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A more common cause of B12 deficiency, however, is a shortfall of stomach acid, which is more likely to occur among older people

Gastrointestinal effects usually settle across the first month, then return temporarily after each increase

Endothelial cell proliferation and angiogenic signalling (VEGFR2, eNOS pathways)

Because B12 is primarily found in animal products (meat, fish, dairy, eggs), people following vegetarian or vegan diets may be at higher risk of deficiency

- when there is risk of torsades de pointes, for example in patients with prolonged QT, concomitant administration of other medications that produce torsades de pointes (amiodarone, quinidine, bepridil, IV erythromycin, halofrantine, pentamidine, sparfloxacin, sultopride, vincamine, betrilio, disopyramide, sotalol, etc)

Then further maintenance doses every 4,6 or 12 weeks