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At our Corpus Christi clinic, providers review medical history, current goals, and ongoing treatments before recommending injectable options

Options for managing tolerance include a brief dose reduction for 4 to 8 weeks ("drug holiday" at a lower dose, not complete cessation), lifestyle optimization to maximize the medication effect, evaluation for other contributing factors (thyroid function, cortisol, sleep quality, medication interactions), and consideration of adding a complementary compound to address specific aspects of the plateau

doi:10.2174/1574886309666140605114614 Ferri: Ferri's Clinical Advisor 2013, 1st ed

It is highly suggested these individuals switch to Pfizer or Moderna for their second dose

Inherited defects in Cbl metabolism are mostly associated with, for example: failure to thrive, irritation, feeding problems, and neurological or neurodevelopmental disorders