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The potential buffering effect of food is far outweighed by the increased enzymatic activity and delayed gastric transit it causes

Caution is advised in patients with Leber optic atrophy, a genetic disorder caused by chronic cyanide intoxication (such as from smoking, alcohol or some plants), against the use of cyano-B12 due to its cyanide moiety, whilst hydroxo-B12 is a cyanide antagonist and can therefore be used in these patients

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