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Individuals on certain medications : Medications like proton pump inhibitors, metformin, or H2 receptor antagonists can interfere with B vitamin absorption

Split dosing may help if: single morning dose produces effects that fade by afternoon, you are using higher doses (450-500mcg) where sustained levels may help, or evening administration fits your schedule better than early morning

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Understanding Risks and Contraindications in B-12 Injection Therapy Informed consent depends on clear, honest communication about what can go wrong