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[27] Additionally, anyone with Lebers hereditary optic neuropathy (a rare inherited eye disease) must avoid cyanocobalamin injections, since B can precipitate rapid worsening of that condition

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The release of MMP enzymes by severe reactive astrocytes can impair BBB integrity and trigger the production of proinflammatory cytokines 52

Patient Education Medication guidance: Provide detailed instructions on the injection method, dosage and possible side effects