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As a general rule, IM is favored when the goal is rapid correction of a clinical deficiency, when the patient has difficulty absorbing B12 through oral or sublingual routes, or when a provider wants predictable peak serum levels
For this reason, NAD + and SAM observations are best treated first as pathway-engagement data, and only secondarily as safety-relevant information when paired with appropriate monitoring endpoints
Though there appear to be no risk and few symptoms associated with too much B12, its wise to keep your level within the upper limit of the standard test range.
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