Acipimox

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Acipimox
Skeletal formula
Ball-and-stick model
Systematic (IUPAC) name
5-Carboxy-2-methyl-1-oxidopyrazin-1-ium
Clinical data
Trade names Olbetam
AHFS/Drugs.com UK Drug Information
Routes of
administration
Oral
Legal status
Legal status
  • UK: POM (Prescription only)
Pharmacokinetic data
Bioavailability 100%
Protein binding None
Metabolism None
Biological half-life Phase 1: 2 hrs
Phase 2: 12–14 hrs
Excretion Renal
Identifiers
CAS Number 51037-30-0 YesY
ATC code C10AD06 (WHO)
PubChem CID 5310993
IUPHAR/BPS 1596
ChemSpider 4470534 YesY
UNII K9AY9IR2SD YesY
KEGG D07190 YesY
ChEMBL CHEMBL345714 YesY
Chemical data
Formula C6H6N2O3
Molar mass 154.13 g·mol−1
  (verify)

Acipimox (trade name Olbetam in Europe) is a niacin derivative used as a lipid-lowering agent. It reduces triglyceride levels and increases HDL cholesterol. It may have less marked adverse effects than niacin, although it is unclear whether the recommended dose is as effective as standard doses of niacin.

Contraindications[edit]

Contraindications are peptic ulcers, acute bleeding, fresh myocardial infarction, acute decompensated heart failure, and severe renal insufficiency.[1]

Adverse effects[edit]

As with niacin and related drugs, the most common adverse effects are flushing (associated with prostaglandin D2[2]) and gastrointestinal disturbances such as indigestion, which occur in at least 10% of patients.[1] Flushing can be reduced by taking aspirin 20 to 30 minutes before taking acipimox. Palpitations have also been described.[citation needed] High doses can cause headache,[3] and precipitate gout.[citation needed] In contrast to niacin, no impairment of glucose tolerance and no disorders of liver function have been found in studies, even under high doses of acipimox.[1][3]

Interactions[edit]

No interactions with other drugs are known. Theoretically, combination with statins and fibrates could increase the incidence of myalgia. Alcohol can increase the risk of flushing.[1][3]

Pharmacology[edit]

Mechanism of action[edit]

Like niacin, acipimox acts on the niacin receptor 1, inhibiting the enzyme triglyceride lipase. This reduces the concentration of fatty acids in the blood plasma and their inflow into the liver. Consequently, VLDL cholesterol production in the liver is reduced, which leads indirectly to a reduction in LDL and increase in HDL cholesterol.[1][2]

Pharmacokinetics[edit]

Acipimox is completely absorbed from the gut. It is not bound to blood plasma proteins and not metabolized. Elimination occurs in two phases, the first having a half-life of two hours, the second of 12 to 14 hours. The substance is eliminated via the kidney.[1]

References[edit]

  1. ^ a b c d e f Haberfeld, H, ed. (2015). Austria-Codex (in German). Vienna: Österreichischer Apothekerverlag. 
  2. ^ a b Benyó, Z; Gille, A; Kero, J; Csiky, M; Suchánková, M. C.; Nüsing, R. M.; Moers, A; Pfeffer, K; Offermanns, S (2005). "GPR109A (PUMA-G/HM74A) mediates nicotinic acid–induced flushing". Journal of Clinical Investigation 115 (12): 3634–3640. doi:10.1172/JCI23626. PMC 1297235. PMID 16322797. 
  3. ^ a b c Dinnendahl, V; Fricke, U, eds. (1989). Arzneistoff-Profile (in German) 1 (6 ed.). Eschborn, Germany: Govi Pharmazeutischer Verlag. ISBN 978-3-7741-9846-3.