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7 Then came the pivotal test
If B12 levels are already normal, additional B12 is unlikely to improve fatigue

Lee, S.-J

Some chemotherapy drugs or antiretroviral medications (for HIV) that suppress bone marrow might also blunt the effectiveness of B therapy

It can also result in pernicious anemia which occurs when your body does not have enough vitamin B12 to produce the required amount of red blood cells
The fuller tolerability picture is covered in the AHK-Cu side effects article
