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The most accepted mechanism of the effect of metformin on vitamin B 12 level is related to the absorption process where metformin antagonism of the calcium cation and interference with the calcium-dependent IF-vitamin B 12 complex binding to the ileal cubilin receptor

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Nevertheless, various studies reported that an extensive pre-purification (Toll et al., 2006) or specific solid-phase extraction (Goumenou et al., 2025) yielded a mass spectrum of the intact subunit

observed that the association of vitamin B 12 deficiency along with the concomitant use of metformin and proton pump inhibitors was significantly greater than those on monotherapy