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they're unregulated, potentially impure, and lack dosage precision, posing health risks like bacterial contamination or heavy metals.[44][45][46] Unregulated online sources amplify dangers with potential counterfeits, unknown additives, or legal violations, as they're not FDA-approved and may lead to adverse effects or inefficacy.[47][48][49] Prioritize compounding pharmacies for reliable, compliant options

Prior authorization and step therapy are usually required

Nicotinamide (niacinamide) does not cause flushing and has fewer side effects, with nausea and liver toxicity reported only at very high intakes ~3 g/day)

Always share your full health history with your provider