American Board of Family Medicine (ABFM) Practice Exam

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Which medication is known to cause vitamin B12 deficiency?

Aspirin
Simvastatin
Enalapril
Metformin

The correct answer is: Metformin

Metformin is a medication commonly used to manage type 2 diabetes, and its association with vitamin B12 deficiency is well-documented. The mechanism by which metformin can lead to decreased vitamin B12 levels is primarily related to its effects on the gastrointestinal tract. It has been shown to alter intestinal motility and may lead to bacterial overgrowth, which can interfere with B12 absorption. Additionally, metformin may affect the permeability of the intestinal mucosa to vitamin B12. Patients on metformin are advised to have their vitamin B12 levels monitored regularly, especially those on long-term therapy or those exhibiting symptoms of deficiency, such as neuropathy. Recognizing the risk of vitamin B12 deficiency in patients undergoing metformin therapy is crucial for early detection and management, ensuring that proper supplementation or dietary adjustments can be made to prevent complications associated with low B12 levels, such as anemia and neurological issues.