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Side effects can occur, however

Most patients can come off all blood pressure medications with proper weight loss

Because nicotinamide would otherwise re-enter the NAD+ salvage pathway through NAMPT and NMN, NNMT activity sits at a junction between cellular methylation capacity and NAD+ regeneration, which is why the enzyme became a target after Kraus and colleagues (Nature, 2014) reported the consequences of antisense Nnmt knockdown in white adipose tissue and liver

Elevated copper can contribute to relative zinc deficiency, and chronic high-copper states can produce zinc depletion over time

Over time, this can contribute to a worsening overall skin condition

The necessary legislative change is not anticipated until 2025 at the earliest due to the significant public consultation which will be required, due to the nature of the significant change on Parenteral Administration