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[7] [4] Neurological symptoms can occur even before anaemia develops and include paraesthesia (pins and needles) in the hands and feet, numbness, difficulty walking, and balance problems due to subacute combined degeneration of the spinal cord

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Starting low and escalating gradually produced fewer gastrointestinal side effects than starting directly at a higher dose, which is why the 2mg +2mg-every-4-weeks schedule became the standard escalation approach in the published data