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This patient was also receiving several other nephrotoxic medications (ie, furosemide, vancomycin, and piperacillin-tazobactam), which may have prevented the patients kidneys from properly clearing methotrexate

In: Shils ME, Shike M, Ross AC, Caballero B, Cousins RJ, editors

Research has shown, however, that these medications are actually kidney-protective long-term

Insurance companies often deny coverage for off-label dual therapy, and prescribers face liability if adverse events occur without robust safety data

Preliminary evidence suggests NAD-boosting compounds (nicotinamide riboside, NMN, niacin) may improve mitochondrial function and insulin sensitivity in rodent and some human studies, but effect sizes remain modest