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In that case, injections are not appropriate

Lightheadedness has been reported occasionally, potentially related to the vasodilatory effects of some components

, VanDyck K., Holman B., Tang D., Chui B, and Spiess BD

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These include people who: Have taken metformin for several years Take higher daily doses Are over the age of 60 Follow vegetarian or vegan diets Have gastrointestinal disorders such as Crohns disease or celiac disease Have previously undergone stomach or intestinal surgery Take medications that also reduce vitamin B12 absorption, such as proton pump inhibitors (PPIs) The presence of multiple risk factors increases the likelihood that vitamin B12 stores will gradually decline over time