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- People with significant liver disease (the 9-month monkey toxicology study showed dose-dependent periportal vacuolation in hepatocytes that the FDA flagged as a possible safety signal)

Other factors include: Underlying cause of deficiency : Pernicious anaemia, malabsorption disorders, or dietary insufficiency may affect treatment response Medication use : Metformin and proton pump inhibitors can reduce gastrointestinal B12 absorption (though this does not affect the efficacy of intramuscular injections) Individual variation : Differences in how efficiently your body utilises the injected vitamin Adherence to treatment schedule : Missing injections or delaying maintenance doses can slow recovery Discussing these factors with your healthcare provider helps set realistic expectations for your treatment journey

It aids in the metabolism of fats and helps reduce blood cholesterol

Perspective The primary analytic perspective was that of the Ministry of Health and Long-Term Care