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Silverstein said he decided to investigate the over-prescribing of B12 shots, because "as an internal medicine resident, I have seen many patients come into the emergency department, and they were getting B12 injections without having a really good reason for it." His study could not determine why family physicians were prescribing it inappropriately including whether it was initiated by the doctor or at the request of the patient

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Therefore, parenteral cyanocobalamin should be administered to a pregnant woman if the benefits outweigh the risks.[15][16] Cyanocobalamin is excreted in the breast milk of nursing women in levels similar to the level of vitamin B12 in maternal plasma.[25] The distributed cyanocobalamin in breast milk has been found to be compatible with breastfeeding by the American Academy of Pediatrics.[26] In addition, there has not been any reports of adverse effects associated with the intake of normal daily requirements of vitamin B12 during lactation

clinicians adjust therapy accordingly