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Patients should also be aware that certain medicationssuch as proton pump inhibitors (PPIs) and metformincan interfere with B12 absorption, though this is less relevant once on injection therapy

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Persistent or severe symptoms suggest dose reduction or potential sensitivity

No published human pharmacokinetic programme was identified

This complex process means that conditions affecting the stomach or intestines can significantly impair B12 absorption, including pernicious anaemia, atrophic gastritis, previous gastric surgery, coeliac disease, Crohn's disease, and long-term use of certain medications (such as metformin, proton pump inhibitors, and H2 antagonists)