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Animal studies showed thyroid C-cell tumors at exposures much higher than clinical doses

The safety data for each compound individually is reassuring, but combination safety requires its own evaluation because pharmacological interactions can produce unexpected results even when each agent is well-characterized on its own

Conditions like pernicious anemia, gastrointestinal disorders, and certain surgeries can impair B12 absorption, requiring specific interventions

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Ulanovskaya OA, Zuhl AM, Cravatt BF. NNMT promotes epigenetic remodeling in cancer by creating a metabolic methylation sink. Nat Chem Biol. 2013 May;9(5):300-6. doi: 10.1038/nchembio.1204. Epub 2013 Mar 3. PMID: 23455543; PMCID: PMC3631284