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It is typically considered an elective treatment

Metformin interferes with vitamin B12 absorption in the terminal ileum, with approximately 10-30% of patients on long-term therapy developing biochemically low or low-normal B12 levels

Potential side effects are minimal in studies, but include mild gastrointestinal issues

Regular exercise further aids in reducing pain and inflammation

New Insights on Muscle Strength: The Role of Inhibiting an Enzyme that Hinders NAD+ Synthesis University of Texas Medical Branch researchers show that treating with an inhibitor of an enzyme that breaks down an NAD+ precursor enhances muscle strength and endurance and shortens recovery time in aged mice

Individual B12 injections typically range from $20-50 per shot at medical clinics, though prices vary widely