Any stomach disorders, or conditions like pernicious anemia where Intrinsic Factor is lacking, can prevent B12 absorption, as can intestinal inflammation such as Crohns disease if a damaged terminal ileum cannot take up vitamin B12
Good long-term plans also include patient education on sticking to the treatment and possibly needing it for life
Vitamin B12 injections are considered very safe, but this precaution must still be followed and without exception
Symptoms of vitamin B12 deficiency can vary widely and may include fatigue, weakness, pale skin, shortness of breath, neurological symptoms such as numbness or tingling in the hands and feet, difficulty walking, memory loss, and mood changes
P to GSL : Appropriate when the medicine can be sold with reasonable safety outside of a pharmacy environment, meaning the hazard to health, risk of misuse, or need for special precautions is small, and wider sale is a convenience