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Nicotinamide (Niacinamide) for Skin Cancer Prevention:
Safe, Inexpensive, But Hard to Find
By Todd V. Cartee, MD, FACMS
Since a phase 3 clinical trial was published in late 2015 supporting the chemopreventative benefits of nicotinamide, some dermatologists have been recommending this vitamin B3 analogue to transplant patients and other patients with a heavy skin cancer burden. However, our patients have experienced a number of obstacles in obtaining the correct product. Niacin (nicotinic acid) is the most common commercially available form of Vitamin B3. Nicotinamide or niacinamide is an amide form of niacin. It is a precursor of NAD+, an essential cofactor in ATP production. Nicotinamide has UV protective properties by enhancing DNA repair mechanisms and also reduces UV-induced immunosuppression. Nicotinamide is better tolerated than niacin, which can cause significant flushing in susceptible patients. Indeed, nicotinamide has almost no side effects at doses below 3 g/day. Niacin and nicotinamide generally have similar biologic effects except nicotinamide lacks the lipid lowering properties of niacin.
Nicotinamide at a dose of 500 mg PO BID was studied in a large randomized controlled trial of 386 patients who had been diagnosed with at least 2 NMSCs in the prior 5 years –so a relatively low tumor burden1. They were treated for 12 months and followed for 18 months. At 12 months the rate of new NMSC was 23% lower in the nicotinamide group (P=0.02), a statistically significant improvement, and actinic keratoses were reduced by 13% (P=0.001). While admittedly the benefit is small, the intervention is inexpensive and was free of any adverse events. The authors noted a trend toward a greater effect in patients with a higher skin cancer burden (>5 prior NMSCs). Interestingly, immunosuppressed patients were excluded from the study.
Based on these findings, we began recommending nicotinamide to some of our patients last year but quickly learned that the nutritional supplement could be surprisingly difficult for them to acquire. I went on a local scavenger hunt to try to ascertain nicotinamide’s availability. Remarkably, CVS, Rite-Aid, Walgreen’s, Wal-Mart, K-Mart, and GNC do not carry nicotinamide in my area (central Pennsylvania). The Vitamin Shoppe, a national nutritional supplement retailer which is located in most metropolitan areas, was the only store where I could find it. The Vitamin Shoppe carries nicotinamide 500 mg capsules under their own brand and sells 300 capsules, or a 5 month supply, for $21.99 (roughly 7¢ each). Nicotinamide is readily available online and can be purchased at Amazon under the label “Nature’s Way,” a large US-based supplement manufacturer, for ~$15 per 300 capsules (5¢ each). [Pricing not guaranteed] It is important to note that the product in both cases is labelled with the alternative name “Niacinamide.” This will no doubt prove a point of confusion unless patients are properly instructed.
*Niacinamide and nicotinamide are synonyms
- Chen AC, Martin AJ, Choy B, et al. A Phase 3 Randomized Trial of Nicotinamide for Skin-Cancer Chemoprevention. N Engl J Med 2015;373:1618-26.