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Slowing the ramp to the label cadence (2.5 mg start, 2.5 mg steps, four-week holds) dropped that to mid-single digits at every maintenance dose, at no cost to the 12-week result, and the dedicated slow-titration trial reached placebo range. Reaching 15 mg is not the problem

The enzyme that transfers a methyl group from S-adenosylmethionine (SAM) to nicotinamide, producing 1-methylnicotinamide

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Patients with Multiple Endocrine Neoplasia syndrome type 2, a genetic condition associated with increased risk of medullary thyroid carcinoma, should also avoid treatment with this medication

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