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It requires reconstitution with bacteriostatic water and should be stored at 2-8C

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10.1038/s41598-018-19248-7 206

Subcutaneous may offer slightly more consistent plasma levels, but the practical difference is marginal given the compounds short half-life requiring daily dosing either way

This increases cost without clear benefit and eliminates the ability to increase dose if initial response is insufficient

Vitamin B12 deficiency has the next strongest association, particularly through its effect on skin pigmentation and red blood cell production