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For example, someone with severe B12 deficiency and neurological symptoms might need more frequent injections at first

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It is susceptible to carboxypeptidase cleavage, light-driven copper photo-oxidation and pH extremes, with an optimum of about 5.0 to 6.5

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Receiving peptides that were exposed to elevated temperatures during transit may result in degradation before reconstitution

This indicates that while higher doses may have some impact on kidney function, this effect is reversible and does not occur at lower, more commonly used doses