Nasal SprayFrom $166/mo
InjectionFrom $166/mo
Medically reviewed by Vanessa Niles, R.N., M.D., F.A.C.O.G. —
Definition
Pellagra, in plain English
StatPearls describes niacin deficiency as causing pellagra, with the classic triad of dermatitis, dementia and diarrhea. NIH lists a pigmented rash on sun-exposed skin; vomiting, constipation or diarrhea; and depression or memory loss.
Left untreated, pellagra can be fatal. It's rare in the U.S. today and is mostly seen with heavy alcohol use, certain medical conditions or very limited diets.
- Cause
- Severe niacin deficiency
- Classic signs
- Dermatitis, diarrhea, dementia
- Treatment
- Niacin, under medical care
How it connects
How pellagra relates to NAD+
Pellagra is essentially what happens when the body can't make enough NAD and NADP. It shows how essential NAD+ is to the skin, gut and brain.
For your treatment
What pellagra means for NAD+ therapy
Pellagra is a medical condition treated with niacin under a doctor's care, not with NAD+ therapy. If you have symptoms, see a doctor promptly.
- Free online consultation with a licensed U.S. provider
- NAD+ nasal spray or injection, plans from $166 a month if prescribed
- NAD+ has no FDA-approved use; compounded NAD+ isn’t FDA-approved
Questions
Pellagra: common questions
What is pellagra?
Pellagra is the disease caused by severe niacin (vitamin B3) deficiency. It's classically described by three Ds: dermatitis, diarrhea and dementia.
Is pellagra still around?
It's rare in the U.S., partly because many foods are fortified with niacin, but it still occurs, particularly with heavy alcohol use or very restricted diets.
Does pellagra mean I need NAD+ therapy?
No. Pellagra is treated with niacin under a doctor's care. NAD+ therapy isn't a treatment for it.
What strengths does NADMedics prescribe?
Nasal spray: 30 mg per 0.1 mL in a 15 mL bottle. Injection: 200 mg/mL in a 5 mL vial. Your provider sets your dose.
How do I report a side effect?
Tell your provider, and you can report it to the FDA's MedWatch program. Call 911 for chest pain or trouble breathing.
Do I need a prescription for NAD+?
Yes. Compounded NAD+ requires a prescription from a licensed provider after a review of your health.
Keep learning
Related NAD+ terms
Terms that connect to pellagra, each explained on its own page.
- Vitamins & precursorsNiacinNiacin is vitamin B3, an essential nutrient the body turns into NAD and NADP. It includes nicotinic acid and nicotinamide and comes from foods such as poultry, fish, nuts and grains.
- Vitamins & precursorsTryptophanTryptophan is an essential amino acid found in protein foods. The body can turn some of it into niacin and NAD+: about 60 mg of tryptophan yields 1 mg of niacin.
- MoleculesNAD+NAD+ is the oxidized form of nicotinamide adenine dinucleotide, a coenzyme found in every living cell. It carries electrons for energy metabolism and is used by enzymes involved in DNA repair.
- Vitamins & precursorsNicotinamideNicotinamide, also called niacinamide, is a form of vitamin B3. It's the building block the body recycles to remake NAD+, and unlike nicotinic acid it doesn't cause skin flushing.
Official sources
Pellagra: sources and official resources
Official government and research sources behind this page, so you can check the facts yourself.
- NIH National Library of Medicine (StatPearls)Niacin Deficiency
Pellagra and its classic triad of dermatitis, diarrhea and dementia.
- NIH Office of Dietary SupplementsNiacin: Health Professional Fact Sheet
Explains how the body turns niacin (vitamin B3) into NAD, a coenzyme used by more than 400 enzymes.
- NIH Office of Dietary SupplementsNiacin: Fact Sheet for Consumers
What niacin (vitamin B3) does, how much adults need and which foods provide it.
- MedlinePlus (National Library of Medicine)Niacin and niacinamide (Vitamin B3)
Uses, safety and interactions of the two main forms of vitamin B3.
Medically reviewed by Dr. Vanessa Niles, R.N., M.D., F.A.C.O.G., on October 12, 2026. This glossary is general education, not medical advice. NAD+ has no FDA-approved use, and compounded NAD+ is not FDA-approved or evaluated by the FDA for safety or effectiveness. Talk with a licensed provider before starting any supplement or treatment.
Questions about NAD+? Ask a provider
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