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Drug Interactions Several common medications reduce B12 absorption: Metformin (diabetes) significant reduction in B12 absorption Proton pump inhibitors (Omeprazole, Pantoprazole) reduce stomach acid needed for absorption H2 blockers (Ranitidine, Famotidine) similar effect to PPIs Colchicine (gout) may reduce B12 absorption If you take any of these medications long-term, B12 supplementation is strongly recommended

Testing for MTHFR and transcobalamin mutations can show metabolic challenges

However, regular intramuscular injections are a significant strain on resources (both time and financial) and are inconvenient for patients, so a trial of oral replacement therapy may be suitable in some cases

A study comparing ID and subcutaneous (SC) delivery of radiolabeled vitamin B12 in rabbits found that while the bioavailability was slightly higher for the SC route, the Tmax (time to reach maximum concentration) was almost identical for both methods