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Baseline vitamin B12 levels before starting metformin Annual monitoring for patients on long-term metformin therapy Consideration of vitamin B12 supplementation if deficiency is detected Antibiotics and Chemotherapy Agents That Affect B12 Metabolism Certain antibiotics and chemotherapy agents can harm vitamin B12 metabolism

With age, the decrease in stomach acid secretion and the quantity of the digestive enzyme pepsin results in diminished absorption of vitamin B12

As a result, there are repeated reports of severe nerve disorders after nitrous oxide anaesthesia, which however can be remedied with B12 supplements if taken promptly afterwards (65, 66)