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You must seek immediate medical attention if you develop any signs or symptoms of skin infection, or other significant side effects.

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Inadequate secretion of intrinsic factor, resulting from lesions that destroy the gastric mucosa (which can be caused by ingestion of corrosives, extensive tumors, and conditions associated with gastric atrophy, such as multiple sclerosis, certain endocrine disorders, iron deficiency, and subtotal gastrectomy) Structural lesions leading to vitamin B 12 deficiency, including regional ileitis, ileal reactions, and malignancies Competition for vitamin B 12 by intestinal parasites or bacteria

Concurrent use of other nasally administered medications

Moreover, we conducted a pairwise meta-analysis using a random effect model to obtain direct estimates for outcomes