Niacin promotes insulin resistance and reduces glucose tolerance in a dose-dependent manner. For people without diabetes, blood glucose levels generally remain within normal limits. Diabetics should limit their daily niacin intake to a maximum of 1.5 grams to minimize effects on blood glucose levels.
Niacin in doses above 50 mg may cause a 'niacin flush' with redness of the face, arms, and chest (sometimes accompanied by slight swelling of the skin), a burning, tingling, and/or itching sensation, and sometimes a headache. These effects usually last between 30 minutes and an hour. This reaction is intense but harmless and temporary. It is not an allergic reaction. The flush can be limited by gradually increasing the dose and combining niacin with a B-complex vitamin and vitamin C.
High doses of niacin (greater than 3 grams per day) may be toxic to the liver, leading to elevated liver function tests and jaundice, and can cause gastrointestinal issues such as nausea, vomiting, acid reflux, loss of appetite, bloating, diarrhea, and peptic ulcers. Niacin may also worsen allergic reactions by stimulating the release of histamine.
A dose of niacin from 1000 mg per day may significantly increase homocysteine levels. This increase can be prevented by also supplementing with vitamin B6.