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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

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Here are some factors that can affect how quickly you notice results: Severity of Deficiency: Individuals with mild deficiencies may experience quick relief, but those with very low B12 levels might require several doses before a noticeable difference occurs

Everyones situation is different, but most people who have pernicious anemia take vitamin B12 supplements for the rest of their lives