Niacinamide is a form of vitamin B3 that can treat pellagra, boost skin health, help with diabetes, and more. Topical formulations are used for acne, eczema, psoriasis, and other skin conditions. But how much is too much? Keep reading to learn the benefits, dosage, and potential side effects of niacinamide.
What is Niacinamide?
A Variation of Vitamin B3
Vitamin B3, also known as niacin, consists of two forms: niacinamide (or nicotinamide) and nicotinic acid. Although both molecules compose vitamin B3, they affect the body in different ways [1].
This article will only cover niacinamide.
How It Works
Niacinamide is needed to make NAD+/NADH and NADP+/NADPH, which slow aging and support cell repair, immune function, and energy use in the body [2, 3].
Snapshot
Proponents:
- Fights skin inflammation, acne, rosacea, and psoriasis
- Reduces dark spots and skin aging
- May prevent skin cancer
- May help with diabetes
- Lowers high phosphate levels
- May improve arthritis
Skeptics:
- Mild skin adverse effects (itching)
- Mild oral adverse effects (nausea)
- May lower blood platelets
Food Sources
Niacinamide is a water-soluble vitamin that can be found in animal products (such as meat and poultry) and non-processed cereals; it is also available as a supplement [4].
Best food sources of niacinamide [4]:
| Food source | Niacinamide content (mg/100 gr) |
| Brewer’s yeast | 120 |
| Red meat | 100 |
| Peanuts | 100 |
| Chicken | 70 |
| Fish | 50 |
| Coffee | 50 |
| Barley | 20 |
| Wheat | 15 |
| Beans, rice, potatoes | 10 |
| Fruits | 4-8 |
| Vegetables | 2-4 |
The body can also make niacinamide from the essential amino acid tryptophan, but it takes 60 mg of tryptophan to produce only 1 mg of niacinamide [1].
Niacinamide Benefits
Likely Effective:
1) Niacin Deficiency/Pellagra
Symptoms of a mild niacin deficiency include [5]:
- Indigestion
- Fatigue
- Canker sores
- Nausea
Severe niacin deficiency causes pellagra, which manifests with dermatitis, diarrhea, and dementia (known as the “three Ds”) [6].
Niacinamide (300-500 mg daily) can resolve the symptoms within one week. It’s FDA-approved for the prevention and treatment of pellagra and preferred over nicotinic acid because it doesn’t dilate the blood vessels and cause face flushing [7, 8].
Possibly Effective:
2) Acne
One of the causes of acne is excess sebum production, which makes skin oily. Topical niacinamide lowered skin oil production in 50 Japanese people and decreased skin sebum levels in 50 Caucasian (white) people [9, 10, 11].
On the other hand, some people with acne struggle with dry, damaged skin. Topical niacinamide increases beneficial skin lipids called ceramides. In turn, it strengthens the skin barrier, moisturizes the skin, and reduces water loss [12, 13, 14, 15, 16].
In a clinical study of 28 people with dry skin, niacinamide cream decreased water loss and increased hydration in the outer skin layer (stratum corneum) better than white petrolatum [12, 13, 14, 15, 16].
In other clinical studies of over 210 people with mild or moderate acne, niacinamide gel improved acne and decreased acne lesions as effectively as the antibiotic clindamycin [17, 18, 19, 20].
Oral niacinamide combined with zinc, copper, azelaic acid, pyridoxine, and folic acid reduced acne severity and improved overall skin appearance in a clinical study on 235 people. The same product improved both acne and rosacea in another clinical study on 198 people [21, 22].
However, in clinical trials conducted on a total of 185 people with acne, adding niacinamide to clindamycin had no effect or was only slightly better than clindamycin alone [23, 24, 25].
3) Skin Irritation and Inflammation
Rosacea
A topical gel containing niacinamide reduced skin peeling, redness, lesions, and irritation while increasing hydration and the skin barrier health in clinical studies of over 75 people with rosacea [26, 27].
Psoriasis
Topical niacinamide together with a synthetic form of vitamin D (calcipotriol) improved psoriasis in 50% of the cases in a clinical study on 66 people, compared to a 19% response with placebo [28].
Seborrheic Dermatitis
In 48 patients with facial seborrheic dermatitis, niacinamide 4% cream (once daily for 3 months) reduced the symptoms such as redness and scaling by 75%, compared to a 35% reduction with a placebo cream [29].
