Nicotinamide
Useful mainly for people with prior nonmelanoma skin cancers seeking recurrence prevention, or anyone with pellagra (B3 deficiency).
Quick decision guide
May help most
People with prior nonmelanoma skin cancers seeking recurrence prevention, or anyone with pellagra (B3 deficiency)
Common dosing range
50–500 mg/day oral; topical 4–5% formulations for skin
When to expect effects
Weeks for skin effects; months for cancer prevention endpoints
Watch out for
Doses above 3,000 mg/day risk hepatotoxicity; avoid in liver disease
What is it
Nicotinamide, also called niacinamide, is the amide form of vitamin B3 (niacin). It is one of the two main forms of vitamin B3, alongside nicotinic acid, and serves as a precursor to the coenzymes NAD+ and NADP+ that are essential for energy metabolism and cellular function.
Is it worth it for you?
Use this as a quick fit check, not a diagnosis.
Worth considering if…
Probably skip if…
Evidence at a glance
| Goal | Effect | Best fit | Time |
|---|---|---|---|
nonmelanoma skin cancer prevention Good Evidence | ~23% reduction in new nonmelanoma skin cancer rate | Adults with at least two prior nonmelanoma skin cancers | Months |
acne (topical) Limited Evidence | Comparable to topical clindamycin 1% in some trials | Adults with mild to moderate acne vulgaris | 4–8 weeks |
NAD+ elevation (biomarker) Limited Evidence | Raises blood NAD+ levels | Adults with age-related or illness-related NAD+ decline | Weeks |
nonmelanoma skin cancer prevention
- Effect
- ~23% reduction in new nonmelanoma skin cancer rate
- Best fit
- Adults with at least two prior nonmelanoma skin cancers
- Time
- Months
acne (topical)
- Effect
- Comparable to topical clindamycin 1% in some trials
- Best fit
- Adults with mild to moderate acne vulgaris
- Time
- 4–8 weeks
NAD+ elevation (biomarker)
- Effect
- Raises blood NAD+ levels
- Best fit
- Adults with age-related or illness-related NAD+ decline
- Time
- Weeks
Evidence for 3 uses
AI-assisted evidence assessment — talk to your doctor before relying on any single supplement.
nonmelanoma skin cancer prevention
Disease adjunctA well-designed RCT (ONTRAC, n=386) found that 500 mg oral nicotinamide twice daily significantly reduced new nonmelanoma skin cancers and actinic keratoses in high-risk patients (two or more prior tumors) compared to placebo over 12 months. The mechanism likely involves enhanced DNA repair and immunomodulation. Evidence is limited to this population — not established for primary prevention.
Bottom line: Reasonable adjunct for secondary prevention of nonmelanoma skin cancer in high-risk patients; not established for people without prior skin cancers.
acne (topical)
Supplement benefitMultiple RCTs show that topical 4% niacinamide gel reduces inflammatory and noninflammatory acne lesions. Its mechanisms include anti-inflammatory effects, sebum regulation, and improved skin barrier function. It is notably effective in patients who prefer to avoid antibiotics or who have antibiotic-resistant acne.
Bottom line: An effective topical acne option, particularly as an antibiotic alternative, with a favorable tolerability profile.
NAD+ elevation (biomarker)
Biomarker supportNicotinamide is an NAD+ precursor. Oral supplementation raises blood NAD+ concentrations in RCTs. However, whether raising circulating NAD+ biomarker levels translates to clinically meaningful outcomes (improved energy, aging, or metabolic health) in healthy humans has not been established in adequately powered trials. Nicotinamide riboside is a more potent NAD+ precursor per gram.
Bottom line: Oral nicotinamide raises blood NAD+ — a biomarker change. Clinical benefit in healthy humans from this biomarker elevation is not established.
How it works
How to take it
What to track
4 commercial forms
Compare the main delivery options and what they’re best suited for.
Nicotinamide (niacinamide)
Standard form for both supplementation and skincare. Preferred when flushing is undesirable.
Well-absorbed oral form; does not cause flushing.
