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While generally well-tolerated, some patients may experience nausea, vomiting, constipation, diarrhea, or headache

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Studies indicate that long-term metformin use can reduce serum B12 blood test levels by up to 20%, necessitating regular monitoring and preventive B12 supplementation protocols

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Pregnancy and breastfeeding are also contraindicated due to a lack of safety data for systemic use in these populations