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Persistent or expanding reactions warrant clinician review

The most commonly reported side effects at therapeutic doses include mild nausea, particularly in the first week of a protocol, which typically resolves by day 7 to 10 without any dose adjustment

Women planning a pregnancy should take additional folic acid: 400 micrograms daily is the standard recommendation for most women, but 5 mg daily may be advised for those at higher risk including many post-bariatric patients in line with local NHS policy and RCOG guidance

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