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For severe deficiency, the AAFP recommends loading doses typically daily or every other day for one to two weeks followed by monthly maintenance injections
Studies such as this one published in PMC highlight the role of malabsorption from mucocutaneous disorders like epidermolysis bullosa can lead to deficiencies that cannot be addressed adequately with oral supplements
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There is also a rule that matters for anyone in competitive sport, since AOD 9604 is prohibited by the World Anti-Doping Agency, so athletes subject to testing need to be aware before they consider it
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