66.有關使用niacin（nicotinic acid）治療血脂異常的敘述，下列何者錯誤？
(A)適合單一藥物治療，或合併膽酸清除劑，用於治療原發性高膽固醇血症（primary hypercholesterolemia）
(B)可作為治療高三酸甘油脂血症或糖尿病性血脂異常（diabetic dyslipidemia）之首選藥品
(C)常會引起臉紅與皮膚癢的不良反應，可於使用前服用325 mg aspirin以減輕不良反應
(D)與 laropiprant（一種 prostaglandin D2 拮抗劑）併服，會顯著增強臉紅與皮膚癢的不良反應
(E)B.D

(A) Niacin 目前只建議用在 TG>500 但常規治療無效或無法耐受常規治療者

(B) Niacin 可能引發新診斷的糖尿病或使既有的糖尿病惡化

(C) Niacin 潮紅的副作用可以aspirin 或NSAID 預防

(D) Niacin + laropiprant 顯著增加糖尿病相關的副作用，其他顯著增加的副作用還有GI、musculoskeletal、skin、infection、bleeding

Niacin is no longer recommended, except in specific clinical situations (eg, high triglyceride levels [>500 mg/dL], if not able to achieve desired response, or intolerance to other therapies) (ACC [Lloyd-Jones 2017]; Boden 2014; Garg 2017; Landray 2014; Wierzbicki 2014).

To attenuate flushing symptoms, may premedicate with aspirin 30 minutes before dose; avoid ingestion of alcohol, hot or spicy foods/liquids concurrently with niacin. May also use other NSAIDs to prevent flushing according to the manufacturer.

Diabetes: Use is associated with new-onset diabetes or worsening glucose tolerance in patients with preexisting diabetes (Garg 2017; Goldie 2016).

UpToDate Vitamin B3 (niacin): Drug information

Assignment to niacin–laropiprant, as compared with assignment to placebo, had no significant effect on the incidence of major vascular events (13.2% and 13.7% of participants with an event, respectively; rate ratio, 0.96; 95% confidence interval [CI], 0.90 to 1.03; P=0.29). Niacin–laropiprant was associated with an increased incidence of disturbances in diabetes control that were considered to be serious (absolute excess as compared with placebo, 3.7 percentage points; P<0.001) and with an increased incidence of diabetes diagnoses (absolute excess, 1.3 percentage points; P<0.001), as well as increases in serious adverse events associated with the gastrointestinal system (absolute excess, 1.0 percentage point; P<0.001), musculoskeletal system (absolute excess, 0.7 percentage points; P<0.001), skin (absolute excess, 0.3 percentage points; P=0.003), and unexpectedly, infection (absolute excess, 1.4 percentage points; P<0.001) and bleeding (absolute excess, 0.7 percentage points; P<0.001).

HPS2-THRIVE. Effects of extended-release niacin with laropiprant in high-risk patients. NEJM. 2014

「新英格蘭醫學期刊」（NEJM）發表一篇隨機分配臨床試驗，經過降血脂標準療法後，納入25,673位原有心血管病史的人進行隨機分配，比較使用複方製劑(含2 g緩釋型Niacin和40 mg Laropiprant)與安慰劑(Placebo)的療效，追蹤時間的中位數為3.9年，發現此複方劑型相較於安慰劑LDL平均減少了10 mg/dL，HDL平均增加6 mg/dL，TG平均減少33 mg/dL，但並不能減少主要心血管事件(非致死心肌梗塞、冠心病死亡、中風、冠狀動脈或非冠狀動脈血管重建手術)發生的風險

參考資料：https://meddataspeaks.wordpress.com/2014/07/18/%E9%99%8D%E8%A1%80%E8%84%82%E8%80%81%E8%97%A5niacinlaropiprant%E7%99%82%E6%95%88%E5%AE%89%E5%85%A8%E6%80%A7/