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Concurrent Use with Other NNMT Inhibitors or Methylation Modulators Combining with supplements or drugs that also inhibit NNMT or alter methylation (e.g., SAMe , niacin , methylfolate , resveratrol ) could lead to: Excess NAD accumulation Methyl donor depletion Unpredictable metabolic effects Use caution and monitor methylation-related pathways if stacking 3

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Challenges in effective management While treatment with hydroxocobalamin is effective in most cases, some patients may continue to experience symptoms (particularly neurological symptoms and fatigue)[27]

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