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Healthcare professionals are advised to check serum-vitamin B 12 levels if deficiency is suspected and consider periodic monitoring in patients with risk factors for deficiency. Patients and their carers should be counselled on the signs and symptoms of vitamin B 12 deficiency and advised to seek medical advice if these occur. Manufacturer advises caution in chronic stable heart failure monitor cardiac function, and concomitant use of drugs that can acutely impair renal function; interrupt treatment if dehydration occurs, and avoid in conditions that can acutely worsen renal function, or cause tissue hypoxia. See also Prescribing in the elderly. Abdominal pain; appetite decreased; diarrhoea; gastrointestinal disorder; nausea; taste altered; vitamin B12 deficiency; vomiting.

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