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Concomitant monitoring requirements (SUA levels and liver/renal function) impose additional burdens: frequent phlebotomy provokes patient resistance, while toxicity surveillance (ALT, AST, and creatinine) demands individualized schedules that increase healthcare encounters (Kaur et al., 2024

When B12 levels are low, these signals slow down, affecting concentration, focus, and memory

Huang H-C, Nguyen T, Pickett CB

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Vomiting occurs in 5 to 12 percent of cases, more commonly at higher doses