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If the patient has not adhered to the prescribed schedule, the possibility of pregnancy should be considered at the time of the first missed period and oral contraceptive use should be discontinued until pregnancy is ruled out

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When the tissue SAM level is sufficient to maintain vital transmethylation reactions, SAM reduces the rate of remethylation of homocysteine into methionine by 5-methylTHF, through an inhibition of MTHFR activity (Fig

doi: 10.1016/S0015-0282(00)00518-5 21 ShiMSirardM-A