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Routine monitoring discussions should occur if: You have been taking metformin for more than three years without recent B12 testing You are taking high-dose metformin (2g or more daily) You are aged 65 or older You follow a vegan or vegetarian diet You are taking acid-suppressing medications (such as omeprazole or ranitidine) You have other risk factors for B12 deficiency Patients should not commence B12 supplementation without medical advice, as inappropriate supplementation may mask underlying conditions such as pernicious anaemia or other causes of deficiency that require specific investigation and management

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You are taking prescription medications, especially chemotherapy drugs or medications that affect the immune system