Niacin promotes insulin resistance and reduces glucose tolerance in a dose-dependent manner. In non-diabetics, the blood glucose level usually remains within the normal range; in diabetics it is advisable to take a maximum dose of 1.5 g niacin per day (at this dose, the effect on the blood glucose level is minimal).
Niacin in doses above 50 mg may cause a 'niacin flush' with reddening of the face, arms and chest (sometimes with slight swelling of the skin) and a burning, stinging and/or itching sensation and sometimes headache. These symptoms usually last from 30 minutes to an hour. This reaction can be severe, but is harmless and transient. It is not an allergic reaction. This flush can be limited by gradually increasing the dose and combining niacin with a vitamin B complex and vitamin C.
Niacin is a supraphysiological dose that reduces the excretion of uric acid, which may increase the risk of hyperuricemia and gout.
A dose of niacin above 3 grams per day may be toxic to the liver (increased liver function tests, jaundice) and cause gastrointestinal complaints (nausea, vomiting, heartburn, loss of appetite, flatulence, diarrhoea, peptic ulcer).
Niacin may aggravate an allergic reaction by stimulating the release of histamine.
A dose of niacin from 1000 mg per day can significantly increase homocysteine levels; giving vitamin B6 in addition to niacin prevents an increase in homocysteine levels.