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Drug Interactions: Certain medications, like metformin and stomach acid reducers (PPIs), can interfere with B12 absorption from food, which may increase the need for injections

In these clinical cases, injections may be given three times a week for several weeks until symptoms begin to subside

doi: 10.1124/mol.64.6.1295

[150] 12 Commercial production [edit] Industrial production of vitamin B 12 is achieved through fermentation of selected microorganisms

Therefore, there is an incremental cost of $790,567 in the first year of converting patients to oral vitamin B12

That matters if you have trouble absorbing B12 from food or pills, which is more common than most people realize