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Long term prescription of medications such as the following are likely to increase the cause of, or exacerbate the risk of B12 deficiency - the proton pump inhibitors (esomeprazole, lansoprazole, omeprazole, pantoprazole, rabeprazole), famotidine, ranitidine, metformin, glibenclamide, gliclazide, glimepiride, glipizide, sodium valproate, gabapentin, doxycycline, some oral contraceptives

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Start with 0.5 percent and increase to 1 or 2 percent if tolerance is good and results warrant intensification

Patients with Leber's hereditary optic neuropathy should avoid cyanocobalamin (hydroxocobalamin is preferred in the UK)