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If side effects persist or grow worse with each dose increase, clinicians usually slow escalation, reduce the dose, or suspend therapy while investigating other causes

Both the thioredoxin (Trx) and GSH-dependent glutaredoxin (Grx) antioxidant systems have been found to reduce methionine sulfoxide reductases in vitro and/or in vivo (see Figure 2 ) (28)

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Maintenance Dose: Once B12 levels are normalized, a maintenance dose of 1,000 mcg monthly or every few months may be recommended