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Primary action: inhibition of the NNMT enzyme

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[13] Chloramphenicol has been shown to blunt reticulocyte response to cyanocobalamin, while ethanol, colchicine, and nitrous oxide interfere with cobalamin metabolism or utilization, each warranting clinician awareness when evaluating suboptimal treatment outcomes

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If moving to every other day doesnt make symptoms worse, that frequency is likely enough