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Patients should seek urgent medical advice if they develop neurological symptoms, as these may require immediate treatment with intramuscular hydroxocobalamin

The melanoma risk, while unproven causally, is biologically plausible

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Splitting a daily dose (e.g., 500 g total given as 250 g twice daily) may theoretically provide more stable plasma levels, though direct comparative studies specifically examining once versus twice-daily protocols are limited