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[12] Gastric acid-suppressing agents (proton-pump inhibitors and H-receptor antagonists) diminish dietary B12 liberation from protein complexes, a pharmacodynamic interaction that can exacerbate underlying deficiency

Oh, and in addition to their B name, they each have an alternative moniker as well

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These symptoms may indicate advanced deficiency requiring immediate treatment, particularly in pregnancy, infancy, or following nitrous oxide exposure

Some patients may struggle to absorb enough B12 from diet or oral supplements, especially those with conditions like pernicious anemia, gastrointestinal disorders, or those who have undergone certain surgeries