Acne and Vitamin B3

Vitamin B3 is required for the proper function of more than 50 enzymes. Without it, your body would not be able to release energy or make fats from carbohydrates. Vitamin B3 is also used to make sex hormones and other important chemical signal molecules.

Vitamin B3 comes in two principal forms: niacin (nicotinic acid) and niacinamide (nicotinamide). When taken in low doses for nutritional purposes, these two forms of the vitamin are essentially identical. However, each has its own particular effects when taken in high doses. Niacinamide gel has demonstrated potential for the topical treatment of acne. A common form of the gel is sold under the name Nicomide-T.

Taking vitamin B3 orally has not shown as much potential.

Niacinamide gel might help treat acne by addressing the infection and inflammation associated with the condition.

Read more details about Vitamin B3.

In a double-blind trial, 76 individuals with moderately severe acne were treated with either 4% niacinamide gel or 1% clindamycin gel (a standard antibiotic treatment).¹³ Niacinamide proved to be just as effective as the antibiotic over an 8-week trial period. However, because this study lacked a placebo group, its results are considered to be of limited significance.

Safety Issues

When taken at a dosage of more than 100 mg daily, niacin frequently causes annoying skin flushing, especially in the face, as well as stomach distress, itching, and headache.⁶⁵ In studies, as many as 43% of individuals taking niacin quit because of unpleasant side effects.⁴⁴

A more dangerous effect of niacin is liver inflammation. Although some reports suggest that it occurs most commonly with slow-release niacin, it can occur with any type of niacin when taken at a daily dose of more than 500 mg (usually 3 g or more). Regular blood tests to evaluate liver function are, therefore, mandatory when using high-dose niacin (or niacinamide or inositol hexaniacinate). This reaction almost always goes away when niacin is stopped. Note: Contrary to claims on some manufacturers' websites, there is no reliable evidence that inositol hexaniacinate is safer than ordinary niacin.

As noted above, a single dose of 2.5 to 5 grams of niacin (used in the vain hope of passing a urine drug test despite the presence of drugs in the system) can cause life-threatening disturbances in body function.⁷⁰ Since this range includes the high-end of the dosage used for treating cholesterol, presumably people who gradually work up to taking several grams of niacin daily can accommodate it in a way that those who take it suddenly cannot.

If you have liver disease, ulcers (presently or in the past), gout, or drink too much alcohol,⁴⁵ do not take high-dose niacin except on medical advice.

While there has been some concern that niacin may raise blood sugar levels in diabetics, the effect appears to be slight, and it carries little, if any, clinical significance.^46,56,71

Combining high-dose niacin with statin drugs (the most effective medications for high cholesterol) further improves cholesterol profile by raising HDL (“good”) cholesterol.^52-54 Unfortunately, there are real concerns that this combination therapy could cause a potentially fatal condition called rhabdomyolysis.

A growing body of evidence, however, suggests that the risk is relatively slight in individuals with healthy kidneys. Furthermore, even much lower doses of niacin than the usual dose given to improve cholesterol levels (100 mg versus 1,000 mg or more) may provide a similar benefit.⁵⁵ At this dose, the risk of rhabdomyolysis should be decreased.

Nonetheless, it is not safe to try this combination except under close physician supervision. Rhabdomyolysis can be fatal.

Another potential drug interaction involves the anticonvulsant drugs carbamazepine and primidone. Niacinamide might increase blood levels of these drugs, possibly requiring reduction in drug dosage.⁵⁰ Do not use this combination except under physician supervision.

The maximum safe dosage of niacin for pregnant or nursing women has been set at 35 mg daily (30 mg if 18 years old or younger).⁵¹

Interactions You Should Know About

If you are taking:

• Cholesterol-lowering drugs in the statin family, niacin might offer potential benefits; however, there are real dangers to this combination. Do not try it except under physician supervision.
• The antituberculosis drug isoniazid (INH): You may need extra niacin.
• Anticonvulsant drugs such as carbamazepine or primidone: Do not take niacinamide except under physician supervision.

If you drink alcohol excessively:

• Do not take niacin except under physician supervision.

13. Shalita AR, Smith JG, Parish LC, et al. Topical nicotinamide compared with clindamycin gel in the treatment of inflammatory acne vulgaris. Int J Dermatol. 1995;34:434-437.