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However, B12 shots can lead to side effects including: - Headache - Dizziness - Diarrhea - Skin rash and itching - Nausea and vomiting - Fatigue - Swelling and tingling sensation Additionally, excess vitamin B12 can also result in rare but severe allergic reactions also known as anaphylaxis

Therapy with bovine pancreatic enzyme extracts is not sufficient to restore cobalamin absorption in dogs with EPI, as intrinsic factor appears to be species-specific

If oral B12 replacement has been trialled in a person with metformin-associated B12 deficiency, I would suggest that a repeat measurement of B12 levels after 812 weeks is a good time to reassess whether absorption is adequate or whether a switch to intramuscular replacement is required

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