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This medication requires careful attention to the following safety warnings to ensure proper use and minimize potential risks. Please review these points thoroughly and consult with your healthcare provider if you have any questions or concerns.

• Allergic Reactions: There is a risk of allergic reactions to vitamin B12 (cyanocobalamin), which can be severe and life-threatening, such as facial swelling, shock, and anaphylaxis, indicated by symptoms like difficulty breathing, choking sensation, swelling around the eyes, lips, or tongue, dizziness, or nausea. Seek immediate medical attention if any of these symptoms occur.

• Leber’s Disease: Individuals with Leber's disease, a rare genetic eye condition, may experience significant eye damage when using vitamin B12 (cyanocobalamin). It is not recommended for patients with this condition, and they should discuss alternative supplements with their healthcare provider.

• Severe Pernicious Anemia: Patients with severe pernicious anemia should consult their healthcare provider regarding the suitability of oral vitamin B12 (cyanocobalamin) supplements. Treatment may lead to serious issues such as low potassium and high platelet levels. Regular monitoring through blood tests is necessary to check potassium and platelet levels. Symptoms like headache, confusion, shortness of breath, heart palpitations, muscle weakness, cramps, or unusual bleeding should be reported to a healthcare provider immediately.

• Folic Acid Deficiency: Vitamin B12 can mask anemia caused by low folic acid levels, potentially leading to undiagnosed folic acid deficiency. Healthcare providers should check folic acid levels before starting vitamin B12 (cyanocobalamin) to ensure comprehensive treatment of all nutrient deficiencies. Caution is advised when taking more than 10 mcg of vitamin B12 daily.

Please contact your healthcare provider if you have any concerns or need further clarification on these warnings.

Common side effects:

• Skin rash
• Itching
• Hives

Less common but important to monitor:

• Trouble breathing
• Swelling of the lips
• Swelling of the tongue
• Swelling of the face
• Vomiting

Serious side effects:

• Diarrhea
• Fatigue
• Headache
• Nausea

Vitamin B12 is essential for red blood cell formation, nerve function, and DNA production. However, certain medications and substances can interfere with its absorption or utilization, potentially leading to deficiency. It's important to be aware of these interactions to maintain adequate vitamin B12 levels.

Medications That May Reduce Vitamin B12 Absorption:

• Metformin: Commonly prescribed for type 2 diabetes, metformin can decrease vitamin B12 absorption in the gastrointestinal tract. Long-term use has been associated with reduced vitamin B12 levels, so monitoring is advisable.

• Proton Pump Inhibitors (PPIs): Drugs like Omeprazole and Lansoprazole, used to treat acid reflux and ulcers, reduce stomach acid production. This decrease can impair the release of vitamin B12 from food, leading to lower absorption.

• H2-Receptor Antagonists: Medications such as Cimetidine and Famotidine, also used for acid-related conditions, can similarly reduce stomach acid and hinder vitamin B12 absorption.

• Colchicine: Used to treat gout, colchicine may interfere with vitamin B12 absorption in the small intestine.

• Aminosalicylic Acid: Employed in treating digestive issues, this drug can reduce the body's ability to absorb vitamin B12.

• Chloramphenicol: An antibiotic that may interfere with the utilization of vitamin B12, potentially affecting red blood cell production.

Substances That May Affect Vitamin B12 Levels:

• Alcohol: Regular alcohol consumption can irritate the stomach lining and reduce stomach acid production, impairing vitamin B12 absorption.

• Vitamin C Supplements: High doses of vitamin C taken simultaneously with vitamin B12 can reduce the availability of vitamin B12 in the body. To avoid this interaction, it's recommended to take vitamin C at least two hours after a vitamin B12 supplement.

Recommendations:

If you're taking any of these medications or substances, consider the following steps:

• Consult Your Healthcare Provider: Discuss the potential for vitamin B12 deficiency and whether monitoring or supplementation is necessary.

• Regular Monitoring: Periodic blood tests can help detect vitamin B12 deficiency early, especially if you're on long-term medication that affects its absorption.

• Dietary Considerations: Ensure your diet includes adequate sources of vitamin B12, such as meat, fish, dairy products, and fortified cereals.

Being proactive about these interactions can help maintain optimal vitamin B12 levels and prevent associated health issues.