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Even with a favorable advisory committee vote, the FDA requires formal rulemaking before compounding pharmacies can act

These tests may require specialist laboratory referral Holotranscobalamin (active B12) where available, may be used as a second-line test when standard B12 results are borderline Intrinsic factor antibodies to identify pernicious anaemia, the most common cause in the UK Parietal cell antibodies may be useful if intrinsic factor antibodies are negative but pernicious anaemia is still suspected Thyroid function and folate levels to exclude other causes of similar symptoms According to current UK guidance, patients presenting with neurological symptoms suggestive of B12 deficiency should not have treatment delayed whilst awaiting test results

Both modifications slow peptidase cleavage further and extend the effective duration of action

Missing occasional doses wont derail progress, but consistent daily administration produces best results

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