Risk factors that should prompt consideration of B12 deficiency include advancing age (reduced stomach acid production), strict vegan or vegetarian diets, pernicious anaemia, gastrointestinal surgery (particularly gastric bypass or ileal resection), long-term use of certain medications (metformin, proton pump inhibitors, H2-receptor antagonists), nitrous oxide exposure (including recreational use), and conditions affecting the gut such as Crohn's disease or coeliac disease
Use in individuals under 18 is not recommended without specific medical supervision
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However, most of these are limited to bruising and bleeding at the injection site, headache, and dizziness
All handling must comply with applicable regulations.