Synapsin B12 is a prescription therapy used for cognitive and vitamin B12 support.

Patients seeking support for cognitive and vitamin B12 support may qualify after evaluation by a licensed provider

Yes. Synapsin + B12 is a compounded nasal spray that requires a valid prescription from a licensed provider. A telehealth consultation and medical intake are required before dispensing to ensure it is appropriate for your health history, goals, and current medications.

Synapsin + B12 is generally well tolerated at therapeutic doses. Mild nasal irritation, congestion, or transient burning upon administration are the most commonly reported effects. Mild headache or lightheadedness may occur following initial doses and typically resolves as the body adjusts. Transient changes in sleep quality are consistent with NAD+'s influence on circadian and mitochondrial function. Methylcobalamin is not associated with toxicity at therapeutic intranasal doses. Report any unusual or persistent symptoms to your provider.

Not appropriate for patients who are pregnant or breastfeeding. Patients with a history of hormone-sensitive cancers should consult their provider before use given RG3's interaction with estrogen receptor pathways. Those with active nasal infections, significant nasal polyps, or recent nasal surgery should not use intranasal therapy until cleared by their provider. Patients with Leber's hereditary optic neuropathy should avoid high-dose methylcobalamin without specialist evaluation. Not indicated for patients under 18.

RG3 has mild acetylcholinesterase inhibitory activity; patients on cholinergic medications including donepezil or rivastigmine should disclose concomitant use as effects may be additive. NAD+ influences sirtuin and PARP pathways; patients on PARP inhibitors or chemotherapy agents should discuss with their oncologist before starting. Methylcobalamin may reduce the efficacy of certain antibiotics including chloramphenicol. Patients on blood thinners should exercise caution given ginseng-derived compounds' mild anticoagulant properties.

Patients with a history of hormone-sensitive cancers should not use without thorough provider evaluation given RG3's estrogen receptor interaction. Those with neurodegenerative conditions including Alzheimer's or Parkinson's disease may be candidates but require close provider supervision. Patients with pernicious anemia or documented B12 malabsorption may benefit particularly from the intranasal B12 route. Patients with chronic nasal conditions, autoimmune disorders, or significant hepatic impairment require careful provider review before starting.