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People with Certain Medications Long-term use of certain medications, like proton pump inhibitors, H2 receptor antagonists, or metformin, can interfere with B12 absorption

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CDC summarizes USP guidance: date an opened multi-dose vial at first puncture and discard it within 28 days unless the manufacturer states another opened-vial date. The dose count and 28-day window together require three vials for the 12-week protocol

This reaction is accelerated by heat and by acidic or basic pH extremes