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doi:10.1016/s0140-6736(78)92379-6

Other factors include: Underlying cause of deficiency : Pernicious anaemia, malabsorption disorders, or dietary insufficiency may affect treatment response Medication use : Metformin and proton pump inhibitors can reduce gastrointestinal B12 absorption (though this does not affect the efficacy of intramuscular injections) Individual variation : Differences in how efficiently your body utilises the injected vitamin Adherence to treatment schedule : Missing injections or delaying maintenance doses can slow recovery Discussing these factors with your healthcare provider helps set realistic expectations for your treatment journey

Medications side effects Vitamin B12 Some other prescription medications can directly cause a vitamin B12 deficiency, such as proton pump inhibitors and metformin

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The most commonly reported events in active arms were mild and transient: injection site reactions in some subcutaneous subjects, occasional headache, and in some oral dosing arms, minor gastrointestinal tolerance issues