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Gastrointestinal adverse events induced by metformin are associated with dose escalation, immediate-release formulations, alterations in gut microbiota, epigenetic susceptibility, inhibition of organic cation transporters, as well as interactions with serotonin, histamine, and enterohepatic circulation [72]

The article describes several simultaneous processes beyond appetite suppression: improved insulin sensitivity, decreased hepatic glucose production, delayed nutrient absorption from slowed gastric emptying, and potential shifts in food preferences

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Overall, NAD+ Injection is considered compatible with most other therapies, with no known adverse drug interactions, but comprehensive disclosure of ones medication regimen to the treating provider is important for safe care

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