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The serum folate level was 16.5 ng/mL, while the vitamin B12 level was critically low at less than 150 pg/mL, with elevated methylmalonic acid (MMA) (21,600 nmol/L) and homocysteine (HC) levels (276.3 mol/L), further supporting a diagnosis of vitamin B12 deficiency

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Switch to a non-oral contraceptive method, or add a barrier method of contraception for 4 weeks after starting medication and for 4 weeks after each dose escalation until you reach a maintenance dose