The Journal of Clinical Lipidology this month has published a clinical study comparing a popular wax-matrix extended release niacin to inositol hexanicotinate (No-Flush niacin) and placebo*. This University of Minnesota study enrolled mildly dyslipidemic subjects and randomized them into one of the three study arms after a dietary lead-in. It measured changes in lipids; total cholesterol, LDL-C, HDL-C and triglycerides. A secondary analysis examined plasma levels of nicotinic acid and its major metabolites; nicotinamide and nicotinuric acid at 2 hour intervals.
Not surprisingly, the lipid results demonstrated that the wax matrix niacin was effective at lowering cholesterol while raising the HDL-C, and the no-flush niacin was not, performing identically to the placebo arm. Most informative was the kinetic sub-study, which showed distinct serum peaks of nicotinic acid followed by peaks of the metabolites for the wax matric niacin, but no changes in plasma nicotinic acid or metabolites for the inositol hexanicotinate. In short, the nicotinic acid contained in inositol hexanicotinate is not bioavailable.
The lead investigator notes that tolerance was very good for both preparations, which is consistent with previous studies of wax matrix niacin. Of great concern is the amount of "no-flush" niacin currently being sold in the United States, and the author notes, "Patients are wasting money on a worthless remedy and may be delaying appropriate treatment for a potentially serious health problem."
*Keenan JM, Wax-matrix extended-release niacin vs inositol hexanicotinate: A comparison of wax-matrix extended-release niacin to inositol hexanicotinate "no-flush" niacin in persons with mild to moderate dyslipidemia. J Clin Lipidol. 2013 Jan;7(1):14-23.