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By selectively inhibiting NNMT an enzyme central to energy regulation and fat metabolism this compound has demonstrated, in preclinical studies, the capacity to elevate intracellular NAD and SAM levels, suppress lipid accumulation in adipocytes, and reduce white adipose tissue mass in diet-induced obese mouse models

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If you have a vitamin B12 deficiency, that can cause fatigue

High dose oral cobalamin would be a reasonable alternative as maintenance in patients unable to tolerate intramuscular injections provided there is good compliance with treatment

doi: 10.1152/ajpregu.00463.2004

Some patients prefer syringes for very small or precise dosing (especially using half-unit syringes)