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Pernicious anemia occurs more commonly in people who already have diseases that are linked to immune-system abnormalities, such as Graves disease, hypothyroidism (under-functioning thyroid gland), thyroiditis (inflammation of the thyroid), vitiligo, and Addison's disease (adrenocortical insufficiency)

MHRA-approved options include orlistat (prescription and over the counter), semaglutide (Wegovy, supported by NICE TA875), and liraglutide (Saxenda, supported by NICE TA664)

they might slow down future injections or ensure you havent taken other vasodilators (like hot drinks or exercise immediately prior) that could amplify that effect

Then further maintenance doses every 4,6 or 12 weeks