Niacinamide still useful — but high oral doses may carry cardiovascular risk
A literature review confirms that oral nicotinamide (niacinamide) is a versatile, generally well‑tolerated tool in dermatology: it reduces non‑melanoma skin cancer incidence in immunocompetent patients and has documented benefit as an adjunct in blistering disorders, acne , pruritic conditions and for reducing UV‑induced immunosuppression. However, newer data associating higher serum levels of nicotinamide terminal metabolites — N1‑methyl‑2‑pyridone‑5‑carboxamide and N1‑methyl‑4‑pyridone‑3‑carboxamide — with increased risk of major adverse cardiovascular events raise safety concerns when doses exceed commonly recommended therapeutic ranges (≈500 mg/day).
What’s the clinical takeaway? It’s to continue to consider oral nicotinamide for supported indications at standard doses, but be cautious about long‑term or high‑dose supplementation. Review cardiovascular risk before prescribing higher doses, counsel patients using over‑the‑counter high‑dose supplements, and favor evidence‑based dosing and duration. Where high doses are contemplated, weigh dermatologic benefit against potential systemic risk and monitor appropriately; additional large prospective safety studies are needed to define safe upper limits.
J Drugs Dermatol. 2025;24(11):1075-1079. doi:10.36849/JDD.9092
Blog write-up assisted by AI
