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Caution is advised in patients with Leber optic atrophy, a genetic disorder caused by chronic cyanide intoxication (such as from smoking, alcohol or some plants), against the use of cyano-B12 due to its cyanide moiety, whilst hydroxo-B12 is a cyanide antagonist and can therefore be used in these patients

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This includes vegans, vegetarians, those with pernicious anaemia, malabsorption disorders, or previous gastrointestinal surgery

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PMID: 19180561