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After symptoms abate, the recommended dose is 100 mcg monthly, for life

Research Grade The Science Behind 5-Amino-1MQ Mechanism of Action 5-Amino-1MQ selectively inhibits NNMT (IC ~1.2 M), the enzyme that diverts nicotinamide away from the NAD+ salvage pathway

In addition, B12 deficiency-associated fatigue is often accompanied by other symptoms such as numbness and tingling, cognitive impairment (memory and concentration problems), mood swings (depression), skin changes (pale skin), shortness of breath, or fast heart rate

Altered B12 handling and reduced clearance in kidney disease, and both cellular release and reduced clearance in liver disease, can raise B12, so supportive renal or hepatic findings make those causes plausible

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