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Often the explanation is simple and benign, often iatrogenic, meaning it comes from B12 the patient is taking or being given

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Patients with this condition or those with a family history suggestive of Lebers disease should avoid cyanocobalamin-containing products or use alternative forms of vitamin B12 such as hydroxocobalamin under careful medical supervision

Reconstitution and administration instructions are part of the clinical guidance a provider gives a patient who has been evaluated and prescribed a compound