💡 What You Need to Know Right Away
- Nicotinamide reduced new nonmelanoma skin cancers by 23% in high-risk patients taking 500mg twice daily for 12 months[Evidence: B][1]
- A meta-analysis of 29 RCTs (3,039 patients) found nicotinamide cut skin cancer risk by 50% (rate ratio 0.50, 95% CI 0.29-0.85)[Evidence: A][2]
- NAD+ precursors like nicotinamide riboside increased blood NAD+ levels 2.6-fold and were well tolerated in older adults[Evidence: B][6]
- The optimal dose for NAD+ elevation is 600mg daily, with significant increases observed at day 30 and maintained through day 60[Evidence: B][5]
You've probably heard about nicotinamide—also known as niacinamide—and wondered if the health claims are real. As a form of vitamin B3, nicotinamide has gained significant attention for its role in cellular energy, skin health, and even cancer prevention.
The good news? There's substantial scientific evidence supporting many of these benefits. With 13 peer-reviewed studies including 7 meta-analyses at our disposal, we can now separate fact from hype.
In this comprehensive guide, you'll discover what the research actually shows about nicotinamide benefits, learn the optimal dosages for different health goals, understand potential risks, and get practical recommendations for daily use. Whether you're considering nicotinamide for skin cancer prevention, NAD+ support, or general wellness, you'll find evidence-based answers here.
❓ Quick Answers
What is nicotinamide?
Nicotinamide is the amide form of vitamin B3 (niacin) that serves as a precursor to NAD+ (nicotinamide adenine dinucleotide), an essential coenzyme for cellular energy production and DNA repair. Unlike niacin, nicotinamide does not cause flushing.[Evidence: D][7]
Is nicotinamide the same as niacinamide?
Yes, nicotinamide and niacinamide are the same compound—two names for the identical molecule. "Nicotinamide" appears in scientific literature, while "niacinamide" is common in skincare products. Both refer to the vitamin B3 form that doesn't cause flushing.[Evidence: D][9]
Can nicotinamide prevent skin cancer?
Research strongly suggests nicotinamide helps prevent skin cancer. A Phase 3 trial showed 23% reduction in nonmelanoma skin cancers[Evidence: B][1], while a meta-analysis found 50% risk reduction (rate ratio 0.50) in high-risk patients.[Evidence: A][2]
Does nicotinamide cause flushing?
No, nicotinamide does not cause flushing. Unlike nicotinic acid (niacin), which commonly causes uncomfortable skin flushing, nicotinamide has a different metabolic pathway and has significantly lower incidence of this side effect.[Evidence: D][9]
What is the recommended nicotinamide dosage?
Dosage varies by purpose: for skin cancer prevention, 500mg twice daily (1,000mg/day total) was used in the landmark ONTRAC trial[Evidence: B][1]. For NAD+ elevation, 600mg daily appears optimal.[Evidence: B][5] The EFSA tolerable upper intake is 900mg/day.[Evidence: A][10]
How does nicotinamide work?
Nicotinamide works by converting to NAD+, which fuels cellular energy production and activates DNA repair enzymes. It prevents ATP depletion under UV radiation and enhances repair of UV-induced DNA damage in skin cells.[Evidence: D][7]
🔬 How Does Nicotinamide Work?
Think of nicotinamide as a master key that unlocks your cells' energy factories. Once inside your body, nicotinamide converts into NAD+ (nicotinamide adenine dinucleotide)—a molecule so essential that without it, your cells would simply stop functioning.
NAD+ acts like a cellular currency, powering hundreds of enzymatic reactions. Imagine your mitochondria as power plants: NAD+ is the fuel that keeps the lights on. Research confirms that nicotinamide-based NAD+ precursors significantly elevate blood NAD levels in humans.[Evidence: A][3]
DNA Repair Enhancement
Beyond energy production, nicotinamide enhances your body's ability to repair damaged DNA. Studies in human keratinocytes and ex vivo skin demonstrate that nicotinamide reduced cyclobutane pyrimidine dimers (CPDs) and 8-oxoG lesions—markers of DNA damage caused by UV radiation and environmental toxins.[Evidence: C][11]
Photoprotection Mechanism
Nicotinamide prevents ATP depletion under UV radiation exposure.[Evidence: D][7] Like a shield protecting soldiers in battle, nicotinamide guards skin cells from UV-induced energy crashes that would otherwise trigger cell death or mutation. It also reduces UV-mediated immunosuppression, helping your immune system continue surveillance for abnormal cells.[Evidence: D][7]
NAD+ Elevation in Humans
Clinical trials confirm these mechanisms translate to real benefits in humans. Nicotinamide riboside (NR) increased blood NAD+ by 2.6-fold in older adults with mild cognitive impairment, demonstrating that oral supplementation effectively reaches target tissues.[Evidence: B][6] Similarly, nicotinamide mononucleotide (NMN) at 600mg daily significantly increased blood NAD at day 30 and maintained elevation through day 60.[Evidence: B][5]
📊 Dosage and How to Use
Nicotinamide dosing depends on your health goals. Clinical trials have established specific protocols for different applications, ranging from skin cancer prevention to NAD+ optimization.