Topical nicotinamide
Used for skin barrier, pigmentation, acne, and sensitive skin. Typical concentrations 2 to 10%.
Applied directly to skin; absorbed into the dermis.
Nicotinic acid (niacin)
Used at high doses for cholesterol management. Not interchangeable with nicotinamide for all uses.
Different form of B3 that causes characteristic flushing reaction.
Nicotinamide riboside (NR)
Marketed as a 'newer' NAD+ precursor; more expensive than nicotinamide with overlapping effects.
Distinct molecule that raises NAD+ via a separate pathway.
Safety
Know the common side effects, key cautions, and who should avoid it.
Common side effects
Serious risks
Hepatotoxicity at doses above 3,000 mg/day
May impair glucose tolerance at high doses
Who should avoid it
- Liver disease (avoid high doses)
- Diabetes with uncontrolled glucose (monitor blood sugar at therapeutic doses)
- Kidney disease or gout (consult clinician)
Pregnancy & breastfeeding
RDA-level nicotinamide (14 mg/day for women) is safe in pregnancy; therapeutic doses (500 mg twice daily) are not established as safe and should be avoided without medical supervision.
Interactions
Nicotinamide may increase anticonvulsant blood levels
High-dose nicotinamide may worsen glucose tolerance, opposing drug effects
Monitor liver enzymes when combining with statin therapy at therapeutic doses
May potentiate antihypertensive effects at higher doses
Protocols featuring Nicotinamide
Evidence-backed routines where Nicotinamide plays a role.
NAD+ & Cellular Energy
longevity
NAD+ (nicotinamide adenine dinucleotide) is a coenzyme essential for mitochondrial energy production, DNA repair (via sirtuins and PARPs), and cellular signaling. NAD+ levels decline measurably with age — roughly 50% by middle age in some tissues. The 2020s have seen explosive interest in NAD+ precursors (NMN, NR) as longevity interventions, popularized by researchers like David Sinclair. The honest framing: NAD+ precursors RELIABLY raise blood NAD+ levels in human trials. What''s less clear is whether this translates to meaningful longevity, cognitive, or healthspan endpoints in humans — most positive evidence is from animal models or small short-duration human trials. This stack is for adults interested in cellular energy support, especially over 40 — with the explicit caveat that this is experimental territory relative to the rest of the library. Foundational Longevity remains the better starting point for general healthspan; this protocol is for adults who want to specifically explore the NAD+ pathway.
Cholesterol Support
cardiovascular
Elevated LDL-C and ApoB are causal drivers of cardiovascular disease — the leading killer of adults. Statins are the gold-standard pharmaceutical intervention with the strongest trial evidence ever assembled in medicine. This stack is NOT a substitute for statin therapy when one is indicated by your cardiovascular risk profile. It IS useful as: a complement to statins for additional LDL reduction, an option for statin-intolerant adults, or a preventive layer for adults with borderline lipids who want to reduce risk before pharmaceutical intervention is warranted. Red yeast rice is essentially low-dose lovastatin (a natural statin compound) and carries similar precautions; bergamot, plant sterols, and niacin each have independent LDL-lowering evidence with different mechanisms. If your LDL-C is over 160 mg/dL, you have a family history of premature cardiovascular disease, or you have other risk factors, please see your doctor. ApoB is a better predictor than LDL-C alone; ask for it.
