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The subcutaneous route exists for researchers using a lyophilized vial format, but it is limited to small doses

Patients with Leber's hereditary optic neuropathy should avoid cyanocobalamin (hydroxocobalamin is preferred in the UK)

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NNMT excessively consumes the precursor (nicotinamide) required for NAD+ synthesis, essentially creating a leak in the NAD+ production pipeline, leading to accelerated NAD+ depletion