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Avoid use if you have a severe nasal infection or blockage

Heart palpitations Because estrogen helps keep blood vessels healthy and relaxed, the perimenopause-induced drop in estrogen levels may affect your cardiovascular system and your heartbeat

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Stomach acid changes, intestinal conditions, and autoimmune processes such as pernicious anemia can impair B12 uptake

Conclusions I welcome this clear advice from the MHRA, clarifying the frequency of vitamin B12 deficiency in patients taking metformin, especially those on higher doses and longer-term therapy