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[36] Vitamin B 12 deficiency is most commonly caused by malabsorption, but can also result from low intake, immune gastritis, low presence of binding proteins, or use of certain medications

Since both drugs influence gastrointestinal function, starting with lower doses and gradual titration is generally advised

The review found no significant difference in outcomes, and in one case, oral B12 even outperformed injections in raising blood levels A more recent 2020 randomised controlled trial from Spain further supports this