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Routine testing of vitamin B12 levels in metformin-treated patients should be considered. Because metformin often causes digestive tract upset, many patients are also put on a proton pump inhibitor (PPIs) such as esomeprazole ( Nexium ), lansoprazole ( Prevacid ) or omeprazole ( Prilosec )

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Loss of appetite Congestion with open mouth breathing High fever (or the extreme listlessness that implies a high fever if you cannot take the cats temperature)

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