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March 2020

If needed for a clear medical indication (such as treating pellagra in a pregnant patient), niacinamide can be used with caution, but unnecessary high-dose B supplementation is avoided in pregnancy

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What lipotropic injections plausibly contribute is more modest and more defensible: correction of real deficiencies, a tolerable non-stimulant option for patients who cannot or will not take prescription weight loss medication, and a recurring touchpoint that keeps patients engaged with a supervised program

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High dose oral cobalamin may be a suitable alternative in selective cases, where intramuscular injections are not tolerated and compliance is not a problem