Early signs include tingling or 'pins and needles' in the feet and hands, numbness in the extremities, burning pain (often worse at night), balance problems, and muscle weakness
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Several drugs, including para-aminosalicylic acid, have been reported to reduce the absorption of methylcobalamin, vitamin B12
Mechanism of action These medications cause decreased sympathetic outflow to the cardiovascular system by agonistic activity on central 2 receptors
This risk exists even in those using B12 for off-label purposes, as underlying undiagnosed B12 deficiency could be present