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If you havent had a bowel movement in 2 days, call your healthcare provider

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Mechanisms and outcomes Vitamin B12 interventions are commenced upon diagnosis of low B12 status, typically comprise high dose injections until levels are within acceptable range, and then the intervention is changed to a maintenance dose that is typically administered every 3 months ad infinitum

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This conservative start minimizes the risk of early side effects like insomnia, elevated heart rate, and anxiety without leaving you under-dosed for longer than necessary