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An enzyme called NNMT (nicotinamide N-methyltransferase) drains the NAD+ salvage pathway by methylating nicotinamide, one of NAD+'s precursors

But if youre planning long-term high-dose B12 therapy and you have diabetes or high blood pressure as additional risk factors, they might be worth discussing with your healthcare provider

(2021) Effects of vitamin B12 supplementation on cognitive function, depressive symptoms, and fatigue: a systematic review, meta-analysis, and meta-regression

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B12 deficiency can make you feel unusually irritable, anxious, or down

These include: Drugs called H2 receptor antagonists Metformin Proton pump inhibitors