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If nausea persists beyond 3-4 weeks on a stable dose, consider reducing to the previous dose level and attempting re-escalation more gradually after 4-6 weeks

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Among others, In one case, high-dose oral supplementation was found to be at least as effective as parenteral supplementation, and the authors venture to say —based on a study—that it is even superior when it comes to maintenance doses, since the levels of methylmalonic acid that remained slightly above the upper limit decreased more slowly in the group that received intramuscular injections