Niacinamide (nicotinamide)

Tier 2 — promising · Knee OA · NAD precursor · Skin · No flush · B3 form

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.