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When NNMT activity is high: NAD levels drop, impairing mitochondrial energy production

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In pharmacological doses for hyperlipidemia (1 to 4.5 g/day depending on the preparation), common side effects of niacin are flushing, nausea, vomiting, pruritus, hives, mild elevation in serum aminotransferases and constipation

This patient's lack of smoking history, clear lungs on auscultation, and normal oxygen saturation make severe emphysema unlikely