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Deficiency can also cause increased muscle aches and pain, mood swings, and can negatively affect memory

(More information) The long-term use of certain medications, such as inhibitors of stomach acid secretion and the anti-diabetes drug, metformin, can adversely affect vitamin B 12 absorption

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In cases of suspected cobalt hypersensitivity, an intradermal test dose should be administered

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Elderly patients tend to have a greater frequency of decreased hepatic, renal, or cardiac function, and also have concomitant disease or receiving other drug therapy