What Is Nicotinamide?

Medically reviewed by Kristie Reed, PharmD

Nicotinamide, also known as niacinamide, is one of the most common forms of niacin (vitamin B3) used in dietary supplements.

Nicotinamide can help maintain healthy B3 levels and is often used to treat niacin deficiency, which is more common in certain populations, such as people who have eating disorders or have a low dietary intake of niacin-rich foods.

Nicotinamide supplements may offer several health benefits, such as reducing the risk of skin cancer and improving glaucoma. Plus, nicotinamide supplements cause fewer side effects compared to other forms of niacin.

Benefits of Nicotinamide

Nicotinamide is a form of niacin, or vitamin B3. When consumed and absorbed by the body, B3 is converted into its main active form, nicotinamide adenine dinucleotide (NAD). NAD helps triggers reactions in the body involving cellular communication, energy production, and many other critical functions.

Prevents Niacin (B3) Deficiency In Certain Conditions

Most people can get enough niacin through diet alone. Your body can convert small amounts of the amino acid tryptophan into NAD, so tryptophan, which is found in foods like chicken, fish, eggs, and seeds, is considered a dietary source of niacin. However, some people may require a supplement like nicotinamide if they cannot get enough niacin through food.

Certain populations are more at risk of developing a niacin deficiency due to poor dietary intake of niacin, tryptophan, and other nutrients involved in the conversion of tryptophan to niacin. If left untreated, niacin deficiency can lead to pellagra, a medical condition that causes dermatitis, dementia, and diarrhea, and can result in death.

People with alcohol use disorder, Crohn’s disease, anorexia, carcinoid syndrome, and HIV/AIDS are often malnourished, which could lead to niacin deficiency. People who are living in poverty and don’t have consistent access to food can also develop niacin deficiency caused by a lack of proper nutrition.

Additionally, people with Hartnup disease, a rare genetic condition, depend on niacin supplements because their body lacks the ability to absorb certain amino acids from their diet, which can lead to low nutrient levels, including low levels of niacin.

People who have inadequate dietary intake of niacin, tryptophan, and other nutrients needed for the production of niacin in the body require niacin supplements, such as nicotinamide, to maintain healthy niacin levels.

May Protect Against Skin Cancer

Some evidence suggests supplementing with nicotinamide may help reduce the risk of skin cancer recurrence in some populations.

A study that included 386 people who had had at least two nonmelanoma skin cancers in the previous five years found participants who supplemented with 500 mg of nicotinamide per day for one year had a 23% reduced risk of developing skin cancer. They also had a 13% lower risk of developing precancerous skin spots called actinic keratoses compared to a placebo group.

Additionally, a recent review of 29 studies found nicotinamide supplements significantly reduced new skin cancers in healthy people and organ transplant recipients compared to control groups.

Nicotinamide may help prevent skin cancer by protecting against UV-associated cellular damage, boosting cellular energy, and enhancing DNA repair. It also helps protect against the immunosuppression that’s typically caused by sun damage.

Could Help Protect Against High Phosphorus Levels in People on Dialysis

People with end-stage renal disease (ESRD) on dialysis lack the ability to remove excess minerals, like phosphorus, from their blood. Because of this, phosphorus levels can build up in the body and cause health issues.

Nicotinamide supplements may help people with ESRD break down phosphorus, which could help reduce phosphorus levels in their blood.

A review of 12 studies found nicotinamide was safe and effective for reducing phosphorus levels in people undergoing hemodialysis. The researchers also found nicotinamide supplements helped boost heart-protective HDL cholesterol in this population.

However, nicotinamide may increase the risk of thrombocytopenia, or low platelet levels, in people with ESRD, which could negatively impact health.

If you have ESRD and are interested in taking nicotinamide, consult your healthcare provider to make sure it’s the right choice for your specific health needs.

May Improve Acne

Nicotinamide supplements have been shown to be helpful for people with acne.

A review of 10 studies, two of which used oral nicotinamide supplements, found nicotinamide supplements led to a significant reduction in acne compared to baseline in both studies.

Nicotinamide has powerful anti-inflammatory effects, which may help reduce acne symptoms.

Although oral nicotinamide may be effective for reducing some acne symptoms, evidence is limited at this time, and most studies investigating the effects of nicotinamide on acne severity have focused on topical, not oral treatments.

Doesn’t Cause Skin Flushing

Some forms of supplemental B3, such as nicotinic acid, cause skin flushing when taken in high doses.

When consumed in doses of 1,000 to 3,000 mg per day, nicotinic acid can cause a flushing reaction characterized by red and sometimes itchy skin, most commonly in the face, arms, and chest. This reaction is associated with its crystalline nicotinic acid component.

Nicotinamide has a different chemical structure than nicotinic acid and does not cause the same adverse reactions when taken in high doses. This is why some people often prefer nicotinamide supplements over nicotinic acid.

Could Protect Eye Health In People With Glaucoma

Glaucoma is a group of eye diseases that may cause blindness by damaging the optic nerve. Nicotinamide may help improve eye function and vision in people with glaucoma by protecting against nerve damaging and enhancing cellular health.

A study of 57 people with glaucoma found the participants treated with 1.5 grams (g) of nicotinamide daily for six weeks followed by 3 g daily for another six weeks experienced improvements in their inner retinal function and vision compared to a placebo treatment. The retina is the innermost tissue of the eye, and plays a key role in vision.

