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Counsel patients on the importance of returning for follow-up blood tests every 3 to 6 months to confirm adequacy of therapy [see Dosage and Administration (2.3)]

Niacin can produce a variety of GI effects, such as nausea/vomiting, abdominal pain, diarrhea, bloating, dyspepsia, or flatulence, when taken in large doses

Journal of Clinical Psychopharmacology, 33 (5), 643-648

They do because they're being told to

Clinical studies, although limited in size, report improvements in irritability, hyperactivity, sleep quality, communication, and oxidative stress biomarkers following supplementation with vitamin C, CoQ10, folinic acid, and mitochondrial support formulations (Mousavinejad et al., 2018

Dopamine plays a central role in the brains reward system, reinforcing behaviors by creating feelings of pleasure