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Under the Ryan Haight Online Pharmacy Act (2008) , prescribing controlled substances via telemedicine typically requires at least one in-person medical evaluation

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Concurrent medication use: Patients on medications that influence mitochondrial or oxidative function, such as metformin, statins, or certain antidiabetics, may respond unpredictably when NAD+ is added

While these symptoms can be caused by other conditions, their presence together may warrant a conversation with your doctor about a potential deficiency

For other gastrointestinal symptoms, consult your prescriber before making any changes to your treatment regimen, as this may affect glycaemic control in diabetes management