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The standard NHS schedule For a confirmed deficiency, the NHS treatment pathway sets out: Loading phase: 1mg of hydroxocobalamin on alternate days for up to two weeks (longer if there are neurological symptoms), to refill your stores

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Methylcobalamin injections deliver B12 directly into the bloodstream through an intramuscular injection

At the molecular level, 5-amino-1MQ functions as a competitive inhibitor of NNMT, demonstrating remarkable potency with an IC of 1.2 0.1 M under standard assay conditions (50 M SAM, 100 M nicotinic acid). This represents a dramatic 10-fold improvement over the parent compound 1-methylquinolinium, achieved through strategic amino group substitution that enhances binding affinity to the NNMT active site. The compound's mechanism centers on preventing the methylation of nicotinamide to 1-methylnicotinamide (1-MNA), thereby preserving nicotinamide for recycling back to NAD+ through the salvage pathway. This intervention effectively blocks what researchers have termed the "NNMT metabolic drain" a process that simultaneously depletes NAD+ precursors and consumes cellular methylation capacity

Decreased levels of NAD + have been implicated in hypertension