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Currently,the lay public and most physicians are very concerned about achieving lower serum cholesterol levels.This concern is a result of several studies showing that reducing total cholesterol with drug treatment could decrease the morbidity and mortality of coronary heart disease.Since then,reviewers and expert panels have advocated nicotinic acid as the drug of choice for those hypercholesterolemic patients whose condition has not responded to dietary therapy.These recommendations are based on studies demonstrating that nicotinic acid is effective in lowering cholesterol levels with acceptable side effects and cost.The most common adverse effects of nicotinic acid have been flushing,pruritus, gastrointestinal intolerance,skin hyperpigmentation,and occasional hypotension.Other more rare adverse effects include acanthosis nigricans, toxic amblyopia,atrial arrhythmias,and panic attacks.Laboratory abnormalities have also been reported including elevation of plasma glucose,uric acid,aspartate transaminase(AST),alkaline phosphatase,and serum bilirubin.Occasionally,jaundice and fulminant hepatitis have been reported secondary to nicotinic acid.We report three cases of nicotinic acid-associated myopathy.We are unaware of previous reports of this adverse effect. |
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