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Subcutaneous administration (which bypasses first-pass metabolism and delivers more peptide to target tissues) was not extensively tested in human trials, and this route is what most current research protocols use
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
Pralatrexate: 1 (milligram) mg of vitamin B12 as an injection no more than 10 weeks prior to the first dose and every 8 to 100 weeks thereafter
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