Will it have any additional cholesterol lowering benefits if I take both?
If it is safe, what dosage of niacin per day?

BKS,

As a general rule, I'd say it was unsafe. You would be taking 3 cholesterol drugs all of which are capable of causing liver problems and myalgia (muscle pain.)
Taking 3 is just ASKING for trouble.

BKS, As a general rule, I'd say it was unsafe. You would be taking 3 cholesterol drugs all of which are capable of causing liver problems and myalgia (muscle pain.) Taking 3 is just ASKING for trouble.

My understanding so far is that there are two ways of reducing cholesterol levels in the blood. One way is in the intestines by reducing the absorption of cholesterol from foods we ingest. An example of this would be soluble fiber. The other way of reducing cholesterol is lowering the amount the liver produces. An example of this would be by statins (Lipitor etc.) I am curious about the method of reduction for many remedies suggested. For example does niacin work in the intestines or the liver? Where do omega-3 fatty acids work?

My high cholesterol is probably caused by over-manufacture in the liver. So is soluble fiber not particularly beneficial to me?

Many thanks.

Atually WARD there are several ways of reducing cholesterol in the blood.

Among them is eating less saturated and trans fats (dietary methods), by blocking the action of HmgCoA reductase in the liver (how statins work), attaching to cholesterol rich bile in the intestines thus preventing it's recycling (bile sequesterants and probably the effect of a high soluble fiber diet), and using fibrates like gemfibrozil that work in the liver also by causing less fat to be produced overall.
Niacin methhodology is not too well defined but certainly involves the liver in a couple of ways as well:
It may
involve several actions including partial inhibition of release of free fatty acids from adipose
tissue, and increased lipoprotein lipase activity, which may increase the rate of chylomicron
triglyceride removal from plasma. Niacin decreases the rate of hepatic synthesis of VLDL
and LDL, and does not appear to affect fecal excretion of fats, sterols, or bile acids.

So you can see that almost EVERY method involves intervention at the liver with the least liver dependent being the bile sequesterants which aren't very popular these days...hard on digestion.

I guess the root word "LIVE" was well applied to the LIVER.

I would say niacin works in the liver. But, as Lenin said, it probably isn't a good idea to start taking niacin on top of a statin without consulting with your doctor first. Although statins excel at lowering TC and LDL, niacin possessus other advantages. It's ability to increase HDL is unsurpassed. It can potentially lower lipoprotein(a), another dangerous risk factor, and it is capable of promoting a favorable shift towards increased LDL particle size, or Pattern A LDL, the more benign form of LDL. In addition, it is a great circulatory agent.

If you are currently taking a statin such as Lipitor or Zocor, and wish to include the benefits of niacin, why not ask your doctor about switching to Advicor. Advicor is a statin and niacin (Niaspan) all in one pill. In fact, I'm puzzled that it is seldom mentioned on these boards. We hear so much about Lipitor, Zocor, and Crestor. But that's about it. Overall, I tend to believe that Advicor would be more advantageous if you must choose between statins. Otherwise, my preference would naturally be plain, simple niacin.

Health Canada, the Canadian equivalent to the FDA today put out a warning on EZTIMIBE which is one of the drugs in VYTORIN. As well as the following adverse effects, EZETIMIBE ( or Zetia ) may negatively interact with warfarin:

~~~~~~~~~~~~

Subject: Association of Ezetrol® (ezetimibe) with myalgia, rhabdomyolysis, hepatitis, pancreatitis, and thrombocytopenia

The Product Monograph for Ezetrol® (ezetimibe) has been updated to include information from international post-marketing reports of rare, and in some cases serious, adverse events. The Patient Information section is being updated to inform patients of the signs and symptoms of hepatic, muscle, and pancreatic adverse events, for which early consultation with a physician is recommended.

Additional reports of myalgia, many accompanied by elevated creatine phosphokinase (CK) values, have been reviewed by Health Canada.

The Warnings, Precautions, and Adverse Events sections are being updated to reflect the occurrence of the following adverse events in patients taking Ezetrol® (ezetimibe) alone or in combination with a statin:

* myalgia;
* rhabdomyolysis;
* hepatitis;
* acute pancreatitis;
* thrombocytopenia; and
* suspected interaction between Ezetrol® (ezetimibe) and warfarin

While it is not possible to definitively establish a causal relationship between these adverse events and the use of Ezetrol® (ezetimibe), the Product Monograph changes and the following recommendations are based on the potentially serious nature of these events.

Adverse muscle events:

Myalgia

Myalgia has been reported in patients treated with Ezetrol® (ezetimibe).

Importantly, a number of patients treated with Ezetrol® (ezetimibe) in whom myalgia occurred, had previously experienced myalgia (with or without elevated CK levels) with statin therapy. Patients with a history of statin intolerance (myalgia with or without elevated CK levels) should be closely monitored for adverse muscle events during treatment with Ezetrol® (ezetimibe).

Rhabdomyolysis

Patients treated with Ezetrol® (ezetimibe), who experience persistent muscle pain, should be instructed to contact their physicians for evaluation of the possibility of rhabdomyolysis. In most reported cases, rhabdomyolysis resolved when the drugs were discontinued.

Adverse hepatic events:

Elevations of liver transaminases and cases of hepatitis have been reported in patients treated with Ezetrol® (ezetimibe). Liver function monitoring is recommended when therapy with Ezetrol® (ezetimibe) is initiated in patients treated or about to begin treatment with a statin.

Health care professionals should be aware that the use of Ezetrol® (ezetimibe) in combination with a statin is contraindicated in patients with active liver disease or unexplained persistent elevations of liver transaminases.

Care should be exercised in the use of Ezetrol® (ezetimibe) in patients with active liver disease or unexplained persistent elevations of liver transaminases.

Adverse pancreatic events:

Physicians should consider the diagnosis of pancreatitis in patients who develop sudden acute abdominal pain during therapy with Ezetrol® (ezetimibe).

Suspected interaction between Ezetrol® (ezetimibe) and warfarin:

Additional International Normalized Ratio (INR) measurements are recommended in patients treated with warfarin, and in whom Ezetrol® (ezetimibe) is initiated.

The identification, characterization, and management of marketed health product-related adverse reactions are dependent on the active participation of health care professionals in adverse reaction reporting programmes. Any occurrences of muscle, hepatic, pancreatic, hematologic, suspected interaction with warfarin or other serious and/or unexpected adverse reactions in patients receiving Ezetrol® (ezetimibe) should be reported to Merck Frosst/Schering Pharmaceuticals or Health Canada at the following addresses:

Well, I'm certainly glad that my father refused to open up those samples of Zetia that the doctor gave to him, although I thought that it would be completely harmless if he decided otherwise. Thanks for that information! :wave: Apparently Canada is far more truthful and honest regarding prescription drug dangers than the U.S.

I so agree. I knew zetia was bad for me. I tried to take it twice for a month and i started having problem in my stomach (under the rib cage) and in my back where the liver is located. My dr brushed it off as nothing and wanted me to continue taking it. I refused.

Thanks for the info.