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Prompt parenteral (intramuscular) B12 treatment is recommended in such cases, in line with BSH guidance, to prevent further or irreversible neurological injury

Snchez-Ruiz de Gordoa J, Erro ME, Vicua-Urriza J, Zelaya MV, Tellechea P, Acha B, Zueco S, Urdnoz-Casado A, Roldn M, Blanco-Luquin I, Mendioroz M (2020) Microglia-related gene triggering receptor expressed in myeloid cells 2 (TREM2) is upregulated in the substantia nigra of progressive supranuclear palsy

Blood samples collection procedure For the PK study, heparinised blood samples were collected at time 0 (baseline), 9.5 min (end of pemetrexed infusion), 15, 30, 50 min (end of vinorelbine infusion), 1 h, 1 h 20 min, 2, 4, 8, 24, 48 and 72 h, for measurement of plasma pemetrexed and vinorelbine concentrations over a 72-h period following the start of pemetrexed administration in first cycle

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This effect was not sensitive to naloxone, indicating a distinct mechanism from its opioid-mediated antinociceptive effects 8