Is pill-splitting an option with Niaspan ER?

With all due respest, there is significant miss-information here.  There is no difference between the terms "sustained-release", and "extended-release".  There is a PERCEPTION, that non-prescription, sustained-release preparations are a slower release than prescription Niaspan, but actual dissolution testing in a study funded by its manufacturers demonstrates this is not true.  (Poon et al. Amer Jour Health-Syst Pharm. 2006.) While there is significant variability between over-the counter preparations, only one demonstrated an equivalent release to Niaspan, according to the dissolution tests - endur-acin.  ALL, others were a quicker release! 

So why does SR/ER, non-prescription niacin have an association with raising liver enzymes which can lead to hepatotoxicity, when Niaspan does not?  The simple answer is dosing regimen, and monitoring procedures.  When SR niacin was first developed, it was dosed frequently, like the immediate release, crystalline niacin, and investigators did not understand the prolonged the exposure to the liver dramatically increased its clinical effect on lowering LDL, and increased the liklihood of hepatotoxicity. (read The Niacin Solution, by William Parsons Jr, MD, the pioneering investigator of niacin for cholesterol from Mayo clinic. retired in 1999 with 5 decades of experience with niacin.)  While dosing an extended release niacin 2 or 3 times a day maximizes tolerability and increases LDL response, it must be used in smaller doses than immediate release niacin. 

Regardless of what niacin preparation you choose, it should be physician monitored so one can determine its effect on cholesterol and and liver enzymes. Dosing once daily will cause more flushing, but is probably less likely to increase these enzymes. It also improves HDL response, and reduces LDL response. (read Usage Guide to Niacin by Joseph Keenan, MD)

Because of this side-effect potential, you and your physician should choose a preparation that has published data demonstrating its release, consistency, safety, and efficacy.  Only two, non-prescription preparations have been identified in the medical literature as "..objectively shown to be safe and effective.." 

And which two non-prescription preparations of niacin have been identified in the medical literature as "safe and effective"?

                                    BCBonarigo, PhD. MD.

Enduracin and Sloniacin have both been cited as having published data to support their use.

TJP, I am really jazzed to learn about these Niaspan substiututes and just ordered Enduracin on Amazon directly from  Endurance.  Thank you. I had researched Niaspan substitutes months ago on the interent and never found Enduracin or the other med you cited.  I had tried to order Niaspan the past few days through several different Canadian pharmacies that held themselves out as selling it, only to find out after I faxed the Rx that they were out of stock, which tranlsated to me as never carrying them as their first offer was to sell some other alleged generic, and the Niaspan ER they allegedly sold was $150/4 mo. supply versus $50 for Enduracin ($45+$4.90 shipping).

Rugby offers  Niacin 500mg ER. You can get it @ Swansons Vitamins $21+$5 shipping for 1000 tabs  (I think that is $.026 a tab vs $5 a tab for Niaspan). You do not need the combo statin drug. Take them separately and use a generic. Most superdrugs now offer 3mo generic statin for $10.00.

Another Niacin ER is made by Endur Products of Oregon (Enduracin :Niacin ER 500mg). I think it runs about $35 for 1000 tabs. It also has medical/chemical info (clinic trial info) on the drug similar to what you would find enclosed with Niaspan.