Nicotinamide has been mainly used to treat pellagra in past clinical practice and is an effective agent in treating some neurodegenerative diseases. Biochemical activity of nicotinamide is based on the conversion into nicotinamide adenine dinucleotide (NAD). As a procurer of ATP synthesis, nicotinamide is helpful in the maintenance of cellular energy balance during ischemia and reperfusion. By inhibiting poly (ADP-ribose) polymerase, membrane phosphatidylserine exposure and DNA fragmentation, nicotinamide plays a critical role in maintaining mitochondrial membrane potential and preventing specific cysteine protease activation. Early administration of nicotinamide may be of therapeutic interest in preventing the development of stroke, by rescuing the still viable but injured cells and partially preventing infarction.