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Renal Impairment SYNJARDY or SYNJARDY XR should not be initiated in patients with an eGFR less than 45 mL/min/1.73 m due to the metformin HCl component and is contraindicated in patients with severe renal impairment (eGFR less than 30 mL/min/1.73 m)

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For example, Raasch et al

People deficient in vitamin B12 may only experience some of these symptoms or a few in combination