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Its activity intersects two major metabolic pathways simultaneously: the NAD+ biosynthesis pathway (by consuming nicotinamide, an NAD+ precursor, NNMT competes with the NAD+ salvage pathway) and the methyl-donor pathway (by consuming SAM, NNMT reduces the availability of methyl groups for epigenetic and metabolic methylation reactions)

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ECG monitoring may be necessary, particularly if there are cardiac risk factors or if these medications are used with other QT-prolonging drugs (including ondansetron)

Perhaps understanding the measurable effects of each hormone on heart rhythm is a good place to start

For patients without an underlying absorption disorder who received injections for general wellness, stopping should produce no noticeable negative effects, especially if dietary B12 intake is adequate

Yes, modestly