Medications know to cause bone marrow suppression (e.g., myelosuppressive antineoplastic agents) may result in a blunted or impeded response to methylcobalamin, vitamin B12 therapy
For longer-term needs, consider the aliquoting strategy mentioned above, freezing portions to extend their useful life
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In milder or borderline cases, high-dose oral vitamin B12 may be sufficient, depending on absorption and clinical context
The most important factor is consistency of timing and route day to day, since the mechanism works cumulatively rather than as an acute event to time around a meal