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A favorable recommendation from the FDA's Pharmacy Compounding Advisory Committee (PCAC), scheduled for review in July 2026, followed by formal rulemaking, is required before legal compounding access is restored

Furthermore, the NNMT SNP rs694539 increases risk of acute lymphoblastic leukemia ( NNMT is expressed mainly in the liver and adipose tissue, and a small amount of NNMT can be detected in the kidney, lung, skeletal muscle, and the heart ( NNMT expression is altered in metabolic diseases such as obesity and cirrhosis (27), colorectal cancer (28), bladder cancer (29), ovarian cancer (30), cutaneous malignant melanoma (CMM) (31), gastric cancer (32), pancreatic cancer (33, 34), and glioblastoma (GBM) (35)

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First, the vast majority with low levels have reported being able to raise their B12 levels with oral supplementation in pill, lozenge or liquid form