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Furthermore, there are no reports of a significant clinical trial in the last stage for ASD in which the 7nAChR ligand has demonstrated clear effectiveness as a neuroprotective drug without any side effects

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52 This is primarily due to enzymatic degradation and pH-mediated hydrolysis in the gastrointestinal tract and liver, leading to low absorption rates and high first-pass effect

Excess nicotinamide is eliminated partly through a methylation pathway, meaning it consumes methyl donors in the process of excretion