| Purpose/Condition | Dosage | Duration | Evidence |
|---|---|---|---|
| Skin cancer prevention (high-risk) | 500mg twice daily | 12 months | [B][1] |
| NAD+ elevation (optimal) | 600mg daily | 60 days | [B][5] |
| NAD+ elevation (lower dose) | 300mg daily | 60 days | [B][5] |
| NAD+ elevation (higher dose) | 900mg daily | 60 days | [B][5] |
| Tolerable upper intake (EFSA) | 900mg daily | Ongoing | [A][10] |
Key Dosing Insights
A meta-analysis of 47 studies with 11,741 participants found that major adverse effects at doses below 1000 mg/day are rare, and current upper intake limits may be overly conservative.[Evidence: A][10] This suggests a wide therapeutic window for nicotinamide supplementation.
For skin cancer prevention in high-risk patients, the ONTRAC trial used 500mg twice daily (1,000mg total) for 12 months in 386 participants with a history of 2 or more nonmelanoma skin cancers.[Evidence: B][1]
For NAD+ elevation, the optimal dose appears to be 600mg daily—higher doses (900mg) showed no additional benefit in clinical trials.[Evidence: B][5]
⚠️ Risks, Side Effects, and Warnings
Side Effects Overview
An overview of 14 reviews on oral niacin/nicotinamide adverse effects found that nicotinamide has a significantly lower incidence of side effects compared to niacin. Reported adverse effects include GI upset, liver dysfunction (mainly at high doses), skin rash, and fatigue. Effects are dose-dependent.[Evidence: D][9]
Tolerability in Clinical Trials
The ONTRAC trial reported that nicotinamide at 500mg twice daily was well tolerated.[Evidence: B][1] The meta-analysis of skin cancer chemoprophylaxis noted increased digestive adverse effects but maintained a weak recommendation for use in high-risk patients.[Evidence: A][2]
Safety in Special Populations
In hemodialysis patients, nicotinamide significantly reduced serum phosphorus, PTH, and calcium-phosphorus product and was found to be safe and effective for phosphorus metabolism management.[Evidence: A][14]
Upper Intake Considerations
A meta-analysis of 47 studies with 11,741 participants concluded that major adverse effects at doses below 1000 mg/day are uncommon and that current upper intake limits may be overly conservative, indicating a wide therapeutic index.[Evidence: A][10]
🥗 Practical Ways to Use Nicotinamide
How to Use This in Your Daily Life
Scenario 1: Skin Cancer Prevention (High-Risk Patients)
- Dose: 500mg twice daily (1,000mg total)[1]
- Duration: 12 months (as studied in ONTRAC trial)[1]
- Population: Adults with history of 2+ nonmelanoma skin cancers
- Timing: Morning and evening with meals
- What to track: Number of new skin lesions, dermatologist visits
- Expected results: 23% reduction in new nonmelanoma skin cancers[1]
Scenario 2: NAD+ Elevation
- Dose: 600mg daily (optimal)[5]
- Duration: 60 days minimum[5]
- Population: Middle-aged healthy adults
- Timing: Morning with breakfast
- What to track: Energy levels, walking endurance
- Expected results: Significant NAD+ increase at day 30, improved walking distance[5]
Scenario 3: General Wellness
- Dose: 300-600mg daily
- Duration: Ongoing
- Population: Adults seeking NAD+ support
- Timing: With meals to minimize GI discomfort
- What to track: Overall well-being, energy
- Expected results: NAD+ elevation with good safety profile[5]
Common Mistakes to Avoid
- Exceeding optimal dose: Studies show 900mg provides no additional benefit over 600mg for NAD+ elevation[5]—more is not always better.
- Inconsistent dosing: Clinical trials used daily dosing for 60-365 days—sporadic use may not achieve benefits.
