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However, compounded medications are not required to undergo the same rigorous testing for bioequivalence that generic drugs require

If normal, continue supportive measures without b12 addition

Under these conditions, the powder remains stable for months to years depending on manufacturing date

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

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