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A deficincia secundria pode ocorrer em pacientes com doena renal em estgio terminal, bebs prematuros que dependem de nutrio parenteral ou indivduos sob uso crnico de medicamentos especficos, como o cido valproico ou certos antibiticos conjugados com pivalato

concurrent use requires medical supervision

Phillips IR, Shephard EA

Organic nitrates are enzymatically metabolized to generate nitric oxide and nitrite

Several clinical trials have indicated high-carbohydrate diets may shorten the time needed to fall asleep and periods of wakefulness, and increased fiber in the diet may increase deep slow-wave sleep

So while it is produced naturally by the body, it can also be supplemented through oral, topical, or intravenous means to enhance its effects