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While routine vitamin B12 monitoring is not specifically mandated in tirzepatide prescribing information, clinical judgment should guide individualized screening strategies based on patient risk factors and clinical presentation

Assay interference, sample handling and taking a supplement shortly before the blood draw can all distort a reading, and different laboratories use different methods and reference ranges

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The WHO pharmacological monograph on phentermine identifies this directly as a consequence of its peripheral alpha-agonist activity

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