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Its job is specific: it inhibits an enzyme called NNMT nicotinamide N-methyltransferase that becomes overactive in fat tissue, especially as we age
The main practical risks are: Injection-site soreness, bruising or mild redness , which settles within a day or two
Indicated especially when neurological signs or severe anemia are present
Sublingual and transdermal formulations have shown negligible absorption in bioavailability studies, making injection the only viable route for these compounds
The dividing line is absorption, not severity
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