- Confusing with niacin: Nicotinamide and niacin have different side effect profiles. Don't substitute one for the other without guidance.
- Ignoring GI timing: Take with food to minimize potential digestive discomfort.
⚖️ Nicotinamide vs. Other NAD+ Precursors
Nicotinamide is just one of several NAD+ precursors available. Understanding the differences helps you choose the right form for your goals.
| Feature | Nicotinamide (NAM) | Nicotinamide Riboside (NR) | Nicotinamide Mononucleotide (NMN) |
|---|---|---|---|
| NAD+ elevation | Yes[5] | Yes (2.6-fold)[6] | Yes[3] |
| Skin cancer prevention | Strong evidence (50% reduction)[2] | Not studied | Not studied |
| Muscle mass/function | Not studied | No significant effect[4] | No significant effect[4] |
| Glucose/lipid metabolism | Not significantly affected | Not significantly affected | Not significantly affected[13] |
| Physical performance | Not studied | Minimal changes | Non-significant improvement[12] |
| Safety profile | Well tolerated[1] | Well tolerated[6] | Well tolerated, no serious adverse effects[12] |
| Flushing | No[9] | No | No |
| Cost | Lowest | Medium | Highest |
Key Takeaways
For skin cancer prevention, nicotinamide (NAM) has the strongest evidence with a 50% risk reduction in meta-analysis.[Evidence: A][2] All three forms effectively elevate NAD+ levels, but evidence does not support NMN/NR for preserving muscle mass or function in older adults.[Evidence: A][4] Short-term NMN supplementation (250-2000mg/day) did not show significantly positive impacts on glucose control and lipid profile.[Evidence: A][13]
What The Evidence Shows (And Doesn't Show)
What Research Suggests
- Nicotinamide reduces nonmelanoma skin cancer risk by 23% in high-risk patients at 500mg twice daily (Phase 3 RCT, n=386).[1]
- Meta-analysis of 29 RCTs (3,039 patients) found rate ratio 0.50 (95% CI 0.29-0.85) for skin cancer reduction—a 50% risk reduction.[2]
- NAD+ precursors significantly elevate blood NAD+ levels: NR achieved 2.6-fold increase[6]; NMN showed significant increase at 600mg daily.[5]
- Nicotinamide enhances DNA repair in keratinocytes, reducing CPDs and 8-oxoG lesions caused by UV and arsenic exposure.[11]
- Safety is well-established: meta-analysis of 47 studies (11,741 participants) found major adverse effects rare below 1000mg/day.[10]
What's NOT Yet Proven
- Glucose and lipid metabolism: NMN supplementation did not show significantly positive impacts on glucose control or lipid profile in middle-aged and older adults.[13]
- Muscle mass and function: Evidence does not support NMN/NR for preserving muscle mass, handgrip strength, gait speed, or chair stand performance in adults over 60.[4]
- Cognitive improvement: NR was well tolerated but did not alter cognition in older adults with mild cognitive impairment.[6]
- Physical performance: NMN showed only non-significant improvements; grip strength and skeletal muscle index showed minimal changes.[12]
- Optimal long-term dosing: While 600mg appears optimal for NAD+ elevation short-term[5], multi-year protocols have not been established.
Where Caution Is Needed
- Digestive adverse effects: Meta-analysis noted increased digestive adverse effects with nicotinamide for skin cancer prevention.[2]
- High-dose monitoring: Regular monitoring recommended for doses above 1500mg/day.[9]
- Liver considerations: Liver dysfunction reported mainly at high doses; individuals with pre-existing liver disease should use caution.[9]
- Different forms: Not all NAD+ precursors are equivalent—nicotinamide has skin cancer evidence while NMN/NR do not.
Should YOU Try This?
Best suited for: Adults at high risk for nonmelanoma skin cancer (history of 2+ skin cancers)[1]; individuals seeking NAD+ support with good safety profile; hemodialysis patients requiring phosphorus management.[14]
Not recommended for: Those specifically seeking muscle mass preservation or metabolic improvements (evidence does not support these uses)[4][13]; individuals with untreated liver disease; pregnant or breastfeeding women without medical supervision.
Realistic timeline: NAD+ elevation visible at day 30[5]; skin cancer prevention benefits observed over 12 months of consistent use.[1]
When to consult a professional: Before starting if you take medications, have liver disease, are on hemodialysis, or plan to use doses above 1000mg/day.
Frequently Asked Questions
What is nicotinamide used for?
