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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

The volume is then made up to 20ml using distilled water

10.1002/hep.29257 224 ZhangX.-J.JiY.-X.ChengX.ChengY.YangH.WangJ.et al (2021a)