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Lung Cancer 49 : 401412 de Jonge MJ, Punt CJ, Sparreboom A, Planting AS, Peters ME, van De Schraaf J, Jackman A, Smith R, de Mulder PH, Verweij J (2002) Phase I and pharmacologic study of oral ZD9331, a novel nonpolyglutamated thymidylate synthase inhibitor, in adult patients with solid tumors

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Methionine synthetase generates methylcobalamin, and the methyl group is then used to convert the amino acid homocysteine to the amino acid methionine

It is likely that many patients will require intramuscular B12 replacement for the duration of their metformin treatment, although a trial of oral replacement initially may be worthwhile.