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Patients should discuss risks, contraindications, and alternatives with a licensed clinician

Its overactivation disrupts nicotinamide metabolism, reduces NAD+ levels, promotes hepatic lipid accumulation and lipotoxicity, and represents an important therapeutic target for hepatic metabolic disorders

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Additionally, a randomized, double-blind, placebo-controlled trial in 2,588 healthy older adults with mild hyperhomocysteinemia found that daily supplementation with 500 g of vitamin B 12 and 400 g of folic acid for two years reduced blood homocysteine concentrations but had no benefit on depressive symptoms in those with or without depressive symptoms at baseline (110)