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For example, it may have a benefit for hypertension, but we also need to look at how not just the benefit of actual hypertension meds compares but also the adverse event profile

2-7

Pharmacotherapy, 42(9), 659-667

For patients who experience a paradoxical decrease in energy levels, it doesnt mean you should stop taking the B12 but instead decrease your dose by half (so take 2,500mcg every 7 days) or simply take 5,000mcg every 14 days instead

Proper titration over 16-20 weeks allows you to reach your therapeutic dose while minimizing nausea and GI side effects that might otherwise discourage adherence