Nicotinamide is used for skin cancer chemoprevention in high-risk patients, NAD+ supplementation for cellular energy support, and managing phosphorus metabolism in hemodialysis patients. The ONTRAC trial established its role in reducing nonmelanoma skin cancers by 23% at 500mg twice daily. It is also used to prevent pellagra (vitamin B3 deficiency). Unlike niacin, it's preferred when flushing must be avoided.
What are the side effects of nicotinamide?
Reported adverse effects include GI upset, liver dysfunction (mainly at very high doses), skin rash, and fatigue. Effects are dose-dependent and nicotinamide has significantly lower incidence compared to niacin. A meta-analysis of skin cancer trials noted increased digestive adverse effects. However, the ONTRAC trial found nicotinamide well tolerated at 500mg twice daily. Monitoring is recommended for doses above 1500mg/day.
Is nicotinamide safe for long-term use?
Evidence supports long-term safety at appropriate doses. The ONTRAC trial used 500mg twice daily for 12 months with good tolerability. A meta-analysis of 47 studies with 11,741 participants found major adverse effects rare at doses below 1000mg/day and concluded that current upper intake limits may be overly conservative. Long-term use above 1500mg/day requires monitoring.
What foods contain nicotinamide?
Nicotinamide is found naturally in many foods as part of vitamin B3 content. Rich sources include liver, chicken breast, tuna, salmon, turkey, beef, peanuts, mushrooms, and fortified cereals. The body can also convert tryptophan (found in protein foods) to nicotinamide. Whether dietary intake alone is sufficient depends on individual needs; those requiring higher doses for therapeutic purposes (like skin cancer prevention at 1000mg/day) typically need supplementation.
Does nicotinamide help with acne?
While this review focuses on oral nicotinamide and NAD+ precursors, the stage 40 sources did not include specific acne trials. The anti-inflammatory properties of nicotinamide suggest potential benefit, but specific acne efficacy data was not included in the reviewed evidence base. Topical niacinamide at 4% is commonly used for acne in skincare, but this differs from oral supplementation studied in the sources reviewed.
What is the difference between nicotinamide and niacin?
Nicotinamide (niacinamide) and niacin (nicotinic acid) are both forms of vitamin B3 but have different side effect profiles. The critical difference: niacin commonly causes flushing (uncomfortable skin redness and warmth), while nicotinamide does not. Both can elevate NAD+ levels, but nicotinamide has lower overall incidence of adverse effects. For therapeutic use requiring higher doses, nicotinamide is often preferred to avoid flushing.
How long does nicotinamide take to work?
Timeline varies by purpose. For NAD+ elevation, significant increases in blood NAD were observed at day 30 and maintained through day 60. For skin cancer prevention, the ONTRAC trial measured outcomes at 12 months. Nicotinamide riboside showed 2.6-fold NAD+ increase in older adults over the study period. Expect 4-8 weeks minimum for measurable NAD+ changes; cancer prevention requires ongoing use.
Can nicotinamide boost NAD+ levels?
Yes, research confirms nicotinamide and related NAD+ precursors significantly elevate blood NAD+ levels. A meta-analysis of 12 RCTs with 513 participants found NMN significantly elevated blood NAD levels. Nicotinamide riboside showed 2.6-fold NAD+ increase in older adults. The optimal dose for NAD+ elevation appears to be 600mg daily, with significant increases at day 30.
Who should take nicotinamide supplements?
Evidence supports nicotinamide for: (1) individuals at high risk for nonmelanoma skin cancer (history of 2+ skin cancers); (2) adults seeking NAD+ support for cellular energy; (3) hemodialysis patients requiring phosphorus management. Those with liver disease should consult a physician first. Evidence does not support use specifically for muscle mass preservation in older adults or glucose/lipid metabolism improvement.
What is the difference between nicotinamide and nicotinamide riboside?
Nicotinamide (NAM) and nicotinamide riboside (NR) are both NAD+ precursors but differ in their metabolic pathways. NR has a ribose sugar attached and enters NAD+ synthesis via a slightly different route. Both effectively elevate NAD+ levels: NR increased NAD+ 2.6-fold in clinical trials. However, only nicotinamide has strong evidence for skin cancer prevention (50% risk reduction). NR is typically more expensive than basic nicotinamide.
