Objective:

To provide guidelines on the cautious use of nicotinamide as a neuroprotective agent specifically for patients with open-angle glaucoma.

Key Findings:

• High doses of nicotinamide (≥3 g/day) have shown improvements in retinal function in early human trials, indicating potential benefits for glaucoma patients.
• Two cases of drug-induced liver injury (DILI) were reported in glaucoma neuroprotection trials associated with high-dose nicotinamide, raising safety concerns.

Interpretation:

While nicotinamide shows potential as a neuroprotective agent, its safety at high doses is uncertain, necessitating caution and further research.

Limitations:

• Nicotinamide is not approved as a glaucoma treatment, which limits its clinical application.
• Safety concerns arise from high doses exceeding the recommended daily intake, necessitating careful monitoring.

Conclusion:

The AGS and AAO recommend cautious use of nicotinamide due to potential serious side effects, particularly at high doses, and emphasize the need for monitoring in clinical practice.