Niacin-induced myopathy

Abstract

Treating hypercholesterolemia is effective both for the prevention and regression of coronary artery disease. 1–3 Lipid-lowering agents are being used more frequently and practitioners are therefore more likely to encounter the unusual side effects of these drugs. Niacin (nicotinic acid, vitamin B 3) inhibits very-low-density lipoprotein secretion by the liver. It lowers total cholesterol, low-density lipoprotein (LDL) and triglycerides and raises high-density lipoprotein (HDL). Treatment with niacin may reduce the incidence of nonfatal myocardial infarctions, and in conjunction with bile resins, promote regression of coronary lesions. 1–3 It is the only lipid-lowering agent shown to reduce mortality, 3 and has been given at lower doses to treat hypoalphalipoproteinemia (selective low levels of HDL). Niacin in conjunction with 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors increases the risk of myopathy associated with the latter. 2 We report here 2 cases of myopathy induced by niacin without concomitant treatment with other hypolipidemic agents and review the relevant literature.