AGS Recommends Cautious Approach to Nicotinamide

Overview

The American Glaucoma Society (AGS) advises caution regarding nicotinamide use for glaucoma neuroprotection due to emerging safety concerns, particularly regarding high doses (≥3 g/day) linked to drug-induced liver injury. Careful monitoring of liver function is necessary.

Background

Nicotinamide, a form of vitamin B3, has garnered interest as a potential neuroprotective agent for glaucoma, particularly in preserving retinal ganglion cells. Despite promising early trial results, the safety profile at higher doses remains uncertain, prompting the AGS and American Academy of Ophthalmology to issue new guidelines emphasizing the need for caution and monitoring. Understanding the implications of nicotinamide supplementation is crucial for patient safety and effective glaucoma management.

Data Highlights

Include relevant findings from trials regarding the effects of nicotinamide on retinal function and safety concerns.

Key Findings

• Nicotinamide supplementation may improve mitochondrial function and protect retinal cells in laboratory studies.
• Early human trials indicated potential improvements in retinal function and visual field testing with high doses of nicotinamide.
• Two cases of drug-induced liver injury (DILI) were reported in patients taking high doses of nicotinamide during glaucoma trials.
• The AGS and AAO recommend limiting high-dose nicotinamide use to clinical trials with close monitoring of liver function.
• Current guidelines emphasize prioritizing proven intraocular pressure (IOP) lowering treatments over unapproved supplements.

Clinical Implications

Healthcare professionals should exercise caution when considering nicotinamide supplementation for glaucoma patients, particularly at high doses. Regular monitoring of liver function is advised for any off-label use, and clinicians should prioritize established treatments for managing glaucoma.

Conclusion

While nicotinamide shows promise as a neuroprotective agent in glaucoma, its safety at higher doses raises significant concerns. Ongoing research is essential to clarify its role and establish safe usage guidelines, particularly regarding liver function monitoring.

References

1. American Glaucoma Society-American Academy of Ophthalmology, CoLab, 2025 -- Position Statement on Nicotinamide Use for Glaucoma Neuroprotection
2. the asco post — Can Nicotinamide Reduce the Risk of Skin Cancer Development?
3. The ASCO Post — Simple Means of Preventing Nonmelanoma Skin Cancer Reported Related Articles
4. Archives of Toxicology — Establishing Safe Thresholds for N-nitroso-bisoprolol Using Error-Corrected Next-Generation Sequencing and Benchmark Dose Assessment Combined with QM Modeling and CYP Docking Analysis
5. The ASCO Post — Expert Point of View: Isaac Brownell, MD, PhD Related Articles
6. Can Nicotinamide Reduce the Risk of Skin Cancer Development?
7. Simple Means of Preventing Nonmelanoma Skin Cancer Reported Related Articles
8. Establishing Safe Thresholds for N-nitroso-bisoprolol Using Error-Corrected Next-Generation Sequencing
9. American Glaucoma Society-American Academy of Ophthalmology Position Statement on Nicotinamide Use for Glaucoma Neuroprotection | CoLab
10. Effects of nicotinamide supplementation in normal-tension glaucoma: a crossover placebo-controlled randomised clinical trial
11. Oral nicotinamide provides robust, dose-dependent structural and metabolic neuroprotection of retinal ganglion cells in experimental glaucoma | Acta Neuropathologica Communications | Springer Nature Link