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For active B12 deficiency, most clinicians recommend weekly or biweekly shots for the first 4 to 6 weeks, then a maintenance shot every 1 to 3 months

When adverse effects occurred, they were typically mild and transient, with the most common being mild to moderate headaches (similar frequency to placebo groups), minor injection site reactions (redness, slight swelling), and gastrointestinal effects at higher oral doses (nausea, diarrhea)

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This classification allows for their use only for research development and laboratory studies

In preclinical heart failure models, NNMT enzyme inhibition markedly reduced cardiac 1-MNA (by 77.1%), improved cardiac function, reduced left ventricular hypertrophy and fibrosis, and decreased pro-inflammatory gene expression