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Effects of Aspirin When Added to the Prostaglandin D₂ Receptor Antagonist Laropiprant on Niacin-Induced Flushing Symptoms

From Daiichi Sankyo Pharma Development (Dr Dishy); the Departments of Clinical Pharmacology (Mr Ebel, Dr Wagner, Dr Lai), Clinical Research (Dr Paolini), and Clinical Biostatistics and Decision Sciences (Dr Liu), Merck Research Laboratories Rahway, New Jersey; Healthcare Discoveries, Inc, San Antonio, Texas (Dr Atiee); Covance GFI Research, Evansville, Indiana (Dr Royalty); and Northwest Kinetics, Tacoma, Washington (Dr Reilley).

Niacin is an effective lipid-modifying therapy whose use has been limited by suboptimal tolerability. The adverse effect of flushing is due to prostaglandin D₂ (PGD₂)-mediated cutaneous vasodilation. Adjunctive treatment with the PGD₂ receptor antagonist laropiprant significantly reduces the incidence and severity of niacin-induced flushing. The objective of this study was to assess the effect of aspirin pretreatment on flushing symptoms with extended-release (ER) niacin/laropiprant in healthy volunteers. A randomized, double-blind, placebo-controlled crossover study compared patient-rated flushing following pretreatment with aspirin 325 mg versus placebo administered 30 minutes before ER niacin 2 g/laropiprant 40 mg. Flushing responses were assessed using participant-reported overall symptom severity score (OSSS), including individual characteristics of redness, warmth, tingling, or itching. The overall incidence and severity of flushing were comparable for participants receiving aspirin or placebo before ER niacin 2 g/laropiprant 40 mg. The difference in 3-day average OSSS between treatments was 0.2 (P = .180). Profiles of flushing severity, frequency, and bothersomeness were comparable for the aspirin/ER niacin/laropiprant and ER niacin/laropiprant regimens. All treatments were safe and well tolerated. Coadministration of aspirin 325 mg daily with ER niacin 2 g/laropiprant 40 mg does not further reduce residual flushing symptoms associated with ER niacin 2 g/laropiprant 40 mg alone.

Key Words: aspirin • atherosclerosis • flushing • laropiprant • DP1

Address for reprints: Eseng Lai, MD, PhD, Clinical Pharmacology, Merck & Co, Inc, RY34-A500, 126 E. Lincoln Ave, PO Box 2000, Rahway, NJ 07065-0900; e-mail: eseng_lai{at}merck.com.

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