In states of obesity and aging, NNMT is often overexpressed, leading to the excessive methylation and excretion of nicotinamide
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After initial repletion, a maintenance dose is given, often 1,000 mcg intramuscularly every month or every 2 to 3 months, to prevent recurrence of deficiency
Sende will determine appropriate timing and dosing for transition
I've had that exact conversation with patients who compete, and it's a hard stop for them