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Methylcobalamin helps maintain nerves, shields the myelin sheath, and stimulates the production of red blood cells

Higher-dose oral B12 (e.g., 1000 g daily) is sometimes used but should only be considered under clinical supervision with appropriate monitoring, particularly in cases of malabsorption where intramuscular treatment remains the first-line approach in UK practice

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These include serious infection, uremia or renal failure, drugs with bone marrow suppression properties (e.g., chloramphenicol), or concurrent undiagnosed folic acid or iron deficiency anemia