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Decreased or lack of absorption due to stomach/bowel issues such as celiac disease, bariatric surgery, Crohn's disease and aging
Improper handling degrades them, potentially creating breakdown products that differ in effect from the intact peptide
The consent must accurately characterize the compound as an unapproved bulk drug substance (not as an approved drug used off-label), the evidence base and its limitations, known and theoretical risks, alternatives considered, the monitoring plan, and the patients ability to decline or discontinue
Hepatocellular carcinoma, a primary liver cancer, should remain on the differential when B12 elevation is marked, persistent, and otherwise unexplained
Even when targeting a specific injury, vary the exact injection point within the general area
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