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If the patient has heart failure, the nonrenal (hepatic) clearance might be halved because of hepatic congestion and hypoxia, so the expected clearance would become 5.5 L/h

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Yes, that includes sublingual forms of B12 as well

Patients with chronic kidney disease, reduced kidney function, or other significant medical conditions should always discuss peptide therapy with their healthcare provider before starting treatment

Liposomal delivery provides a protective "bubble" for better absorption

Additionally, NAD is a substrate for ADP-ribosyltransferases, which catalyze ADP-ribose transfer reactions, converting NAD into nicotinamide and ADP-ribosylated products ()