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Assess both vitamin B12 and folate levels prior to initiating therapy with vitamin B12, including Cyanocobalamin Nasal Spray, or with folic acid [see Dosage and Administration (2.1)]
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The more serious risks the medical community watches for with this drug class: thyroid tumors (particularly medullary thyroid carcinoma, which has shown up in rodent studies humans with personal or family history of MTC should avoid this entire class), pancreatitis, and gallbladder issues
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