Flagged risks of consuming the vitamin B3 derivative nicotinamide have been overcome in the Australian developed nutraceutical Nutravision by using “the lowest effective clinical dose based on existing research”, according to co-founder and ophthalmologist Dr Brian Ang.
The American Glaucoma Society and American Academy of Ophthalmology have warned eye doctors to be aware of potentially toxic effects on the liver from nicotinamide as it gains traction as a possible glaucoma therapy.
Because there is a risk of drug-induced liver injury (DILI), the use of nicotinamide at high doses (3 g/day or more) is not recommended “outside the confines of clinical trials where liver function is closely monitored”, according to Dr Aakriti Garg Shukla, from the Columbia University Irving Medical Center in New York City, and colleagues in a statement published in Ophthalmology Glaucoma.1
They also recommended that patients prescribed doses less than 3 g/day should be subject to periodic liver function testing. They “strongly recommended” against the use of niacin in place of nicotinamide, another form of vitamin B3, for patients with current or previous liver disease, stating the two are not interchangeable.
Around the world there are several ongoing clinical trials investigating the role of nicotinamide as a therapeutic neuroprotective treatment for glaucoma. Most prescribe nicotinamide 3 g/day, while one prescribes nicotinamide riboside (300 mg/day) instead, and another includes pyruvate 1 g/day in addition to nicotinamide.1
For Nutravision, I deliberately did not use the high dose of nicotinamide that was used in the clinical trials because of the exact same concerns published by the American Glaucoma Society and American Academy of Ophthalmology.
Low Dose Deliberate Choice in Nutravision
The Nutravision formula is a “world first” nutraceutical supplement designed by Dr Ang to comprehensively target the 10 key cellular and vascular risk factors associated with glaucoma, including vascular dysregulation, mitochondrial dysfunction, and axonal impairment. Listed in the Australian Register of Therapeutic Goods, Nutravision combines 10 clinically researched ingredients, including nicotinamide, into a single, evidence-backed formula to complement existing glaucoma treatments and support individuals with or at risk of glaucoma.
A person taking the optimal dose of two capsules of Nutravision per day (the dose recommended for people with eye health concerns)3 will ingest 500 mg of nicotinamide per day, which Dr Ang assured mivision is “safe when taken over the long term”.4
“For Nutravision, I deliberately did not use the high dose of nicotinamide that was used in the clinical trials because of the exact same concerns published by the American Glaucoma Society and American Academy of Ophthalmology.
“It is usually the doses above 1 g that are associated with adverse side effects, and even then, these remain relatively rare. Multiple studies have confirmed that doses up to 1 g daily are generally well tolerated, even when taken over the long term.4 At 500 mg or less, nicotinamide is considered safe for prolonged use with no significant risk of accumulation or toxicity, as excess amounts are typically excreted in the urine due to its water-soluble nature,” he explained.4
As well as providing comprehensive neuroprotective benefits for patients with or at risk of glaucoma, Dr Ang said Nutravision’s “specific combination of natural antioxidants and bioavailable vitamins means that the entire eye-nerve-brain vision ecosystem is supported – from eye pressure to the macula and retina, to the optic nerve and the brain”.
References
- Shukla AG, Cioffi GA, Liebmann JM, et al. American Glaucoma Society-American Academy of Ophthalmology position statement on nicotinamide use for glaucoma neuroprotection. Ophthalmol Glaucoma. 2025 Jan 10:S2589-4196(25)00007-9. doi: 10.1016/j.ogla.2025.01.002.
- mivision, World-first supplement to support eyes with glaucoma. 17 Oct 2023. Available at mivision.com.au/2023/10/world-first-supplement-to-support-eyes-with-glaucoma. [Accessed 21 Jan 2025].
- Nutravision, Frequently asked questions (webpage) available at: nutravision.com.au/pages/faq [accessed 21 Jan 2025].
- Hwang ES, Song SB. Possible adverse effects of high-dose nicotinamide: Mechanisms and safety assessment. Biomolecules. 2020;10(5):687. doi: 10.3390/biom10050687.
