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Certain medications The following drugs can reduce levels of vitamin B12 in your body: Antibiotics -- long-term use can lower vitamin B levels generally Anti-seizure drugs Chemotherapy medicines, especially methotrexate Drugs used to reduce stomach acid, like H2 blockers (Pepcid AC, Tagamet, Zantac) and proton pump inhibitors (Nexium, Prevacid, Prilosec) Metformin (Glucophage) -- taken for diabetes Colchicine -- taken for gout Some cholesterol-lowering medications Other causes You're over 65

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Consistently low levels below 300 ng/dL, combined with symptoms, may indicate the need for TRT