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In December 2024, the FDA's Pharmacy Compounding Advisory Committee declined to include it on the 503A bulk drug substances list, meaning compounding pharmacies in the United States cannot legally produce it for individual prescriptions

Folate must be checked alongside B12, and folate deficiency should never be treated in isolation when B12 is low, because doing so can mask the anaemia while neurological damage progresses

For patients on these medications, high-dose oral supplementation or injections are clinically necessary to bypass the digestive blockade