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Because it competes at the nicotinamide substrate site rather than the SAM cofactor site, it is also used as the substrate-competitive reference compound against which bisubstrate and covalent NNMT inhibitors are benchmarked

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Potential Side Effects and Warnings Common Side Effects These are reported by at least Nausea Diarrhea Vomiting Constipation Abdominal pain Dyspepsia (indigestion) Gastroesophageal reflux disease (heartburn) Injection site reactions Fatigue Hypersensitivity reactions Hair loss As you can see, the gut is most often affected (gastrointestinal adverse reactions), but these are usually If, however, any of these side effects are severe, dont settle, or are impacting your life, you should ask for medical advice

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If the patient had fatigue, tingling, or other symptoms attributable to B12 deficiency, I want these to be improving (or at least stabilised) before surgery