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Vomiting occurs less frequently than nausea but may affect fifteen to twenty percent of patients, particularly those who experience severe nausea or those who do not implement dietary modifications to manage gastrointestinal symptoms

Similarly, although hepatic dysfunction can occur with large niacin doses (1-3 grams daily over months) causing elevated liver enzymes or jaundice, niacinamide at 100 mg is very unlikely to have any adverse effect on the liver

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They occur due to megaloblastic anemia resulting from impaired red blood cell formation