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Two downstream consequences are mechanistically central: nicotinamide is preserved for re-entry into the NAD+ salvage pathway (raising intracellular NAD+ availability), and SAM is preserved for other methylation reactions

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Retatrutide's Phase 2 trial data (Jastreboff et al., NEJM 2023) identified a side-effect profile broadly consistent with other incretin-based therapies: Gastrointestinal : Nausea, vomiting, diarrhoea, and constipation were the most commonly reported adverse effects, particularly during dose escalation