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Therapeutic response to cyanocobalamin may decrease due to elderly age, infection, renal insufficiency, diabetes mellitus, marrow suppressants use (e.g

As a result, baseline and periodic monitoring of kidney function through blood tests is recommended, especially in patients with pre-existing chronic kidney disease

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Those with a history of arrhythmias, uncontrolled hypertension, coronary artery disease, or previous cardiac events should approach this combination with extreme caution