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First you will see a report from 1971 that in a study on excessive prescribing, B12 treatment was singled out, possibly due to the idea that GPs were giving patients B12 injections, willy nilly as a tonic

Each fat-soluble vitamin has a threshold at which it can become toxic to the body

Since nitrous oxide is commonly used for surgery in the elderly, some experts feel vitamin B 12 deficiency should be ruled out prior to its use or prophylactic vitamin B 12 supplementation implemented before and after exposure to the gas (7, 18)

Further considerations include: Dehydration risk : Combined effects of diarrhoea (from both Crohn's and medication) may increase dehydration risk Medication absorption : While generally minimal, delayed gastric emptying could affect absorption of oral medications with a narrow therapeutic index Monitoring requirements : Regular assessment of disease activity markers, nutritional status, and weight trends is essential Patients should be counselled about these risks and encouraged to report any worsening gastrointestinal symptoms promptly to the MHRA Yellow Card scheme (yellowcard.mhra.gov.uk), as distinguishing between expected side effects and disease progression requires clinical expertise