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We will also make any necessary adjustments to your treatment plan based on your progress and feedback

Identifying the underlying cause is essential for appropriate management: Dietary history to assess B12 intake Medication review (metformin, proton pump inhibitors, H2-receptor antagonists) Assessment for malabsorption disorders (coeliac disease, Crohn's disease) Previous gastric surgery Autoimmune conditions History of nitrous oxide exposure (recreational or medical) NICE guidance emphasises that treatment should not be delayed whilst awaiting test results if clinical suspicion of B12 deficiency with neurological involvement is high, as delayed treatment may result in irreversible neurological damage

Such recommendations would be inconvenient for many people and could lead to some cases of acne-like symptoms in people sensitive to high doses of B12 (see Footnote B in Elevated Vitamin B12 Levels and Mortality)

Women who are pregnant, planning pregnancy, or breastfeeding should avoid the compound entirely due to unknown effects on fetal and infant development