What are the effects of Nicotinamide (Niacinamide) supplements?

From the Guidelines

Nicotinamide supplements are recommended for reducing the risk of non-melanoma skin cancers, particularly in high-risk individuals, at a dose of 500-1000 mg daily, due to their potential benefits in supporting cellular energy production, DNA repair, and reducing inflammation, as suggested by recent studies 1.

Key Points

• Nicotinamide has been shown to reduce the risk of keratinocyte carcinoma in nonimmunosuppressed individuals with a history of such carcinomas, as indicated by a small trial 1.
• The recommended dose for general health maintenance is 500-1000 mg daily, divided into two doses, while higher doses of 1500 mg daily may be beneficial for reducing the risk of non-melanoma skin cancers in high-risk individuals.
• Nicotinamide works by supporting cellular energy production, DNA repair, and reducing inflammation, and it also helps maintain the skin barrier and may decrease sebum production.
• Unlike niacin, another form of vitamin B3, nicotinamide does not cause flushing side effects, and most people tolerate it well, although some may experience mild digestive upset or headaches.

Important Considerations

• Individuals with liver disease, pregnant women, or people taking certain medications should consult a healthcare provider before supplementing with nicotinamide.
• Nicotinamide is water-soluble, so it's best absorbed when taken with food, and excess amounts are excreted through urine rather than building up to toxic levels in the body.
• Further studies are needed to establish the long-term efficacy and safety of nicotinamide as a chemopreventive agent, particularly in organ transplant recipients, as suggested by a phase II RCT 1.

From the FDA Drug Label

Nicotinamide Tablets is a prescription dietary supplement for oral administration, specifically formulated for the dietary management of patients with unique nutritional needs who require increased levels of one or more of the ingredients in this product. Nicotinamide Tablets is indicated for use as a dietary supplement for patients who are deficient in, or who are at risk for deficiency in one or more of the ingredients in this product. PRECAUTIONS: Large doses of Nicotinamide Tablets should be administered with caution in patients with a history of jaundice, liver disease, or diabetes.

Nicotinamide supplements are indicated for use as a dietary supplement for patients who are deficient in, or who are at risk for deficiency in one or more of the ingredients in this product 2.

• The supplement contains 750 mg of Nicotinamide per serving, which is 4700% of the daily value 2.
• Precautions should be taken when administering large doses of Nicotinamide Tablets to patients with a history of jaundice, liver disease, or diabetes 2.

From the Research

Nicotinamide Supplements and Skin Cancer Prevention

• Nicotinamide supplements have been studied for their potential to reduce the incidence of non-melanoma skin cancers, with some studies suggesting a favorable effect 3, 4.
• A systematic review and meta-analysis found that oral nicotinamide was associated with a significant reduction in skin cancers, including basal cell carcinomas and squamous cell carcinomas, compared to control 4.
• However, a phase 3 trial found that oral nicotinamide therapy did not lead to lower numbers of keratinocyte cancers or actinic keratoses in immunosuppressed solid-organ transplant recipients 5.

Mechanisms and Efficacy

• Nicotinamide is thought to enhance the repair of ultraviolet radiation-induced DNA damage and reduce the cutaneous immunosuppressive effects of UV radiation 5.
• A case-control study found that nicotinamide was effective in preventing and treating actinic keratosis in transplant recipients, with significant decreases in AK size and no new AKs developed in the treatment group 6.
• Nicotinamide has also been shown to be effective in reducing the rates of new non-melanoma skin cancers and actinic keratosis in other high-risk populations 3, 4.

Safety and Availability

• Nicotinamide has a favorable safety profile, with few adverse effects reported in clinical trials 4, 5, 7.
• Nicotinamide is available as an over-the-counter supplement, but its integration into clinical practice is ongoing, and it can be hard to find for patients and providers alike 7.
• It is essential to note the difference between nicotinamide and niacin, as they have distinct effects and safety profiles 7.