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Certain conditions may blunt or impede therapeutic response to cyanocobalamin therapy

In these groups of patients with risk factors who are taking metformin, especially over the long term, the new MHRA guidance suggests we should consider checking vitamin B12 levels as part of annual review bloods this is a significant change to current typical practice

Numerous studies have additionally examined the prevalence of a borderline vitamin B12 level, often defined within the range of 148 to 221 pmol/L (range, 200 to 300 pg/mL) [2-5,19,27]

doi: 10.1111/j.1471-4159.2007.04637.x

Understanding that purging is normal (and often a sign the treatment is working) helps users push through this uncomfortable phase rather than abandoning treatment prematurely