Avoid alcohol and anti-inflammatory medications (aspirin, ibuprofen) to reduce the risk of bruising only if safe for you to stop
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The combination is most useful for patients with one or more of the following: BMI of 30 or higher , or BMI 27 with at least one weight-related condition such as type 2 diabetes, hypertension, or sleep apnea History of fatigue, low mood, or brain fog on previous diets or weight loss attempts Metformin use for type 2 diabetes or pre-diabetes (chronic metformin reduces B12) Long-term proton pump inhibitor use such as omeprazole, pantoprazole, or lansoprazole Vegetarian or vegan diet with limited animal protein intake Adults over 50 , where B12 absorption naturally declines Active strength training or higher physical demands while on a calorie deficit Patients who dont fit any of these profiles can still take semaglutide alone, then add B12 if symptoms suggest it
You should also avoid excessive heat, sun exposure, and exercise for the first 24-48 hours post-treatment
184 A UK community practice study reported that only 36% of patients using metformin had their vitamin B12 levels checked and had this assessment added to the yearly recall, despite the test being relatively inexpensive and adding little extra burden on patient or appointment availability