Atopic Dermatitis (Eczema)
Niacinamide 2% cream (twice daily for 2 months) reduced skin water loss and improved skin hydration in 28 patients with atopic dermatitis [16].
Other
Based on cellular studies, it might soothe irritated and inflamed skin by lowering inflammatory compounds (including NF-kB, IL-1, IL-6, TNF-a, and IL-12) [30, 31].
Additionally, niacinamide can block the growth of fungi (Candida albicans, Trichophyton rubrum, and Trichophyton mentagrophytes) causing skin yeast infections [32].
4) Dark Skin Patches
Two clinical studies support the use of topical niacinamide for skin lightening. In over 160 people with dark patches on the face, it reduced skin pigmentation, inflammation, and premature aging [33, 34].
A serum containing 5% niacinamide and tranexamic acid (a synthetic derivative of the amino acid lysine) improved skin tone evenness and texture in clinical studies with over 97 women with hyperpigmentation (dark skin spots) [35, 36].
Combined with vitamin C and ultrasound radiation, topical niacinamide decreased skin coloring after 4 weeks in 60 people with hyperpigmentation [37].
In cell studies, niacinamide blocked the transfer of melanin deposits to the outer skin layer, which may explain its skin-lightening effect [38, 39, 40, 41, 34].
5) Skin Aging
Niacinamide stimulates the production of collagen and protective proteins (keratin, filaggrin, and involucrin), which give structure and elasticity to the skin. It may help smooth out wrinkles and prevent premature skin aging from UV rays (photoaging) [42, 43, 44].
Plus, it may delay skin aging by restoring DNA damage and lowering oxidative stress [45, 46].
Topical niacinamide decreased wrinkles and fine lines, skin redness, and yellowing while improving skin elasticity in clinical studies with 130 women [47, 48, 49].
In four trials of over 300 women, topical creams with niacinamide and other herbs and vitamins (retinol, resveratrol, safflower, vitamin E, kinetin, and others) reduced the appearance of wrinkles and fine lines and improved skin complexion [50, 51, 52, 53].
6) Skin Cancer Prevention
Nonmelanoma skin cancer is usually caused by excessive UV radiation, which can damage the DNA in skin cells and reduce their immune function. The most aggressive forms include squamous cell carcinoma and actinic keratoses [54, 55].
In a clinical study of 386 people at a high risk of skin cancer, oral niacinamide reduced the rate of nonmelanoma skin cancer by 23% compared to placebo. More precisely, it lowered the rate of new squamous-cell carcinomas by 30% and actinic keratoses by 13% [56].
In another clinical study of 74 people with skin cancer, oral niacinamide decreased actinic keratoses compared to placebo [57].
In human cells and mice, topical and oral niacinamide enhanced DNA repair and prevented UV-triggered immune suppression. It also reduced the growth, spread, and survival of melanoma cancer cells [58, 59, 55, 60, 61, 62, 63, 64, 65].
7) High Phosphate Levels
People with chronic kidney disease often have dangerously high blood phosphate levels [66].
In clinical studies with more than 450 adults and 60 children with kidney disease, oral niacinamide decreased high blood phosphate and increased the “good” HDL cholesterol without changing calcium levels [67, 68, 69, 70, 71, 72, 73, 66].
In rats, niacinamide reduced the activity of a transporter that carries sodium and phosphorus from the gut into the bloodstream, thus lowering phosphorus blood levels [74, 75].
8) Diabetes
Type 1
In people with type 1 diabetes, insulin-producing beta cells in the pancreas get destroyed. Low insulin, high blood sugar, and low C-peptide often point to type 1 diabetes [76, 77].
In clinical studies with over 343 adults and 300 children with type 1 diabetes, adding niacinamide to insulin therapy maintained normal C-peptide levels. It preserved the function of beta cells and helped delay disease progression [78, 79, 80, 81, 82].
However, oral niacinamide failed to prevent diabetes type 1 in clinical studies of over 600 high-risk people [83, 84].
Type 2
Niacinamide improved C-peptide and blood sugar levels in a small trial of 18 people with type 2 diabetes [85].
