Contact your GP if you experience: Unexpected symptoms after starting B12 supplementation, including persistent skin reactions, gastrointestinal disturbance, or mild allergic manifestations Neurological symptoms such as significant tingling, numbness, weakness, or balance problemsthese may indicate B12 deficiency paradoxically, or alternative neurological conditions requiring assessment Unexplained fatigue or malaise that develops or worsens despite supplementation Concerns about medication interactions , particularly if taking metformin, proton pump inhibitors, or other medications affecting B12 metabolism [2] [4] Seek emergency medical attention (call 999) if you develop signs of a severe allergic reaction following B12 injection, including facial swelling, difficulty breathing, or widespread urticaria

Box 1: Practical consultation tips for administration of rectal formulations Example advice given to patients for administration of suppositories: You might find it easier to use a suppository before bed to minimise any leakage
While age was associated with clinical symptoms, there was very little association between MMA levels and other biochemical parameters or clinical symptoms, including neurological symptoms
Most protocols are prescribed as subcutaneous injections you can do at home (we teach you exactly how), following a schedule customized by your provider