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Vitamin B12 interactions [Moderate interactions, but CRITICAL] Important notes: - Regarding the first interaction (metformin and vitamin B12), here is the reference & the exact text that mentioned the using of calcium supplements: #Katzungs #basic_and_clinical_pharmacology, 16th edition, chapter 41 pancreatic hormones & glucose-lowering drugs, page 798: metformin interferes with calcium-dependent absorption of vitamin B12-intrinsic factor complex in the terminal ileum, and vitamin B12 deficiency can occur after many years of metformin use

NAD + serves as a cofactor for enzymes such as PARPs (poly ADP-ribose polymerases) and sirtuins, which regulate DNA repair and antioxidant responses

Therefore, emergency department health practitioners need to be careful and should keep the patient under 24-h observation to avoid rebound risk