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The MHRA (2022) recently issued guidance on the increased risk of vitamin B12 deficiency in people treated with metformin, highlighting increased risks with higher metformin doses, longer treatment duration and in patients with risk factors for B12 deficiency, including the following: Existing low B12 levels

Individuals with certain health conditions, such as Lebers disease (a hereditary eye disease), should avoid B12 injections, as they can exacerbate symptoms

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Kamemura, K

Eur Arch Otorhinolaryngol 282 , 37573769 (2025)

Degradation is gradual