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According to the NHS, the usual pattern depends on the cause: Non-dietary cause (for example an absorption problem): an injection of hydroxocobalamin every two to three months, usually for life

As that pathway closes, demand for FDA-approved branded medications will likely increase, with implications for formulary management and pharmacy spend

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Gastrointestinal adverse effects, including nausea and vomiting, remain the most commonly reported side effects and may influence adherence during treatment initiation

Starting low and titrating up under medical supervision helps patients reach their "sweet spot" dose