Niacinamide (Vitamin B3)
Specifically for Glaucoma
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Why it works for Glaucoma:
Glaucoma stresses retinal ganglion cell (RGC) mitochondria and depletes NAD⁺ with age. Raising NAD⁺ with niacinamide supports mitochondrial energy metabolism and appears to make RGCs more resilient. In glaucoma-prone mice, niacinamide replenished retinal NAD⁺, corrected early mitochondrial abnormalities, and markedly reduced RGC loss. At the highest dose, ~93% of eyes did not develop glaucoma, indicating strong neuroprotection. Europe PMC
This neuroprotection is largely independent of intraocular pressure (IOP) (i.e., it’s not an IOP-lowering therapy but a potential adjunct). Mechanistic and preclinical work from Williams et al. (Science, 2017) and related experiments back that up. Europe PMC
How to use for Glaucoma:
There is no approved dosing guideline for glaucoma; use has been off-label in clinical trials alongside standard IOP-lowering care. Typical study protocols:
Nicotinamide alone (crossover RCT, 57 participants; Australia, 2017–2019):
- Dose 1.5 g/day for 6 weeks, then 3.0 g/day for 6 weeks (oral), with participants remaining on their usual glaucoma treatment.
- Primary functional measure (ERG PhNR) improved; IOP did not change—consistent with a neuroprotective (not pressure-lowering) effect. ophthalmopro.com.au
Nicotinamide + pyruvate (phase 2 RCT, 32 completers; USA, 2019–2020):
- Ascending nicotinamide 1,000→3,000 mg/day plus pyruvate 1,500→3,000 mg/day over ~2.2 months, added to standard care.
- More visual-field locations improved vs placebo; no serious adverse events reported during the short study. JAMA Network
- Longer-term trials are ongoing. Examples include a Phase III “NAMinG” trial (nicotinamide vs placebo) and a larger Nicotinamide + Pyruvate trial (≈20 months). These are designed to test whether niacinamide slows progression, not just short-term function. ClinicalTrials
If you and your ophthalmologist consider a trial-style regimen, the patterns above are what have actually been studied. In practice, clinicians who use it off-label typically:
- Use nicotinamide (niacinamide) — not “niacin”/nicotinic acid (which causes flushing and has a different safety profile). ophthalmologyglaucoma.org
- Split doses (e.g., 500–1000 mg with meals, titrating toward study doses if tolerated) to reduce GI upset, and do baseline/periodic liver tests at higher doses. (See warnings below and the specialty-society guidance.) ophthalmologyglaucoma.org
- Continue standard IOP-lowering therapy; niacinamide is considered adjunctive. JAMA Network
Scientific Evidence for Glaucoma:
Human trials
- Nicotinamide (1.5 g→3 g/day) vs placebo; 6 weeks per dose; crossover RCT (n=57): Improved inner retinal function (ERG PhNR) and a trend to better mean deviation on fields; IOP unchanged. Clin Exp Ophthalmol (2020). ophthalmopro.com.au
- Nicotinamide (1–3 g/day) + pyruvate (1.5–3 g/day) vs placebo; phase 2 RCT (n=32 completers; median 2.2 months): Greater number of improving visual-field test locations vs placebo; no serious AEs. JAMA Ophthalmology (2021). JAMA Network
Ongoing:
- NAMinG Phase III—double-masked RCT testing whether nicotinamide slows visual-field loss in open-angle glaucoma. ClinicalTrials
- Columbia trial—longer-term nicotinamide+pyruvate vs placebo (up to 87 weeks). ClinicalTrials
Preclinical (mechanism + effect)
- Science (2017): In aged glaucoma-prone mice, oral nicotinamide (vitamin B3 amide) restored retinal NAD⁺, corrected mitochondrial vulnerability, and prevented glaucoma in ~93% of eyes at the highest dose. Europe PMC
- Frontiers in Neuroscience (2017): Nicotinamide and Wld^S pathway act additively to protect against glaucomatous neurodegeneration. Frontiers
Consensus/position statements
American Glaucoma Society (AGS) & American Academy of Ophthalmology (AAO) position statement (2025):
- Recognizes promising early evidence; recommends cautious, monitored use under physician supervision;
- Emphasizes nicotinamide (niacinamide) should not be substituted with “niacin”;
- Advises dose limits and liver-safety monitoring when using higher doses. ophthalmologyglaucoma.org
Specific Warnings for Glaucoma:
Niacinamide is a vitamin with a wide safety margin at nutritional doses, but glaucoma trial doses are much higher and warrant medical supervision.
- Form matters: Use nicotinamide/niacinamide, not nicotinic acid (“niacin”)—the latter has different pharmacology and more flushing/lipid effects; AGS/AAO specifically caution against substituting niacin for nicotinamide in glaucoma. ophthalmologyglaucoma.org
Liver toxicity at high doses:
- The NIH Office of Dietary Supplements notes nausea, vomiting, and signs of liver toxicity can occur at ~3,000 mg/day of nicotinamide, and reports thrombocytopenia in dialysis patients at 500–1,500 mg/day (used for phosphate control). High-dose regimens should include baseline and periodic LFTs. Office of Dietary Supplements
- Safety reviews also document reversible hepatotoxicity with high-dose nicotinamide in animals and humans; risk increases as doses rise into gram ranges. SpringerLink
Kidney disease / dialysis: Thrombocytopenia has been observed in hemodialysis patients taking nicotinamide; extra caution and blood count monitoring are advised. Office of Dietary Supplements
Pregnancy, pediatrics: Routine dietary amounts are considered safe, but megadose use in pregnancy/children lacks evidence; stick to recommended dietary intakes unless a specialist advises otherwise. (General safety background from NIH ODS.) Office of Dietary Supplements
Drug/condition considerations:
- Pre-existing liver disease, heavy alcohol use, or concurrent hepatotoxic drugs increase risk.
