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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

The B12 dose stays constant

Exposure to direct sunlight or bright artificial light should be avoided, as this can lead to degradation of the cyanocobalamin component and potentially affect the semaglutide as well

All non-protein-bound B12 is quickly excreted by the kidneys

For hematocrit and reticulocyte counts, recommendations are to repeat these tests daily from the 5th to 7th days of treatment and then frequently until the hematocrit returns to a normal range (11, 14, 15)