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So, we recommend using SL vitamin B12 rather than oral and IM, especially in patients who do not tolerate IM injection and patients who need prolonged vitamin B12 supplementation, such as patients with long-term metformin use and patients with pernicious anemia or with gastro-duodenal resection [51,52,53,54]

Recommended supplements and electrolyte support round out the nutritional picture

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(3) non-human studies

Elderly patients may be more sensitive to the medications effects and may require slower titration or lower maintenance doses, particularly if they have reduced renal function or are at higher risk for dehydration from gastrointestinal adverse effects

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