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Pernicious anaemia and deficiency with neurological involvement require more intensive treatment with alternate-day injections until improvement, followed by lifelong maintenance

However, as with any medical treatment, there are certain considerations and contraindications

What the mechanism does NOT prove: A mechanism observed in vitro or in rodents does not predict the magnitude, durability, or route-dependence of clinical benefit in humans

Neurotransmitter production (serotonin, dopamine)

Always allow vials to come to room temperature before opening to reduce condensation, and avoid repeated freeze-thaw cycles

Nicotinamide N-methyltransferase (NNMT) in health and disease. Cellular and Molecular Life Sciences