Rosacea Support
skin conditions
Rosacea is a chronic inflammatory facial dermatosis affecting roughly 5% of adults — disproportionately women aged 30-60 with fair skin (Fitzpatrick I-II), though it occurs across all skin types and is frequently underdiagnosed in darker skin. It presents as four overlapping phenotypes: erythematotelangiectatic (persistent central facial redness with visible vessels), papulopustular (acne-like inflammatory papules and pustules), phymatous (skin thickening and tissue overgrowth, most often on the nose), and ocular (dry, gritty, inflamed eyes — frequently missed because patients see ophthalmology and dermatology separately). The pathology is multifactorial: dysregulated innate immunity via the cathelicidin/LL-37 pathway, mast cell activation, neurovascular hyperresponsiveness, and Demodex folliculorum mite overgrowth all interact. The first-line conventional toolkit — topical metronidazole, ivermectin (Soolantra), azelaic acid, and brimonidine; oral sub-microbial doxycycline; isotretinoin for refractory phymatous disease — is genuinely effective and should not be skipped in favor of supplements. Supplements occupy a narrower supportive role here than in eczema or psoriasis. The trial evidence is thinner, and the most impactful daily actions are trigger identification, photoprotection, and gentle skincare — not a pill regimen. We've included supplements with at least some direct rosacea evidence (oral zinc, niacinamide) plus a few with strong mechanistic rationale (omega-3 for ocular subtype, quercetin for mast cell stabilization). If your rosacea is moderate-to-severe, scarring, or involves the eyes, see a dermatologist (and an ophthalmologist for ocular involvement) — topical ivermectin and oral doxycycline transformed outcomes in the last decade and remain the backbone of treatment.
Food sources
| Food | Amount | %DV |
|---|---|---|
| Chicken breast | 3 oz | 88% |
| Tuna | 3 oz | 70% |
| Turkey | 3 oz | 64% |
| Salmon | 3 oz | 55% |
| Beef liver | 3 oz | 91% |
| Brown rice | 1 cup cooked | 33% |
| Peanuts | 1 oz | 25% |
| Fortified breakfast cereals | 1 serving | 25% |
Chicken breast
- Amount
- 3 oz
- %DV
- 88%
Tuna
- Amount
- 3 oz
- %DV
- 70%
Turkey
- Amount
- 3 oz
- %DV
- 64%
Salmon
- Amount
- 3 oz
- %DV
- 55%
Beef liver
- Amount
- 3 oz
- %DV
- 91%
Brown rice
- Amount
- 1 cup cooked
- %DV
- 33%
Peanuts
- Amount
- 1 oz
- %DV
- 25%
Fortified breakfast cereals
- Amount
- 1 serving
- %DV
- 25%
Choosing a product
What to look for on the label — and what to be skeptical of.
Look for…
Be skeptical of…
Frequently asked questions
What's the difference between niacin and nicotinamide?⌄
Both are forms of vitamin B3. Niacin (nicotinic acid) causes the characteristic flushing reaction and is used at high doses for cholesterol. Nicotinamide does not cause flushing and is preferred for skin uses, pellagra prevention, and general supplementation.
Does nicotinamide raise NAD+?⌄
Yes. Nicotinamide is a direct precursor in the NAD+ salvage pathway and reliably raises NAD+ levels. It is much less expensive than NMN or NR while supporting the same pathway.
Can nicotinamide prevent skin cancer?⌄
In high-risk individuals (those with prior nonmelanoma skin cancers), 500 mg twice daily reduced new skin cancers in clinical trials. Effects fade after stopping. Consult a dermatologist for personalized advice.
Is topical niacinamide effective for skin?⌄
Yes. Topical nicotinamide (2 to 10%) has strong evidence for skin barrier support, reducing hyperpigmentation, and managing acne. It is widely used in dermatology and skincare.
How much is safe daily?⌄
RDA is 14 to 16 mg/day. The supplement Upper Intake Level is 35 mg/day in the US, though much higher therapeutic doses (500 to 1,000 mg) are used safely under supervision. Very high doses can affect liver function.
References by claim
nonmelanoma skin cancer prevention
NAD+ elevation (biomarker)
Safety
Memorial Sloan Kettering — Nicotinamide — MSKCC About Herbs link
Track Nicotinamide with Pilora
Set up dose reminders, check interactions, and join the community in the Pilora iPhone app.
Coming to App StoreDisclaimer: These statements have not been evaluated by the FDA. This page is educational, not a substitute for personalized medical advice. Evidence grades are AI-assisted assessments — talk to your doctor before starting any new supplement, especially if you’re pregnant, breastfeeding, on medications, or managing a chronic condition.