Glaucoma causes vision loss through damage to retinal ganglion cells (RGC), which are nerve cells responsible for sending visual stimuli to the brain. Nicotinamide may help protect these cells from degeneration caused by glaucoma, which would help protect against vision loss.

Though nicotinamide shows promise as a potential treatment for improving glaucoma, more research in this area is needed before strong conclusions can be made.

How to Take Nicotinamide

Nicotinamide is available in capsules, tablets, powdered, and liquid supplements.

Nicotinamide can be taken as a standalone supplement or in a combined supplement with other nutrients, such as other B vitamins, minerals, and herbal ingredients.

Nicotinamide is usually recommended to be taken with meals and is often split into multiple doses per day.

Dosage

Many nicotinamide supplements contain 500 mg or more of nicotinamide per serving. Most studies investigating the health effects of nicotinamide have used doses ranging from 500 mg to 3,000 mg per day.

However, it’s usually not necessary to take very high doses of nicotinamide. Even for people with niacin deficiency, a dose of 500 mg per day is usually enough to increase niacin levels in the body.

Unless prescribed by a medical provider, you should generally avoid taking high-dose nicotinamide supplements, such as those that provide more than 500 mg per day.

Is Nicotinamide Safe?

Nicotinamide is generally well-tolerated. It's known to be safe in doses of 35 mg or less, and possibly safe in doses of 900-1500 mg daily.

When taken in high doses over three grams (3,000 mg) per day, nicotinamide can cause serious side effects such as nausea, vomiting, and liver issues. 

Also, nicotinamide isn't safe for everyone. For example, nicotinamide might make gallbladder disease and stomach ulcers worse, and should generally be avoided in people with these conditions.

Nicotinamide has also been shown to increase the risk for thrombocytopenia, or low platelet levels, in people with kidney failure who are on dialysis.

People with diabetes should also use caution when taking nicotinamide supplements, as they may increase blood sugar levels.

Nicotinamide is considered safe for people who are pregnant or breastfeeding, and for children, when taken within the recommended amounts. It's important children do not take nicotinamide above the upper limits for their age.

If you have any medical conditions, it’s important to check with your doctor before taking any dietary supplement, including nicotinamide.

Potential Drug Interactions

Nicotinamide may interact with the following medications:

• Carbamazepine (Tegretol): Taking nicotinamide may increase levels of the anti-seizure medication carbamazepine by reducing how quickly the body breaks it down.

• Blood thinners: Nicotinamide might slow down the body’s ability to clot blood, which could increase the anti-clotting effects of blood-thinning medications like warfarin (Coumadin) when taken together.

• Primidone (Mysoline): Primidone is an epilepsy medication. Nicotinamide may slow down the body’s ability to break down this medication, which could impact how the drug works.

In addition to medications, nicotinamide may interact certain herbs, such as those that have blood-thinning properties, like ginger and Panax ginseng. For this reason, it’s important to be cautious when taking nicotinamide alongside other dietary supplements, especially those that contain herbal ingredients.

If you’re taking any medications or supplements, talk to your healthcare provider before taking nicotinamide.

What to Look For

When shopping for nicotinamide supplements, it’s best to purchase products from companies that hire independent third-party laboratories to test their supplements for quality and purity. Many supplement companies are certified by third-party organizations like U.S. Pharmacopeia and NSF International, which helps ensure supplement safety and quality.

Nicotinamide is often sold as “flush-free” niacin, as it doesn't cause the same flushing side effect as nicotinic acid.

It’s important to choose a form of nicotinamide that you can tolerate. People who have difficulty swallowing capsules may want to choose a liquid or powdered nicotinamide supplement.

Also, if you have sensitivities or allergies, you’ll want to purchase a nicotinamide supplement that’s free from potential allergens like tree nuts, soy, gluten, and dairy.

Can You Take Too Much Nicotinamide

Nicotinamide supplements are safe when taken appropriately. However, if too high a dose is taken, it can lead to adverse side effects.

For example, nicotinamide may cause symptoms like an upset stomach, dizziness, and rash, and could lead to liver toxicity when taken in very high doses exceeding three grams per day.

Children should not exceed the tolerable upper intake level (UL) for their age group. The ULs for nicotinamide in children ages one to 18 are as follows:

People who are pregnant or breastfeeding and are above 18 years of age should not take more than 35 mg of nicotinamide per day.

Side Effects of Nicotinamide

Nicotinamide is associated with fewer side effects than the other form of niacin (B3), nicotinic acid.

However, when taken in high doses, nicotinamide could cause the following side effects:

• Nausea

• Vomiting

• Gas

• Stomach discomfort

• Headache

• Fatigue

• Dizziness

• Rash

In severe cases, high levels of nicotinamide or niacin can lead to liver toxicity.

If you’re taking nicotinamide and experienced any of these side effects, stop taking the supplement and contact your healthcare provider for advice.

A Quick Review

Nicotinamide is a form of niacin that’s commonly used in dietary supplements. It’s often favored over nicotinic acid, another form of niacin, as it does not cause flushing, even when taken in high doses.

Nicotinamide can help treat low or deficient niacin levels and may also protect against skin cancer and benefit those with certain health conditions, like glaucoma. However, it isn’t safe for everyone and may lead to side effects, such as nausea and dizziness, if taken in high doses.

If you’re interested in taking nicotinamide, consult your healthcare provider. They can help you decide whether a nicotinamide supplement is the right choice for you and can offer advice regarding proper dosing and supplement safety.

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