute to overall protection against the complications of atheroma.
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