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Vegans, vegetarians, people over the age 50, anyone with stomach/bowel issues like chronic gastritis, leaky gut, IBS or celiac, and anyone who regularly takes medications such as Metformin, PPIs (used for GERD), H2 Receptor Antagonists (used for peptic ulcers), or anything that interferes with stomach acid production are actually at risk for vitamin B12 deficiency, and should supplement B12 regularly

However, if you are pregnant, nursing, have a medical condition, or take medications, consult your healthcare provider before use

This guidance was reinforced through IKS Health coding analysis citing Coding Clinic 3Q 2019, Page 37 and remains active in FY2026 guidelines

You may not be suitable for this treatment if you have a blood disorder, iron or folic acid deficiency, low potassium or an allergy to hydroxocobalamin.