First-pass metabolism in the liver further reduces systemic availability [34]
The medication is not directly causing the urination, but it is creating the conditions that lead to it
Biomedicine and Pharmacotherapy, 131, 110673
Additionally, certain medications have been associated with NAION risk, most notably phosphodiesterase-5 inhibitors used for erectile dysfunction
The materials also state that clinicians may begin with a lower dose and adjust over time to support tolerability, and that severe or persistent symptoms should be reported to the treating provider
Some practitioners recommend administering injections in the morning to align peak methyl donor availability with daytime metabolic activity, but clinical evidence supporting timing-specific benefits is limited