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Some practitioners implement cycling to theoretically prevent receptor desensitization, provide physiological breaks, or manage costs, though evidence supporting these approaches is limited

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If needed for a clear medical indication (such as treating pellagra in a pregnant patient), niacinamide can be used with caution, but unnecessary high-dose B supplementation is avoided in pregnancy

According to the Mayo Clinic, parenteral vitamin B12 therapy is clinically indicated for treating deficiency caused by pernicious anemia, gastrointestinal disorders such as tropical sprue, and conditions resulting in malabsorption like pancreatic insufficiency

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