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Journal of Orthopaedic Research, 24(5), 1109-1117

The elimination of these drugs will thus depend primarily on the rate of drug delivery to the organ of elimination

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Di Maro, G., 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