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Patients with mild to moderate renal impairment generally do not require dose adjustment, but closer monitoring may be warranted, particularly for signs of gastrointestinal adverse effects that could lead to dehydration and worsening renal function

The authors suggest that either methyl-B12 and adenosyl-B12 should be given together, or either cyano-B12 or hydroxo-B12 on their own, both of which can be converted into both active forms

A: When administered by a licensed medical professional in a proper clinical setting, B12 and lipo shots are generally considered safe

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NNMT depletes the NAD+ precursor pool by methylating nicotinamide the same nicotinamide that the salvage pathway would otherwise convert back into NAD+ via the enzyme NAMPT