Niacinamide (nicotinamide)
What it is
The amide form of vitamin B3 with completely different pharmacology from niacin — no skin flushing, no lipid-lowering effect, but strong evidence for specific conditions. Multiple RCTs confirm 3,000 mg/day significantly improves knee osteoarthritis pain, matching NSAID efficacy in some trials. As an NAD+ precursor it supports cellular energy at a fraction of the cost of NMN or NR. Oral niacinamide also reduces UV-induced DNA damage and pre-cancerous actinic keratoses (Cochrane-confirmed). Does not raise LDL or cause hepatotoxicity at clinical doses.
Dose
Knee OA: 500–1,000 mg 3× daily (up to 3,000 mg/day). NAD+ support: 250–500 mg/day. Skin UV protection: 500 mg twice daily.
Time of day & tips
Take with food, split across the day. The Jonas 1996 OA protocol (3 g/day) EXCEEDS the NIH ODS UL of 900 mg/day for niacinamide — at this dose, monitor liver enzymes every 3 months, watch for nausea/dark urine. Do not combine with hepatotoxic supplements (kava, high-dose green tea, comfrey) or alcohol. Lower dosing (250–500 mg/day for NAD+ or skin) is well within safety margins.
Cycling
Safe for continuous long-term use. No cycling needed. Very well tolerated across all age groups at therapeutic doses. Preferred form of B3 for those who cannot tolerate niacin flushing.
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