injection vitamin b12 cyanocobalamin up to 1000 mcg (B12) mcg/mL, Multiple Dose Vial 1 mL, 25/Tray Injections may sting Cyanocobalamin 1000mcg/ml Inj, 10ml |

Schroder TH, Sinclair G, Mattman A, Jung B, Barr SI, Vallance HD, et al

Concomitant use with coumarin anticoagulants such as warfarin has been associated with elevations in the international normalized ratio, requiring closer INR surveillance and potential dose adjustment

Seek urgent medical attention (via NHS 111 or 999 in an emergency) if you experience severe or persistent abdominal pain, persistent vomiting, signs of dehydration (such as dizziness, reduced urination, or extreme thirst), or symptoms suggestive of low blood sugar (such as shakiness, sweating, or confusion)

Peptide therapy is generally well-tolerated, with minimal side effects

While many people get enough vitamin B12 from their diet, others may not absorb it efficiently or consume too little

It is likely that many patients will require intramuscular B12 replacement for the duration of their metformin treatment, although a trial of oral replacement initially may be worthwhile.