Medications That May Deplete NIACINAMIDE
Niacin supports energy metabolism, skin health, and nervous system function. See which medications carry a reported association, how strong the evidence is, and what to discuss with your pharmacist.
Niacin supports energy metabolism, skin health, and nervous system function.
Common food sources: Poultry, beef, and fish; Peanuts and legumes; Fortified grains.
Deficiency is rare in a typical diet. Discuss with your provider before using niacin as a supplement — at pharmacologic doses it behaves like a medication.
Caution: Treat high-dose niacin as a medication decision, not a nutrition one.
HelloPharmacist pharmacist-reviewed education. The medication records below are licensed clinical data, shown as published.
Medications associated with NIACINAMIDE depletion
Each record is shown as published in our licensed clinical database. Open a medication for its full nutrient report.
Ethionamide
Moderate DepletionBrand names include Trecator SC
There have been case reports of pellagra-like encephalopathy responsive to niacinamide in people taking ethionamide, usually in combination with other antituberculosis drugs, which could interfere with niacin/niacinamide activity.
Ethionamide, an antibiotic used to treat tuberculosis, appears to interfere with how your body uses niacinamide, a form of vitamin B3 that your skin, nerves, and digestive system depend on. Rather than simply blocking absorption, it seems to disrupt niacinamide's activity at the cellular level, which in some patients has led to pellagra, a serious deficiency condition. This is rated as a moderate concern, meaning it does not affect everyone but is worth watching, especially if you are taking other TB medications at the same time. Ask your pharmacist or doctor whether monitoring or a supplement makes sense for you.
References (2)
- Brooks-Hill RW, Bishop ME, Vellend H. Pellagra-like encephalopathy complicating a multiple drug regimen for the treatment of pulmonary infection due to Mycobacterium avium-intracellulare (letter). Am Rev Resp Dis 1985;131:476.
- Swash M, Roberts AH. Reversible pellagra-like encephalopathy with ethionamide and cycloserine. Tubercle 1972;53:132. PubMed
Isoniazid, Pyrazinamide, Rifampin
Moderate DepletionBrand names include Rifater
There have been case reports of pellagra after pyrazinamide use which responded to niacinamide supplementation.
Pyrazinamide, one of the drugs in this combination therapy, appears to block how the body uses niacinamide, a B vitamin that helps convert food into energy and keeps skin and nerves healthy. Rather than simply flushing it out, pyrazinamide seems to interfere with niacinamide's activity at a cellular level, and there are real case reports of patients developing pellagra, a serious niacinamide deficiency, while taking it. Because the rating here is moderate, this is worth paying attention to, especially for anyone on long-term treatment. Ask your pharmacist or doctor whether a niacinamide supplement makes sense for you.
References (1)
- Jorgensen J. Pellagra probably due to pyrazinamide: development during combined chemotherapy of tuberculosis. Int J Dermatol 1983;22:44-5. PubMed
Full nutrient report for Isoniazid, Pyrazinamide, Rifampin →
Pyrazinamide
Moderate DepletionBrand names include Tebrazid
There have been case reports of pellagra after pyrazinamide use which responded to niacinamide supplementation.
Niacinamide is a form of vitamin B3 that your body uses to turn food into energy and keep your skin and nerves healthy. Pyrazinamide appears to interfere with how the body uses niacinamide, not just how much you absorb, which means even normal dietary intake may not be enough while you are taking this antibiotic. The evidence is strong enough that real cases of pellagra, a serious vitamin B3 deficiency, have been reported and resolved with supplementation. If you are on pyrazinamide, especially for tuberculosis treatment, it is worth asking your doctor or pharmacist whether you need a niacinamide supplement during your course.
References (1)
- Jorgensen J. Pellagra probably due to pyrazinamide: development during combined chemotherapy of tuberculosis. Int J Dermatol 1983;22:44-5. PubMed
This tool is educational and is not a substitute for professional medical advice. An association is not a diagnosis and does not mean a deficiency will occur. Always talk to your pharmacist or healthcare provider before starting, stopping, or changing any medication or supplement.
Disclaimer: This checker finds which nutrients might be depleted by prescription or over-the-counter medications. Each nutrient depletion issue is rated based on clinical significance. Use your own professional judgment prior to making clinical decisions.© 2026 Therapeutic Research Center Licensed records refresh weekly · last updated July 3, 2026.
What drug-induced nutrient depletion means
Some medications can, over time, lower the levels of certain vitamins, minerals, or other nutrients — through reduced absorption, increased loss, or changes in how the body uses them.
Association is not deficiency
An entry here means a depletion has been reported or studied — not that it happens to everyone, or that you are deficient. Dose, duration, diet, and your own health all matter.
Evidence varies by pair
Some drug–nutrient links (like metformin and vitamin B12) are well studied; others rest on limited or preliminary research. Each entry shows the evidence rating from our licensed clinical database.
When to ask about labs
If you take an associated medication long-term, ask your healthcare provider whether monitoring is appropriate for you. Not everyone needs testing — your provider can weigh your dose, duration, and symptoms.
Don't self-supplement blindly
Supplements are not risk-free: some can interact with medications, and some (like potassium or magnesium) can be risky with kidney disease. Talk to your pharmacist before adding anything.
Never stop a medication over this
These medications are prescribed for good reasons, and the benefit usually far outweighs a manageable nutrient consideration. Any change belongs in a conversation with your prescriber.
Food first, usually
For many nutrients, a varied diet covers the gap. Each entry lists common food sources; a supplement is a decision to make with your pharmacist or provider, not a default.
NIACINAMIDE & medications: FAQs
Which medications can lower NIACINAMIDE?
I take one of these medications — am I deficient in NIACINAMIDE?
Should I start a NIACINAMIDE supplement?
Where does this information come from?
Other commonly implicated nutrients
Wondering about your NIACINAMIDE levels?
Ask a licensed pharmacist — free, no appointment needed.
Sources & How We Checked
Medication associations with NIACINAMIDE are evidence-graded and sourced from the Natural Medicines database, and are displayed as published with their citations.
- Natural Medicines (Therapeutic Research Center) — Evidence-graded clinical reference for drug-induced nutrient depletions, supplements, and interactions — the basis for this page.
- MedlinePlus, U.S. National Library of Medicine — NIH consumer drug information, used for medication overviews across the site.
Content is written and reviewed by licensed HelloPharmacist pharmacists. See our data sources and editorial standards for how this information is built and checked.