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It can take a few years to develop a deficiency because your body can store B12 in your liver for a long time

Gynecological Endocrinology , 33(7), 558-562

This means that even if you do have a vitamin B12 deficiency, your body will likely be able to compensate for this at least from a methylation perspective via your dietary choices

Article Summary Lyophilized medications require reconstitution with bacteriostatic water before injection

You increase lisinopril to 20mg, add HCTZ 12.5mg, order BMP to check potassium and creatinine before starting the diuretic, and schedule a four-week follow-up to reassess