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The clinical significance arises when B12 is elevated without a clear exogenous explanation

(There is a method, advocated by some US doctors, in which phenobarbitone, a long-acting barbiturate, is substituted for a benzodiazepine and then slowly withdrawn, but this method has no particular advantages over tapering directly from a long-acting benzodiazepine)

Purity is paramount

The spelling alone does not reveal whether a product contains the free peptide, an acetate-associated material, an amidated derivative or another peptide

Oral versus parenteral route of application: the patient's preference

Never shake the vial, mechanical agitation can damage the peptide structure