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This is also why the first month emphasizes routine so heavily

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This inhibition preserves nicotinamide availability for the NAD+ salvage pathway, the primary route for NAD+ regeneration in mammalian cells

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In murine models, NNMT knockdown did not induce the accumulation of NAM in livers and adipose tissues, nor did it cause significant alterations in the intracellular levels of NAD + in hepatocytes ( + is not necessary for this regulatory process

The standard regimen involves: Loading doses without neurological involvement : 1 mg intramuscularly three times a week for 2 weeks [3] [8] Loading doses with neurological involvement : 1 mg intramuscularly on alternate days until no further improvement [3] [8] Maintenance therapy : 1 mg every 23 months for life in cases of pernicious anaemia or irreversible malabsorption (every 2 months if neurological involvement) [3] [8] This aggressive approach aims to prevent irreversible neurological damage, though recovery of established neuropathy may be incomplete, particularly if treatment is delayed