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At high doses one or more of its phase 1 metabolites destroys hematological stem cells and can cause death due to the failure to produce red blood cells, white blood cells, and platelets

So people at greatest risk for deficiency include those with low stomach acid (e.g., older adults and people on proton pump inhibitors or antacids) or low IF production (known as pernicious anemia), people on medications that interfere with B12 absorption (such as metformin), people who have had gastric surgery, those with GI conditions that impair nutrient absorption (like celiac or Crohn's disease), and people on vegan and vegetarian diets

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These observations underscore the essential role of Sirt1 in mediating NNMTs regulatory effect on glucose metabolism

Do not repeat injections daily without medical supervision