- GI upset is common at higher doses; splitting doses with food can help (as done in trials). JAMA Network
Not a substitute for IOP-lowering therapy: All trials kept standard glaucoma treatment unchanged. Niacinamide has not been shown to lower IOP; it’s being studied as adjunctive neuroprotection. ophthalmopro.com.au
Evidence gaps: Short-term improvements in retinal function/fields are encouraging, but definitive proof that niacinamide slows long-term progression awaits results of larger, longer RCTs now underway. ClinicalTrials
General Information (All Ailments)
What It Is
Niacinamide, also known as nicotinamide, is a water-soluble form of vitamin B3 (niacin). It is an essential nutrient, meaning that the body cannot produce enough of it on its own and must obtain it from diet or supplementation. Unlike niacin (nicotinic acid), niacinamide does not cause flushing—a warm, red, tingling sensation often associated with niacin intake. It plays a critical role in converting food into usable cellular energy, maintaining healthy skin, and supporting nervous system function.
Niacinamide can be derived directly from dietary sources such as poultry, fish, eggs, whole grains, nuts, and legumes, or it can form in the body when there’s an adequate intake of tryptophan (an amino acid) and niacin.
How It Works
At the biochemical level, niacinamide functions primarily as a component of two key coenzymes:
- Nicotinamide adenine dinucleotide (NAD⁺)
- Nicotinamide adenine dinucleotide phosphate (NADP⁺)
These coenzymes are vital for hundreds of enzymatic reactions in the body, especially those related to energy production and cellular repair. NAD⁺ and NADP⁺ facilitate oxidation-reduction (redox) reactions, which are crucial for converting carbohydrates, fats, and proteins into energy.
In addition to its metabolic roles, niacinamide:
- Enhances DNA repair mechanisms, helping cells recover from oxidative and UV-induced damage.
- Supports cell signaling and stress response pathways, influencing inflammation and apoptosis (cell death).
- In the skin, it strengthens the barrier function by boosting ceramide and fatty acid synthesis, improving moisture retention and reducing sensitivity.
- Regulates sebum (oil) production and has anti-inflammatory effects, which make it beneficial for acne and rosacea.
Why It’s Important
Niacinamide is essential for maintaining the normal function of nearly every organ system. Its importance stems from its widespread roles in energy metabolism, cellular defense, and tissue integrity.
- Energy and Cellular Health: Niacinamide-derived NAD⁺ is central to mitochondrial energy production. Adequate levels ensure that cells have enough energy to perform essential biological functions.
- Skin Health: It helps maintain the skin’s lipid barrier, reduces transepidermal water loss, and improves elasticity. Topical niacinamide is frequently used in dermatology for reducing fine lines, hyperpigmentation, and redness.
- Nervous System Function: Niacinamide supports nerve cell survival and neurotransmitter balance, protecting against neurodegenerative processes.
- Cardiovascular and Immune Support: By influencing lipid metabolism and inflammatory mediators, niacinamide may contribute to cardiovascular and immune system balance.
- Deficiency Prevention: A deficiency of vitamin B3 leads to pellagra, a condition characterized by the “three Ds”: dermatitis, diarrhea, and dementia, and if left untreated, it can be fatal.
Considerations
While niacinamide is generally considered safe and well-tolerated, there are important factors to consider regarding dosage, form, and use:
- Dosage and Supplementation: The recommended dietary allowance (RDA) for adults typically ranges from 14 to 16 mg per day, depending on age and sex. Therapeutic doses—sometimes much higher—should only be used under medical supervision, especially for specific conditions like acne, arthritis, or cholesterol management.
- Safety Profile: Niacinamide does not cause flushing (unlike niacin), but excessive doses—especially above 1,000 mg per day—can lead to side effects such as liver toxicity, gastrointestinal upset, or glucose intolerance in some individuals.
- Interactions: It may interact with medications affecting liver metabolism or blood sugar levels. People with liver disease, diabetes, or gallbladder issues should use caution and consult healthcare professionals before supplementation.
- Topical Use: Topical niacinamide (typically in 2–10% concentrations) is well tolerated for most skin types, but mild irritation may occur in sensitive skin when used at higher concentrations.
- Pregnancy and Breastfeeding: Niacinamide is considered safe when used within recommended dietary levels during pregnancy and lactation, as it is essential for fetal growth and maternal health.
Helps with these conditions
Niacinamide (Vitamin B3) is most effective for general wellness support with emerging research . The effectiveness varies by condition based on clinical evidence and user experiences.
Detailed Information by Condition
Rosacea
Strengthens a compromised skin barrier. Niacinamide up-regulates epidermal proteins and stimulates ceramide synthesis, which improves barrier function...
Glaucoma
Glaucoma stresses retinal ganglion cell (RGC) mitochondria and depletes NAD⁺ with age. Raising NAD⁺ with niacinamide supports mitochondrial energy met...
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