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As clinical signs of cobalamin deficiency include chronic wasting or failure to thrive, malaise, and gastrointestinal signs such as diarrhea, serum cobalamin concentration should be measured in any dog with poor response to enzyme replacement therapy for EPI

"Prevention of herpes zoster: recommendations of the Advisory Committee on Immunization Practices (ACIP)" (PDF)

NNMT inhibitors reduced intracellular 1-MNA, increased intracellular NAD + and S-(5-adenosyl)-L-methionine (SAM), and suppressed lipogenesis in adipocytes

Switch to capsules at higher doses, or split the subQ dose across multiple sites if you must inject