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Solid neoplasms Myeloproliferative blood disorders Liver diseases Dementia Depression ADHD Schizophrenia Psychosis Refractory treatment of vitamin B12 deficiency, particularly with hydroxocobalamin and cyanocobalamin Chronic Viral Diseases Lyme disease Prolonged antibiotic treatment Parkinson's Disease Peripheral Neuropathy Paresthesia Pain and numbness in fingers or toes Fatigue Insomnia Dizziness Pain in joints Stomach complaints Difficulty focusing Mood changes Elevated homocysteine Elevated MMA Prolonged oral treatment with vitamin B12 in which serum B12 levels rise but there is no change in symptoms Elevated urinary oxalates or urolithiasis Pyroluria Lung cancer Short Bowel Syndrome All cause Mortality and Paradoxical B12 Deficiency Elevated B12 levels have been associated with higher mortality rates in the elderly (Salles etal, 2008

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After synthesis, glutathione is transported out of the cell and is degraded by GGT into glutamyl moiety (transferred to water or other compounds such as amino acids or peptides) and dipeptide cysteinyl-glycine which is further degraded by dipeptidase into free cysteine and glycine ( Figure 1 )

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A drug can be metabolized in the gut wall (eg, by the CYP3A4 enzyme system) or even in the portal blood, but most commonly it is the liver that is responsible for metabolism before the drug reaches the systemic circulation