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If you believe you may produce a lower amount of intrinsic factor, using it sublingually is a reasonable approach
Vidal-Alaball J, Butler CC, Potter CC: Comparing costs of intramuscular and oral vitamin B12 administration in primary care: a cost-minimization analysis
The side effect profile is similar but slightly more GI effects with the mix, though these are manageable with proper titration
1 If anti-intrinsic factor results are negative but suspicion for pernicious anemia remains, an elevated serum gastrin level is consistent with the diagnosis
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