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Unused B12 is excreted and B12 has a low toxicity rating

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this leads to a malabsorption of the vitamin Certain medications use long term metformin use and chronic acid-reducing drugs decrease the absorption of vitamin B12 from food particles Malignancy of the pancreas or bowel Folic acid deficiency Semaglutide Semaglutide is contraindicated in patients with a history of angioedema, anaphylaxis, or other serious hypersensitivity reaction to semaglutide