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In that case, be sure to stick to the recommended vitamin B12 dosage, and use only as directed

The advice is to investigate and treat the vitamin B12 deficiency in the normal way, following clinical guidelines, and to continue the metformin

Potential interactions include: Metformin (used for type 2 diabetes) Proton pump inhibitors (PPIs) and H2-receptor antagonists (used for acid reflux) Colchicine (used for gout) Nitrous oxide (anaesthetic gas that can inactivate B12) Chloramphenicol (may reduce the haematological response to B12 therapy) If you take any of these medications long-term, discuss B12 monitoring with your healthcare provider

However, many factors can limit or even prevent proper absorption

Let us see what are the symptoms of high vitamin B12 Most people with high vitamin B12 do not experience symptoms related to the vitamin itself