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SARS-CoV-2 infection has been shown to suppress Nrf2 expression in patients with COVID-19, thereby enhancing the infection severity 67

The MHRA advises that metformin commonly reduces B12 levels and recommends testing if deficiency is suspected (for example, in patients with anaemia or neuropathy) and considering periodic monitoring in people with risk factors such as higher doses, longer duration of treatment, or other risk factors for deficiency

Date of last review: July 2026

[9] Transient itching or rash has been noted in some cases, possibly indicating a mild sensitivity reaction

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Exp Clin Endocrinol Diabetes (2011) 119(3):17781.10.1055/s-0030-1261965 81 KaragiannidesIBakirtziKKokkotouEStavrakisDMargolisKGThomouTet alRole of substance P in the regulation of glucose metabolism via insulin signaling-associated pathways