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2014 Aug 13

Metformin and acid-reducing drugs (e.g., omeprazole) can lower B12 absorption over time

One study found that high doses of oral B12 (1,000 mcg daily) could provide adequate absorption even in the presence of intrinsic factor deficiency

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Important things to consider for the rate of administration include: Watching the patients vital signs Changing the rate based on how the patient reacts Not giving it too fast to prevent bad reactions Emergency Protocols for Severe Deficiency For severe Vitamin B12 deficiency with neurological symptoms or severe anemia, emergency steps are needed