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Neurological symptoms may start improving within 12 weeks, but longstanding complications can require 36 months of treatment, with some damage potentially irreversible

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Severe Anemia Risks: In people with severe megaloblastic anemia, aggressive treatment can cause low potassium (hypokalemia) and sudden, serious complications

Rather than directly supplying NAD+ precursors (like NMN or NR), it works by blocking an enzyme that consumes nicotinamide, theoretically preserving the substrate pool for endogenous NAD+ production