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L-Carnitine: A substance produced by the liver and kidneys which convert body fat into energy

Nicotinamide N-methyltransferase (NNMT) is a cytosolic enzyme that catalyzes the methylation of nicotinamide using S-adenosylmethionine (SAM) as a methyl donor, producing 1-methylnicotinamide (1-MNA) and S-adenosylhomocysteine (SAH)

Solution : Refrigerate immediately after reconstitution

Some of these events have been reported in patients without known underlying renal disease

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But it points straight at something Sikiri's own lab published nearly thirty years ago