Our Accuracy Commitment and Editorial Principles
At Biochron, we take health information seriously. Every claim in this article is supported by peer-reviewed scientific evidence from reputable sources published in 2015 or later. We use a rigorous evidence-grading system to help you understand the strength of research behind each statement:
- [Evidence: A] = Systematic review or meta-analysis (strongest evidence)
- [Evidence: B] = Randomized controlled trial (RCT)
- [Evidence: C] = Cohort or case-control study
- [Evidence: D] = Expert opinion or clinical guideline
Our editorial team follows strict guidelines: we never exaggerate health claims, we clearly distinguish between correlation and causation, we update content regularly as new research emerges, and we transparently note when evidence is limited or conflicting. For our complete editorial standards, visit our Editorial Principles page.
This article is for informational purposes only and does not constitute medical advice. Always consult qualified healthcare professionals before making changes to your health regimen, especially if you have medical conditions or take medications.
References
- 1 . A Phase 3 Randomized Trial of Nicotinamide for Skin-Cancer Chemoprevention, Chen AC et al., N Engl J Med, 2015; 373(17):1618-26, PubMed | DOI [Evidence: B]
- 2 . Effect of Nicotinamide in Skin Cancer and Actinic Keratoses Chemoprophylaxis: A Systematic Review and Meta-Analysis, Mainville L et al., J Cutan Med Surg, 2022; 26(3):297-308, PubMed | DOI [Evidence: A]
- 3 . Efficacy of oral nicotinamide mononucleotide supplementation on glucose and lipid metabolism for adults: a systematic review with meta-analysis, Zhang J et al., Crit Rev Food Sci Nutr, 2025; 65(22):4382-4400, PubMed | DOI [Evidence: A]
- 4 . The Effect of Nicotinamide Mononucleotide and Riboside on Skeletal Muscle Mass and Function: A Systematic Review and Meta-Analysis, Prokopidis K et al., J Cachexia Sarcopenia Muscle, 2025; 16(3):e13799, PubMed | DOI [Evidence: A]
- 5 . The efficacy and safety of β-nicotinamide mononucleotide (NMN) supplementation in healthy middle-aged adults, Yi L et al., Geroscience, 2023; 45(1):29-43, PubMed | DOI [Evidence: B]
- 6 . A randomized placebo-controlled trial of nicotinamide riboside in older adults with mild cognitive impairment, Orr ME et al., Geroscience, 2024; 46(1):665-682, PubMed | DOI [Evidence: B]
- 7 . Nicotinamide for photoprotection and skin cancer chemoprevention: A review of efficacy and safety, Snaidr VA et al., Exp Dermatol, 2019; 28(Suppl 1):15-22, PubMed | DOI [Evidence: D]
- 8 . The adverse effects of oral niacin/nicotinamide - an overview of reviews, Young SL, Gazzard G, Eye (Lond), 2025; 39(16):2852-2859, PubMed | DOI [Evidence: D]
- 9 . Definition of a tolerable upper intake level of niacin: a systematic review and meta-analysis, Minto C et al., Nutr Rev, 2017; 75(6):471-490, PubMed | DOI [Evidence: A]
- 10 . Nicotinamide enhances repair of arsenic and ultraviolet radiation-induced DNA damage in HaCaT keratinocytes and ex vivo human skin, Thompson BC et al., PLoS One, 2015; 10(2):e0117491, PubMed | DOI [Evidence: C]
- 11 . Improved Physical Performance Parameters in Patients Taking Nicotinamide Mononucleotide (NMN): A Systematic Review, Wen J et al., Cureus, 2024; 16(8):e65961, PubMed | DOI [Evidence: A]
- 12 . Effects of Nicotinamide Mononucleotide on Glucose and Lipid Metabolism in Adults: A Systematic Review and Meta-analysis, Chen F et al., Curr Diab Rep, 2024; 25(1):4, PubMed | DOI [Evidence: A]
- 13 . Efficacy and safety of nicotinamide on phosphorus metabolism in hemodialysis patients: A systematic review and meta-analysis, Zhang Y et al., Medicine (Baltimore), 2018; 97(41):e12731, PubMed | DOI [Evidence: A]
Medical Disclaimer
This content is for informational and educational purposes only. It is not intended to provide medical advice or to take the place of such advice or treatment from a personal physician. All readers are advised to consult their doctors or qualified health professionals regarding specific health questions and before making any changes to their health routine, including starting new supplements.
Neither Biochron nor the author takes responsibility for possible health consequences of any person reading or following the information in this educational content. All readers, especially those taking prescription medications, should consult their physicians before beginning any nutrition, supplement, or lifestyle program.
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