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61 In practice, some patients may be able to switch to very high dose (ie, 2000 mcg daily) oral supplementation instead of continuing parenteral administration, but it is impossible to predict in whom this can be done safely, and many are at risk of worsening symptoms which may become permanent

Petersburg Institute of Bioregulation and Gerontology and collaborating researchers (including Khavinson, Anisimov)

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This should only be used if the patient has been confirmed to have had inadequate responses to other forms of treatment