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If the deficiency is due to dietary insufficiency and gastrointestinal absorption is intact, oral cyanocobalamin at doses of 50-150 micrograms daily between meals is typically recommended in the UK

In that trial, gastrointestinal side effects including nausea, vomiting, diarrhoea, and constipation were collectively the most frequently reported adverse events

Many practitioners report sustained benefits over extended treatment periods without requiring dose escalation

The IDO1 selective inhibitor epacadostat enhances dendritic cell immunogenicity and lytic ability of tumor antigen-specific T cells

A prior check list should be to have realistic approach and expectation