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Additional risk factors include: Chronic kidney disease : Reduced renal clearance may impair B12 excretion Liver disease : Hepatic dysfunction can disrupt B12 metabolism and storage Myeloproliferative disorders : Certain blood cancers increase B12-binding proteins Concurrent medication use : Some drugs may interact with B12 metabolism, including metformin, proton pump inhibitors, and H2 antagonists Patients with these conditions should have B12 supplementation carefully monitored by their healthcare team

IF revealed that the treatment with epitalon was associated with a significant elevation of PML bodies for both BT474 and 21NT compared to the untreated controls (Fig

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Changes to the treatment plan are made based on these checks to help patients get the best results

Most patients rate nausea during peak weeks as the most challenging symptom, but its manageable with medication and resolves by week 12 for the majority