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It is a coenzyme your cells already make from vitamin B3, and it is central to two things: shuttling electrons through energy metabolism, and serving as a required cofactor for sirtuins, PARPs, and CD38

Your provider suggests dropping to 0.75 mg for two weeks before trying 1 mg again

The key principles for optimizing symptomatic treatment in MG using cholinesterase inhibitors

Do not use if you have primary systemic l-carnitine deficiency or secondary l-carnitine deficiency (inborn errors in metabolism) for which levocarnitine supplementation is prescribed and/or monitored by a health care practitioner

Type II (prostate/follicle enzyme): Less sensitive, with inhibition only at higher levels (IC ~19 M