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As with antibiotics, it may be prescribed topically or orally

Vitamin B 12 deficiency Vitamin B 12 deficiency , also known as cobalamin deficiency , is the medical condition in which the blood and tissues have a lower than normal level of vitamin B 12

References References Selective and membranepermeable small molecule inhibitors of NNMT Roles of Nicotinamide NMethyltransferase in Obesity and Type 2 Diabetes Nicotinamide Nmethyltransferase inhibition mimics and boosts exercisemediated improvements in muscle function in aged mice Reduced calorie diet combined with NNMT inhibition establishes a healthier gut microbiome in obese mice Kraus et al

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This patient has four simultaneous factors compromising b12 status, making supplementation prudent even with normal baseline levels