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This combination may be most relevant for patients with documented hepatic steatosis, suboptimal B-vitamin status, elevated homocysteine, or those plateauing on semaglutide monotherapy under medical supervision

any gout flare-ups might necessitate re-evaluation of niacinamide therapy

It works best when combined with proper nutrition, regular physical activity, quality sleep, and overall healthy habits

High-dose therapy may also cause a brief increase in blood pressure, though this usually returns to baseline within a few hours