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Higher-Caution Situations Extra medical supervision is important if you: have a history of reactions to injectable vitamins/cobalamins have significant kidney or liver disease are pregnant or breastfeeding are offered a compounded MIC B12 product without clear labeling of ingredients, concentrations, and compounding source The FDAs overview of compounding helps explain why quality can vary (see Compounding and the FDA: Questions and Answers )

I cover more on this phenomenon in my folate article

Position the vial upright and away from the refrigerator door where temperature fluctuations occur

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That is the legitimate basis for interest