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Compounded drugs are not directly approved by the FDA in the same way as commercial drugs

First, a 1,000 g dose of cyanocobalamin provides only 19.2 g of cyanide, a trivial addition to the 113 to 164 g already ingested daily from food and air

This paradoxical reaction is not fully understood but is thought to be related to individual metabolic responses

For sublingual use, methylcobalamin may offer advantages because it is absorbed directly into the bloodstream without requiring conversion