Important Warning: Potential Liver Risks with Nicotinamide Use in Glaucoma Treatment

The American Glaucoma Society and the American Academy of Ophthalmology have issued a critical warning to eye doctors about the potential liver damage linked to nicotinamide, a vitamin B3 derivative. As nicotinamide gains interest as a potential therapy for glaucoma, experts are emphasizing the necessity of caution due to its potential for drug-induced liver injury (DILI).

Key Recommendations from Eye Health Organizations

A collaborative statement by Aakriti Garg Shukla, MD, MSc, from Columbia University Irving Medical Center, and her colleagues highlights the need for cautious approach in using nicotinamide:

If nicotinamide doses less than 3 g/day are being considered, primary care physicians should be consulted, and periodic liver function tests should be performed. The use of nicotinamide at higher doses (3 g/day or more) is not recommended outside controlled clinical trials where liver function is closely monitored.

The Distinction Between Nicotinamide and Niacin

It is essential to note that nicotinamide and niacin, though both vitamin B3 compounds, are not interchangeable. While nicotinamide is being studied as a neuroprotective agent for glaucoma, niacin, on the other hand, is known for its hepatotoxicity at high doses and should not be substituted for nicotinamide.

The American Glaucoma Society and Academy strongly recommend against the use of niacin in place of nicotinamide for glaucoma neuroprotection.

Why the Concern?

Victoria L. Tseng, MD, PhD, from the University of California Los Angeles Stein Eye Institute, explains the ongoing interest in nicotinamide:

There is a constant search for therapies that can protect the optic nerve in glaucoma, beyond just reducing eye pressure. Patients are eager for alternatives to traditional eye drops and surgery.

However, this interest in nicotinamide must be balanced against the identified risks. The authors cite two cases in clinical trials where patients experienced DILI while taking nicotinamide:

• A U.S. patient, aged 73, developed DILI at 3 g daily and was hospitalized. Liver enzyme levels returned to normal after discontinuation of the supplement.
• A 69-year-old woman in Singapore developed similar symptoms after taking the same dose or placebo. Her symptoms resolved once she stopped taking the doses.

Glaucoma Specialists Weigh In

Angelo P. Tanna, MD, from Northwestern University Feinberg School of Medicine, elaborated on the concerns of the glaucoma community:

Glaucoma specialists are aware of early clinical trial data that includes reports of hepatotoxicity. Physicians are genuinely concerned about this risk. Drug-induced liver damage is a serious and life-threatening condition.

Patient Safety as a Priority

Both Dr. Tseng and Dr. Tanna support the call for careful patient management:

The risks to the liver are valid concerns, especially with higher dosing. Recommendations for close monitoring of liver function in patients opting for nicotinamide are justified.

For now, there is insufficient evidence regarding the benefits and safety of high dosing to recommend nicotinamide as a routine glaucoma treatment.

Dr. Tanna further advises:

Considering nicotinamide in patients whose glaucoma persists despite ideal intraocular pressure control is reasonable, but with full acknowledgment of the risks. Internists should be involved to monitor liver enzyme levels closely.

Conclusion

As researchers continue to investigate nicotinamide as a potential neuroprotective agent in glaucoma, patient safety remains paramount. The recommendations from the American Glaucoma Society and the American Academy of Ophthalmology emphasize the need for careful monitoring and consultation with primary care physicians.

For individuals considering nicotinamide therapy, it is crucial to weigh the potential benefits against the risks. Engaging in open dialogue with healthcare providers and understanding the importance of regular liver function testing will help ensure a future where innovative treatments can be used safely and effectively.

Have you or someone you know considered nicotinamide for glaucoma treatment? Share your experiences below. We look forward to your comments!

Join the Conversation: Subscribe to our newsletter for regular updates and stay connected by following us on Facebook, Twitter, and Instagram.

Comment Below | Share | Follow Us