nicotinamide: clinical use

Prescribing considerations

• Confirm that acne is mild to moderate and predominantly inflammatory; painful nodules, cysts, extensive disease or scarring warrant further assessment.
• Use only on intact external skin and avoid ocular or mucosal exposure.
• Consider excipient sensitivity in patients with previous reactions to topical products.

Contraindications and cautions

• Hypersensitivity to nicotinamide or any formulation component.
• Use caution if marked dryness, peeling or irritation develops.
• The product information advises particular caution during the first trimester of pregnancy.

Monitoring

• Assess inflammatory lesion response and overall acne severity clinically.
• Monitor for dryness, pruritus, erythema, burning and irritation.
• No routine laboratory monitoring is specified for topical use.

Clinical pharmacology

Nicotinamide is the physiologically active amide form of vitamin B3 and contributes to NAD and NADP coenzymes. Its topical acne activity is attributed principally to anti-inflammatory effects; unlike nicotinic acid, it is not associated with lipid lowering and characteristic vasodilatory flushing.

Formulation and product differences

• The selected licensed formulation is a translucent topical gel containing ethanol, macrogol lauryl ether and other gel-forming excipients.
• It is intended only for external cutaneous application.

Gel

Route: Cutaneous

Strengths: 4% w/w