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The MHRA Drug Safety Update (2022) and NICE guidance recommend testing B12 levels in patients on metformin who develop symptoms suggestive of deficiency (paraesthesia, glossitis, cognitive changes, or unexplained anaemia) and considering periodic monitoring in those on long-term therapy, particularly with risk factors for deficiency

Constipation affects many patients because tirzepatide slows gastric motility

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The procedure is entirely painless and involves very little discomfort or recovery