Niacinamide
TL;DR
Niacinamide is the non-flushing form of vitamin B3. It has solid dermatology evidence at 500 mg twice daily for reducing non-melanoma skin cancers, and topical use improves barrier function and acne.
Ideal For
- People with a history of basal or squamous cell carcinoma, under dermatologist guidance
- People with acne or a compromised skin barrier using topical formulations
- Those who cannot tolerate niacin flushing
Avoid If
- You have liver disease or elevated transaminases
- You are seeking lipid improvement, since niacinamide does not provide it
- You are taking carbamazepine or primidone without monitoring
Frequently Asked Questions
Overview
Niacinamide (nicotinamide) is vitamin B3 in amide form. Unlike nicotinic acid it does not cause flushing and does not meaningfully improve lipids. Its best evidence is the ONTRAC trial, in which 500 mg twice daily for 12 months reduced new non-melanoma skin cancers by about 23 percent in high-risk patients; the effect faded once supplementation stopped. Topically at 4 to 5 percent it reduces transepidermal water loss, improves sebum and pigmentation, and performs comparably to clindamycin for inflammatory acne in head-to-head studies. Niacinamide has also been studied for bullous pemphigoid, chronic kidney disease phosphate control and as an NAD precursor, with weaker results in each case. High doses above 3 g daily can be hepatotoxic, and unlike nicotinic acid it does not raise HDL.
How It Works
- Precursor to NAD+, restoring cellular energy for DNA repair after UV damage
- Reverses UV-induced immunosuppression in skin
- Inhibits PARP-1 overactivation, preserving ATP in stressed cells
- Topically increases ceramide synthesis and reduces transepidermal water loss
- Inhibits melanosome transfer to keratinocytes, reducing hyperpigmentation
Health Concerns Addressed
Skin Cancer
The rare case of a supplement with solid randomised oncology evidence — in a narrowly defined high-risk group.
Acne & Breakouts
Yes for topical use in mild to moderate inflammatory acne. Oral dosing is not the evidence-backed route.
Skin Redness
Mixed. Topical formulations have modest supportive data; oral niacinamide is not a rosacea treatment.
Supporting Research17 studies
A phase 3 randomized trial of nicotinamide for skin-cancer chemoprevention
Chen AC, Martin AJ, Choy B
Nicotinamide reduced new non-melanoma skin cancers by 23% over 12 months in high-risk patients.
A Double-Blind, Randomized Clinical Trial of Niacinamide 4% versus Hydroquinone 4% in the Treatment of Melasma
Navarrete-Solis J, et al.
Niacinamide induces a decrease in pigmentation, inflammatory infiltrate, and solar elastosis. Niacinamide is a safe and effective therapeutic agent for this condition.
Phase 2A Proof-of-Concept Double-Blind, Randomized, Placebo-Controlled Trial of Nicotinamide in Early Alzheimer Disease
Nicotinamide did not significantly lower CSF phospho-tau or improve cognition compared with placebo in early Alzheimer disease.
Topical azelaic acid, salicylic acid, nicotinamide, sulphur, zinc and fruit acid (alpha-hydroxy acid) for acne
Evidence for topical nicotinamide in acne was of low to very low certainty.
Changes in ultraviolet B radiation-induced DNA damage and erythema after oral nicotinamide and polypodium leucotomos in healthy volunteers: an intraindividual controlled trial
Faisal A
NAM did not provide protection against erythema or DNA damage.
Nicotinamide for Skin-Cancer Chemoprevention in Transplant Recipients (ONTRANS)
Oral nicotinamide therapy did not lead to lower numbers of keratinocyte cancers or actinic keratoses in immunosuppressed solid-organ transplant recipients.
Nicotinamide for skin-cancer chemoprevention in transplant recipients (ONTRANS): a randomized trial
Allen NC, Martin AJ, Snaidr VA
Nicotinamide did not reduce new keratinocyte carcinomas in organ transplant recipients.
