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Genomics 32(2):272276

When given by intramuscular injection, the dose bypasses the digestive tract and is absorbed reliably, which matters because dietary B12 absorption depends on stomach acid and a protein called intrinsic factor, both of which decline with age, medication and certain gut conditions

However, GI side effects are common during titration, with nausea, vomiting, and diarrhea increasing at higher doses, and discontinuation rates as high as 25% at the 15 mg level

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