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45 A longer-term placebo-controlled study found that vitamin B12 deficiency absolute risk was 11.2% greater in the group treated with metformin and the number needed to harm was 8.9 per 4.3 years

Patients with a vegetarian diet that includes no animal products may need regular oral vitamin B12, per the label

Nausea (41%), diarrhea (23%), vomiting (20%), and constipation (18%) are the most frequently reported

Oral forms may be considered for general wellness or digestive support, while topical forms may be discussed for localized skin or tissue concerns