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For dietary B12 deficiency without malabsorption, oral cyanocobalamin may be an appropriate alternative to injections

Another significant metformin side effect: vitamin B12 deficiency

Brief exposure during transport (up to 2 hours unrefrigerated) is generally acceptable, but repeated temperature cycling degrades stability and should be avoided

Additionally, there is a dose-dependent decrease in prostaglandin synthesis, which can cause renal blood flow reduction in patients that utilize prostaglandins to support renal blood flow

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