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Certain medications The following drugs can reduce levels of vitamin B12 in your body: Antibiotics -- long-term use can lower vitamin B levels generally Anti-seizure drugs Chemotherapy medicines, especially methotrexate Drugs used to reduce stomach acid, like H2 blockers (Pepcid AC, Tagamet, Zantac) and proton pump inhibitors (Nexium, Prevacid, Prilosec) Metformin (Glucophage) -- taken for diabetes Colchicine -- taken for gout Some cholesterol-lowering medications Other causes You're over 65

doi: 10.1038/s41579-022-00846-2 195

These types of intestinal worms are of primary concern in puppies, as they can be spread through the placenta in utero or through colostrum

Comparing the Effect of Injectable Vitamin B With Conventional Oral Treatment on Aphthous Stomatitis