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Cautious use of parenteral cyanocobalamin is also recommended in patients with renal impairment, including premature neonates, because of the possibility of greater aluminum accumulation, which may cause central nervous system and bone toxicity

Smaller proportions were aged 4559 years (24.6%), 1825 years (7.9%), and 6084 years (8.7%)

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Manufacturers are seeking to improve efficacy by developing new dual- and tri-agonists, studying combinations, and offering more potent doses