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Some people are unable to manufacture Intrinsic Factor, a condition called pernicious anemia, making it impossible to absorb Vitamin B12 from foods or oral supplements

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Initial treatment may involve frequent injections followed by maintenance regimens, with periodic review of symptoms and, where appropriate, blood counts

Similarly, although hepatic dysfunction can occur with large niacin doses (1-3 grams daily over months) causing elevated liver enzymes or jaundice, niacinamide at 100 mg is very unlikely to have any adverse effect on the liver