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High dose oral cobalamin would be a reasonable alternative as maintenance in patients unable to tolerate intramuscular injections provided there is good compliance with treatment
Important Considerations and Nuances While the reasons above are the general basis for the refusal, its also important to note: Patient Symptoms: A patient with Pernicious Anemia may feel their symptoms returning before their scheduled injection
They should not be compared
It is often worst one or two days after an injection and during the week after each increase, then eases at a held dose
Sleep quality optimization For pure sleep quality improvement, the standard dosing protocols described earlier apply
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