Niacin and niacinamide: fact sheet for health professionals
NIH Office of Dietary Supplements
Niacinamide does not cause flushing and does not lower lipids, unlike nicotinic acid.
Oral Nicotinamide for Actinic Keratosis Prevention in Kidney Transplant Recipients: A Pilot Double-Blind, Randomized, Placebo-Controlled Trial
Zhang H, George-Washburn EA, Hashemi KB +1 more
The between-group difference in percent AK change was not significant (P = .38).
Effect of nicotinamide and lanthanum carbonate on serum phosphate in chronic kidney disease: the COMBINE randomized clinical trial
Ix JH, Isakova T, Larive B
Nicotinamide did not lower serum phosphate in CKD and caused more gastrointestinal effects and thrombocytopenia.
Niacinamide: mechanisms of action and its topical use in dermatology
Snaidr VA, Damian DL, Halliday GM
Topical niacinamide improves barrier function, hyperpigmentation and fine lines via cellular NAD+ and ceramide synthesis.
Comparison of topical 5% nicotinamide gel versus 2% clindamycin gel in mild to moderate acne vulgaris: a double-blinded randomized clinical trial
Khodaeiani E, Fouladi RF, Amirnia M
Topical nicotinamide gel matched clindamycin for acne lesion reduction.
Effects of NAD+ precursor supplementation on glucose and lipid metabolism in humans: a meta-analysis
Zhong O, Wang J, Tan Y +1 more
The main research terms of NAD+ precursors were Nicotinamide Riboside (NR), Nicotinamide Mononucleotide (NMN), Nicotinic Acid (NA), Nicotinamide (NAM).
Effects of Nicotinamide Mononucleotide Supplementation on Muscle and Liver Functions Among the Middle-aged and Elderly: A Systematic Review and Meta-analysis of Randomized Controlled Trials
Wang JP, Wang L, Wang T +1 more
Based on changes in gait speed (SMD: 0.34 m/s, 95%CI [0.03, 0.66] p = 0.033), NMN had significant effects on muscle mass.
Nicotinamide riboside supplementation raises NAD+ and affects sirtuin signalling in humans: a randomized trial
Martens CR, Denman BA, Mazzo MR +5 more
Chronic supplementation with the NAD+ precursor vitamin, nicotinamide riboside (NR), is well tolerated and effectively stimulates NAD+ metabolism in healthy middle-aged and older adults.
The Effect of Nicotinamide Mononucleotide and Riboside on Skeletal Muscle Mass and Function: A Systematic Review and Meta-Analysis
Prokopidis K, Moriarty F, Bahat G +1 more
Current evidence does not support NMN and NR supplementation for preserving muscle mass and function in adults with mean age of over 60 years.
Effects of Nicotinamide Mononucleotide on Glucose and Lipid Metabolism in Adults: A Systematic Review and Meta-analysis of Randomised Controlled Trials
Chen F, Zhou D, Kong AP +1 more
Short-term supplementation of NMN of 250-2000 mg/d did not show significantly positive impacts on glucose control and lipid profile.
Safety Information
Potential Side Effects
Well tolerated at 1 g daily. Nausea and headache occur occasionally. Doses above 3 g daily have caused hepatotoxicity. Topical use may cause transient stinging.
Contraindications
Active liver disease; caution in those on hepatotoxic drugs.
Drug Interactions
- May raise carbamazepine and primidone levels
- Additive risk with hepatotoxic medications at high doses
Pregnancy & Breastfeeding
Pregnancy: likely_safe
Breastfeeding: likely_safe
Dosage Guidelines
Dosage Used in Studies
Consult healthcare provider
Forms Compared
Food & Timing
With food to reduce nausea; timing otherwise flexible.
Medical Disclaimer
The information provided on this website is for educational and informational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or before starting any supplement regimen.
Individual results may vary. The statements on this website have not been evaluated by the Food and Drug Administration. Products and information are not intended to diagnose, treat, cure, or prevent any disease.