In rats, niacinamide prevented diabetes by reducing beta-cell destruction, lowering oxidative stress, improving immune function, and maintaining normal insulin and glucose levels [86, 87, 88].
9) Osteoarthritis
Niacinamide blocks the inflammatory compound IL-1, which contributes to osteoarthritis [89, 90].
In a clinical study on 72 people with osteoarthritis, niacinamide improved joint movement, lowered inflammation, and decreased the use of anti-inflammatory drugs compared to placebo [91].
Further research is warranted.
Insufficient Evidence:
No valid clinical evidence supports the use of niacinamide for any of the conditions in this section. Below is a summary of up-to-date animal studies, cell-based research, or low-quality clinical trials which should spark further investigation. However, you shouldn’t interpret them as supportive of any health benefit.
10) Brain Protection
In 30 people with schizophrenia, vitamin B3 (niacin and niacinamide) improved the symptoms in 80% of the patients after one year, compared to 33% in the placebo group [92, 93].
In rats, niacinamide reduced brain damage and improved recovery after stroke. In mice, it decreased the expression of a gene linked to Alzheimer’s disease (PSER1), while restoring cognition and improving memory [94, 95, 96, 97].
It may lower oxidative stress in the brain and reverse damage to blood vessels and nerve cells [98, 99, 100].
Niacinamide Side Effects & Safety
Topical
Topical niacinamide is considered to be safe and non-toxic up to a concentration of 4-5% [101, 50, 47].
Common, mild side effects include [33, 50]:
- Skin redness
- Itching
- Dryness
- Flaking
Oral
Oral niacinamide is safe at doses that don’t exceed the safe upper limit. In adults, this limit is 35 mg daily. Most short-term studies used doses above the upper limit and reported no safety issues. Possible mild adverse effects include [70, 66, 102]:
- Nausea
- Cramps
- Diarrhea
- Vomiting
- Watery stools
In rare cases, it can cause a low platelet count (thrombocytopenia), which can lead to excessive bleeding and prevent wounds from healing properly [71, 73].
Toxicity
In extremely high doses of over 3 grams, niacinamide can be toxic to the liver and cause insulin resistance [103, 104, 105].
Very high doses (2 g/kg) in rats caused and may increase the risk of diabetes type 2. High doses also caused liver damage, tumors, and stunted growth in animals [103].
Niacinamide Supplements & Creams
Dosage & How to Use
The below doses may not apply to you personally. If your doctor suggests using niacinamide, work with them to find the optimal dosage according to your health condition and other factors.
Topical Use
A topical gel or cream containing 4% or 5% niacinamide applied on the skin twice a day for up to 8 weeks reduces acne, hyperpigmentation, and skin aging [18, 17, 33].
Oral Use
- Acne: Nicomide tablets (750 mg of niacinamide, zinc 25 mg, copper 1.5 mg, folic acid 500 mcg) once, twice or 3 times a day. Another option is NicAzel tablets (nicotinamide 600 mg, azelaic acid 5 mg, zinc 10 mg, pyridoxine 5 mg, copper 1.5 mg, and folic acid 500 mcg) up to 4 tablets daily [20].
- Pellagra: 300-500 mg niacinamide daily [7].
- Skin cancer prevention: 500 mg niacinamide tablets once or twice daily [57, 56].
- Diabetes: 25-50 mg/kg niacinamide tablets or capsules daily for delaying the progression of type 1 diabetes [79].
- Reducing high phosphate levels: 500 mg up to 1.75 gr daily niacinamide capsules for 8-24 weeks in people with kidney disease [73].
- Osteoarthritis: 3 g of niacinamide daily for up to 12 weeks [91].
Takeaway
Niacinamide (nicotinamide) is a form of vitamin B3 that supports cell repair, immune function, and energy use in the body. Taken orally, it can support skin health, slows the progression of diabetes, and reduce high phosphate levels.
Skin conditions that may benefit from topical niacinamide include acne, eczema, psoriasis, rosacea, and seborrheic dermatitis. Creams and gels with up to 5% of niacinamide can also reduce dark skin spots and the signs of aging.
Unlike regular vitamin B3, niacinamide doesn’t cause flushing. Both oral and topical forms are safe and well-tolerated. Avoid extreme doses of over 2 grams, as they may damage the liver.
