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For B12, prolonged use of metformin and acid-suppressing drugs (PPIs, H2 blockers) may reduce absorption of oral B12, which is one reason injectable B12 is considered in select patients

Add supplementation only if levels decline below 400 pg per milliliter or symptoms suggest deficiency

Monitor for any new side effects that emerge at the higher dose

Monitoring Intake People with conditions that affect B12 absorption, such as pernicious anemia or gastrointestinal issues like Crohn's disease, should work with a healthcare provider to regularly monitor their B12 levels and adjust intake as needed

Suissa K, Schneeweiss S, Kim DW, et al