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This results in a number of symptoms

Its history began with a breakthrough by a research team at the University of Texas, USA, in 2017.At that time, NNMT was recognized as a key enzyme in cellular metabolism and energy homeostasis, highly active in adipose tissue and closely linked to obesity, type 2 diabetes, and other metabolic diseases

The only positive news I have seen is that it gets better over time as in reduces over time

500 mL) or multiple 250 mL infusion bags to ensure that the concentration of the infusion solution does not exceed 4 mg/mL

List of medicines under additional monitoring European Medicines Agency

In high-dose methotrexate administration a temporary withdrawal of the PPI may be considered in some patients [see Drug Interactions (7)]