For example, people who maintain a vegetarian or vegan diet, people with absorption disorders, and those taking prescription meds like Metformin, Proton Pump Inhibitors (PPIs), and H2 blockers like Pepcid are often at greater risk
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[13] Chloramphenicol has been shown to blunt reticulocyte response to cyanocobalamin, while ethanol, colchicine, and nitrous oxide interfere with cobalamin metabolism or utilization, each warranting clinician awareness when evaluating suboptimal treatment outcomes