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These include: Pre-existing constipation or slow transit constipation Inadequate dietary fibre intake Insufficient fluid consumption Reduced physical activity levels Concurrent medications with constipating effects (such as opioids, certain antidepressants, or iron supplements) Older age , where baseline colonic motility may already be reduced The severity of constipation often correlates with the dose of medication and may be more pronounced during dose escalation phases

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Reduced secretion of gastric acid and pepsin, from the use of H 2 blocker or proton-pump inhibitor (PPI) drugs, can reduce the absorption of protein-bound (dietary) vitamin B 12 , although not of supplemental vitamin B 12

a 5 mg vial in 2.5 mL yields exactly 2,000 mcg per mL, and knowing this calculation before handling product is non-negotiable