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For B12, prolonged use of metformin and acid-suppressing drugs (PPIs, H2 blockers) may reduce absorption of oral B12, which is one reason injectable B12 is considered in select patients

Without enough B12, oxygen delivery is impaired, leading to low energy levels and fatigue

'75mcg one day/ 100mcg the next', or '75mcg +12.5mcg daily' ) if the halves are not quite equal it doesn't matter, it will even itself out in the body , T4 had a long half life in the blood (about 7 days) (12.5mcg tablets are available , but not often prescribed as they are stupidly expensive compared to the other sizes, and they are only made by Teva which doesn't agree with some people) even finer adjustments can be done by eg: 6 days 50 mcg / 1 day 75mcg = 53mcg /day 5 days 50mcg / 2 days 75mcg = 57mcg /day 4 days 50mcg / 3 days 75mcg = 60mcg/ day See how your mum feels after 6-8 weeks on 75mcg , get retested at that point before deciding if any further adjustment is needed ~ 25mcg adjustment are often bigger than is needed , and symptoms can take at least 6 weeks to settle down on new dose

Monitor for any new side effects that emerge at the higher dose

Add supplementation only if levels decline below 400 pg per milliliter or symptoms suggest deficiency