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The study was modified after randomization and treatment of 117 patients to require that all patients receive folic acid 350 mcg to 1,000 mcg daily beginning 1 to 3 weeks prior to the first dose of pemetrexed and continuing until 1 to 3 weeks after the last dose, vitamin B 12 1,000 mcg intramuscularly 1 to 3 weeks prior to first dose of pemetrexed and every 9 weeks thereafter, and dexamethasone 4 mg orally, twice daily, for 3 days starting the day prior to each pemetrexed dose

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doi:10.3109/15563659309000395

Essential Diagnostic Tests Request all three tests simultaneously: serum B12, methylmalonic acid, and homocysteine levels

However, these methods do not consider aspects of molecular structures such as 3D folding