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The intramuscular route is often chosen for the first treatment because it works well
For those with moderate to severe deficiency, this is especially critical
Nicotinamide N-methyltransferase transfers a methyl group from S-adenosyl methionine to nicotinamide, producing 1-methylnicotinamide
In combined B12 and folate deficiency, B12 replacement must be started before folate supplementation to avoid precipitating or worsening neurological damage
Long-term human safety data not established
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