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NNMT (nicotinamide N-methyltransferase) is a cytosolic enzyme that catalyzes a specific methylation reaction: it transfers a methyl group from S-adenosylmethionine (SAM) to nicotinamide, producing two products 1-methylnicotinamide (1-MNA) and S-adenosylhomocysteine (SAH)

Common Side Effects Include: Nausea Vomiting Diarrhea Constipation Loss of appetite Fatigue For dialysis patients, these symptoms can increase the risk of: Dehydration Malnutrition Muscle loss Electrolyte imbalance Low blood pressure during treatment Because dialysis already places stress on fluid balance, vomiting or poor oral intake can become serious quickly

Ask them to talk to each other directly instead of relaying instructions through you, and get whatever they land on in writing