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Strong evidence, from decades of treating individuals with inborn errors of B 12 metabolism, supports the safety of parenteral, lifelong, even high dose hydroxocobalamin, sometimes even at very high doses.6768 Long term epidemiological studies also indicate that treatment with pharmacological B 12 doses and the corresponding increase in serum B 12 do not increase mortality.69 Data on the safety of cyanocobalamin, when administered with high frequency (ie, one to two times a week) for a longer period of time, are lacking