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The physiology of vitamin B-12 is a multistep process that is characterized by multiple trafficking events, associations and dissociations among several binding/carrier proteins, specific and multiligand receptor-mediated endocytosis, intracellular trafficking into different cellular compartments, and protein-specific controlled exit (1, 2)

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[13] Chloramphenicol has been shown to blunt reticulocyte response to cyanocobalamin, while ethanol, colchicine, and nitrous oxide interfere with cobalamin metabolism or utilization, each warranting clinician awareness when evaluating suboptimal treatment outcomes