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The most common adverse reactions or laboratory abnormalities leading to interruption of pemetrexed in this arm (2%) were neutropenia (12%), anemia (7%), asthenia (4%), pneumonia (4%), thrombocytopenia (4%), increased blood creatinine (3%), diarrhea (3%), and fatigue (3%)

Additionally, some individuals have genetic variations that affect B12 metabolism

however, existing medications have limited efficacy and potential side effects, and evidence for non-pharmacological therapies remains limited

With a proper diet and a fully functional digestive system B12 is normally abundant in the body

This includes physician offices, outpatient clinics, and hospital outpatient departments