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As with any injection, there may be slight bruising, redness, and soreness at the injection site.

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You may experience fatigue or lethargy, among other symptoms, if you have a B12 deficiency

Options for managing tolerance include a brief dose reduction for 4 to 8 weeks ("drug holiday" at a lower dose, not complete cessation), lifestyle optimization to maximize the medication effect, evaluation for other contributing factors (thyroid function, cortisol, sleep quality, medication interactions), and consideration of adding a complementary compound to address specific aspects of the plateau