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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
This combination should only be attempted, if ever, under direct endocrinologist supervision with continuous glucose monitoring and frequent blood ketone testing
Consultation costs vary: primary care visits are typically $100-250 without insurance (often covered by insurance with copay), specialist visits run $200-400 without insurance, and telehealth consultations typically cost $50-150
FDA shortage resolved on Feb 21, 2025
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When adverse effects do occur, they are usually mild and transient, often related to the route of administration rather than the vitamin itself
