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The safety of long-term concurrent use has not been evaluated

By inhibiting NNMT, the body maintains higher NAD levels, which in turn activate SIRT1, a longevity-associated gene, which may improve mitochondrial activity, fat oxidation, insulin sensitivity, and by overall energy balance

Common causes include pernicious anaemia (autoimmune condition), plant-based diets without supplementation, gastrointestinal surgery, and long-term use of metformin or proton pump inhibitors

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Intramuscular hydroxocobalamin is the preferred treatment for most patients with confirmed deficiency, particularly when malabsorption is present or neurological symptoms exist