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However, the bulk of research is preclinical, with a significant lack of high-quality clinical trials

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Its use can induce erythema and although it is unknown whether hydroxocobalamin-induced erythema increases the risk for photosensitivity, it is recommended that patients avoid direct sunlight until the redness of skin caused by usage of hydroxocobalamin has resolved

They are a practical alternative for patients who find tablets difficult to tolerate, though current evidence does not clearly demonstrate superiority over standard high-dose oral tablets