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So, we recommend using SL vitamin B12 rather than oral and IM, especially in patients who do not tolerate IM injection and patients who need prolonged vitamin B12 supplementation, such as patients with long-term metformin use and patients with pernicious anemia or with gastro-duodenal resection [51–54]

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Any therapeutic use occurs under physician supervision as off-label research application requiring comprehensive informed consent, medical monitoring, and understanding that the peptide is not an approved pharmaceutical agent