HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH REGISTER		Author Keyword(s) Vol Page [Advanced]

Electronic Letters to:

Papers: Prepared by: British Cardiac Society, British Hypertension Society, Diabetes UK, HEART UK, Primary Care Cardiovascular Society, The Stroke Association JBS 2: Joint British Societies' guidelines on prevention of cardiovascular disease in clinical practice Heart 2005; 91: v1-52v [Full text] [PDF]

eLetters: Submit a response to this article

Electronic letters published:

Use of nicotinic acid in JBS2

Tony Patrikios   (18 January 2006)

Use of nicotinic acid in JBS2 18 January 2006
Tony Patrikios, Senior Medical advisor Merck Pharmaceuticals Send letter to journal: Re: Use of nicotinic acid in JBS2 tpatrikios{at}merckpharma.co.uk Tony Patrikios	Dear Editor, With interest we read the new JSB guidelines but would like to clarify an issue relating to the correct licensed indication for nicotinic acid. Table 11 of the guidelines specifies that nicotinic acid be used in severe hypertriglyceridaemia with prior acute pancreatitis or not responsive to fibrates. The only formulation of nicotinic acid licensed for the treatment of dyslipidaemia is the prolonged release formulation (Niaspan). Other formulations of nicotinic acid are low dose immediate preparations sold as vitamins supplements and not intended for the treatment of dyslipidaemia. Prolonged release nicotinic acid is currently licensed for use with a statin to treat dyslipidaemia (raised LDL-cholesterol and triglycerides and low HDL-cholesterol). These matters are also covered in the BNF. Furthermore we are concerned that the discrepancy between the 'compelling' or 'possible' indications of Table 11 of the guidelines and the licensed indication of nicotinic acid is so great as to potentially cause considerable confusion for those using JBS2 as source of reference. This may have already happened with advice from the Scottish Medicines Consortium issued on 6th January 2006. The advice on Niaspan quotes JBS2 guidance on mixed dyslipidaemia and notes in relation to nicotinic acid that 'combined use with lipid regulating drugs appears only as a possible, rather than a compelling, indication for treatment'. The 'compelling' indication as given in Table 11 would be outside the licensed indication and presumably, therefore, not considered relevant to a drug being assessed within the confines of its licensed indication. We would like the authors to clarify the role of nicotinic acid within its licensed indication.