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As a recent scientific review explains, 4 Owing to its size and charged nature, NAD+ cannot passively pass through cellular membranes, including the plasma membrane. ...this probably occurs indirectly through the generation of NAD+ degradation products, such as NMN, NR or NAM, which act as precursors. In other words, NAD+ taken orally must first be broken down into these smaller molecules before it can re-enter cells and contribute to NAD+ synthesis

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Phase II randomized study of Plitidepsin (Aplidin), alone or in association with L-carnitine, in patients with unresectable advanced renal cell carcinoma

The cyanide produced from the metabolism of cyanocobalamin is not lethal but it will still require effort and energy by the body to get rid of it