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NNMT catalyzes the transfer of a methyl group from S-adenosylmethionine (SAM, the universal methyl donor in cells) to nicotinamide (a form of vitamin B3 and a precursor for NAD+ synthesis), producing 1-methylnicotinamide and S-adenosylhomocysteine (SAH)

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Also, because of its deep red color, hydroxocobalamin may cause hemodialysis machines to shut down due to an erroneous detection of a blood leak. This should be considered before hemodialysis is initiated in patients treated with hydroxocobalamin

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