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After that initial period, it is common to continue injections monthly, though less frequent intervals might be OK if cobalamin blood levels are supportive

People with certain conditions, such as severe kidney disease or allergies to B12 components, should discuss suitability with their provider

Energy: unchanged or slightly reduced

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Medications including metformin, proton pump inhibitors, and H2-receptor antagonists may reduce absorption of B12, potentially prolonging the time to clinical improvement