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If an athlete was competing while intoxicated I can see the argument against that, but at the very least were in an area where the merits of whether or not something should be on the list are debatable

Hydroxocobalamin might also work less well if you're also taking medications that lower blood cell production, like chloramphenicol

Due to the compounds plasma half-life of approximately 3.86.9 hours [4] , twice-daily (BID) dosing may provide more sustained NNMT inhibition

Pharmacologic approaches to glycemic treatment: Standards of care in diabetes2025

and c) irregular dietary patterns), reduced bioavailability (impairment of the intrinsic factor-mediated absorption pathway, often due to the widespread and prolonged use of proton pump inhibitors), and malabsorption syndromes

Dose adjustments can be made after 4-6 weeks based on rate of progress and tolerance