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Int J Mol Sci (2020) 21(7):2299

Niacin can also have an antagonistic effect on gout medications: it elevates uric acid levels, which may counteract drugs like allopurinol or pegloticase that are meant to lower uric acid

Skeletal deformities include cheekbone enlargement, head circumference reduction, cranial stenosis, limb shortening, knee valgus, and, in very severe cases, spherical skulls

Prolonged or severe vitamin B12 deficiency may therefore cause permanent brain or nerve damage