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The metabolism and clearance of both components may be affected by significant liver disease, and patients with severe hepatic impairment should be monitored closely if treatment is deemed necessary

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[DOI] [PMC free article] [PubMed] [Google Scholar] 25.Smoday I.M., Krezic I., Kalogjera L., Vukovic V., Zizek H., Skoro M., Kasnik Kovac K., Vranes H., Barisic I., Sikiric S., et al

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Suggested starting points to discuss with your clinician Deficiency without malabsorption: 1,0002,000 mcg oral cyanocobalamin daily until normalized, then weekly or monthly maintenance per labs (AAFP)