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"A performance evaluation of three drug-induced liver injury biomarkers in the rat: alpha-glutathione S -transferase, arginase 1, and 4-hydroxyphenyl-pyruvate dioxygenase" (PDF)

Although facial flushing is not associated with harm, consuming large doses of niacin can cause other, potentially harmful side effects

Any episode of syncope (loss of consciousness) requires immediate medical assessment, as this may indicate significant hypotension or other serious conditions requiring investigation