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The metabolism and elimination of NAD+ (and its by-products) could be altered in advanced hepatic or renal dysfunction, and high-dose NAD+ might theoretically affect cardiovascular dynamics, so practitioners generally avoid or closely supervise NAD+ use in such settings

Rawls et al., 2006

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Store your lyophilized powder in a cool, dry place or refrigerate for extended shelf life

conversely, an Nrf2 inhibitor abolishes its anti-inflammatory and antiferroptotic effects (164)