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It is generally not recommended in Lebers disease (a hereditary optic nerve disorder), where B12 therapy may worsen the condition

NNMT enzyme inhibition occurs within 24 hours of subcutaneous dosing based on pharmacokinetic modelling, but downstream metabolic effects NAD+ elevation, changes in fat oxidation markers typically require 24 weeks of consistent dosing to manifest in measurable endpoints

They can then change the dose if needed

Metabolic diseases In addition to muscle and neurodegenerative conditions, alterations in NAD + levels and mitochondrial homeostasis are also observed in aging-associated metabolic diseases, particularly those conditions impacting highly mitochondrially-active tissues such as the kidney and liver 292294