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Patients who already have exceptionally high pyridoxine levels or signs of pyridoxine toxicity (such as sensory neuropathy) should not continue to receive high-dose supplementation until those symptoms resolve

Although rare, adverse effects of high-dose vitamin B12 have been reported, including allergic reactions such as fever, rash, itching, hot flushes, dizziness, and nausea, across all cobalamin forms and administration routes (Caballero et al., 2007)

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This is especially true for patients with torn tendons or ligaments, which naturally receive limited blood flow and heal slowly