VITAMIN B12 DEFICIENCY DUE TO METFORMIN

Vitamin B12 deficiency due to metformin is a less common, but potentially severe complication that is often overlooked. Patients at risk for vitamin B12 deficiency include those taking more than 1,000 mg daily of metformin for three years or longer. Patients receiving metformin therapy should be monitored for signs and symptoms of vitamin B12 deficiency such as megaloblastic anemia or peripheral neuropathies.

Also, advise patients on metformin to take a multivitamin with B12 and encourage them to get their recommended daily amount of calcium, although there's no proof this will prevent B12 deficiency.
While neuropathy can be related to hyperglycemia, vitamin B12 deficiency should be ruled out as a cause, especially in those patients with diabetes who are taking metformin.

In patients with vitamin B12 deficiency, supplemental oral vitamin B12 should be administered. Calcium supplementation to assure that the recommended daily allowance is being met can also be considered

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