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If heart rate increases remain problematic despite these measures, your physician may consider additional evaluation (such as ECG, electrolyte testing, or thyroid function tests), dose reduction, temporary treatment interruption, or discontinuation if clinically indicated

A sweet or fruity urine odour may indicate ketosis, a metabolic state where the body breaks down fat for energy and excretes ketones through urine

For these individuals, methylcobalamin may provide superior results

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