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This is actually one of the more common causes of high vitamin B12 levels

Chi et al

Other factors include: Underlying cause of deficiency : Pernicious anaemia, malabsorption disorders, or dietary insufficiency may affect treatment response Medication use : Metformin and proton pump inhibitors can reduce gastrointestinal B12 absorption (though this does not affect the efficacy of intramuscular injections) Individual variation : Differences in how efficiently your body utilises the injected vitamin Adherence to treatment schedule : Missing injections or delaying maintenance doses can slow recovery Discussing these factors with your healthcare provider helps set realistic expectations for your treatment journey

Improvement was noted within one month after prescription of topical ZO Retamax (as indicated in the before and after photographs below)

Are B12 injections effective for people with fatigue caused by vitamin deficiencies