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This review discusses and compares the mechanistic pathways involved in these two clinical presentations of this enzyme disorder

Three B vitamins are therefore essential for keeping homocysteine levels in check: Vitamin B12 (in the methionine synthase pathway) Folate (B9) (also in the methionine synthase pathway) Vitamin B6 (in the cystathionine beta-synthase pathway) When any of these three is low, the body cannot process homocysteine efficiently, and blood levels rise

Adv Drug Deliv Rev 65(10):13401356

Promethazine (Phenergan): Alternative if Zofran ineffective

A 2018 study highlighted this importance

If you are unsure, talk to your GP