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Food & Drug Administration, et al

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Talk to your doctor if you B12 supplements are safe for most adults, but medical guidance is important in these scenarios: You are pregnant or breastfeeding (confirm dose and form with your OB/GYN or midwife) You suspect a B12 deficiency or have symptoms like persistent fatigue, numbness, or cognitive changes (a blood test can confirm) You take metformin, proton pump inhibitors (PPIs), or H2 blockers, which may reduce B12 absorption You have a history of pernicious anemia or other autoimmune conditions affecting B12 absorption You are considering high-dose B12 (5,000 mcg+) for a specific clinical reason High-dose B12 supplementation can mask the lab signs of folate deficiency (specifically, it can normalize the blood cell abnormalities caused by low folate while leaving the neurological damage to progress)

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Lang CH, Nystrom GJ, Frost RA