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[12] Gastric acid-suppressing agents (proton-pump inhibitors and H-receptor antagonists) diminish dietary B12 liberation from protein complexes, a pharmacodynamic interaction that can exacerbate underlying deficiency
According to NICE guidance, hydroxocobalamin injections are the recommended first-line treatment for pernicious anaemia and other malabsorption-related deficiencies
The B12 component adds another layer that most guides skip entirely
[11] Long-term metformin therapy reduces calcium-dependent intrinsic-factor binding, lowering B12 absorption and potentially necessitating higher or more frequent parenteral doses
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