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Patients on Certain Medications Metformin, proton pump inhibitors, and H2 blockers can reduce B12 absorption over time

Other causes include severe illness, sepsis, retained placenta, trauma, excessive weight-bearing on one limb, certain medications, black walnut exposure, pregnancy-related insulin resistance, and some forms of toxicity

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Women of childbearing potential should use effective contraception, and semaglutide should be stopped at least 2 months before a planned pregnancy