No further studies of niacinamide have been published since Dr. Kaufman's work, but reports of its clinical use remain positive. Niacinamide is often recommended as an alternative to niacin because it produces fewer side effects. This is one remedy, however, for which medical supervision is essential. The large amounts of niacinamide used in this treatment, from 500 milligrams twice a day to 1,000 milligrams three times a day, have the potential to cause liver problems. If the levels are elevated, the dose should be reduced.
Nausea is an early warning sign of stress on the liver.
If you have liver disease, you should not use this treatment. Many doctors do not make dietary recommendations for the treatment of osteoarthritis beyond maintaining normal weight. Some nutrition-oriented doctors, however, recommend an array of nutrients, including these. This amount of folic acid should be taken only under medical supervision, as excess folic acid can actually mask signs of vitamin B 12 deficiency. Large amounts of niacinamide can cause liver problems.