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Ahmet E, et al

To minimise these effects, take metformin with or immediately after meals, and consider extended-release formulations if standard metformin causes significant digestive upset

Loss of presenilin function causes impairments of memory and synaptic plasticity followed by age-dependent neurodegeneration

You should also contact your GP if: You are unable to attend scheduled maintenance injections, as missing doses can lead to symptom recurrence You develop new symptoms that might indicate other deficiencies or health problems You are planning pregnancy, as B12 requirements may change You experience persistent side effects such as headaches, dizziness, or gastrointestinal symptoms If you experience any side effects, talk to your doctor, pharmacist or nurse