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If a patient cant tolerate allopurinol and meets the criteria (see above) for probenecid, that can be tried

Biguanides (metformin): Medications used to treat type 2 diabetes, metabolic syndrome, nonalcoholic fatty liver disease, and polycystic ovary syndrome can lead to decreased vitamin B12 absorption (5)

MOTS-c modulates the FOXO transcription factors and regulates cellular senescence, the state in which aged or damaged cells stop dividing but refuse to die, instead secreting a cocktail of inflammatory signals known as the senescence-associated secretory phenotype (SASP)

Sometimes it is the uterus

Nicotinamide N-methyltransferase: At the crossroads between cellular metabolism and epigenetic regulation