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BioPsychoSocial Med 19(1):1, 2025

coeliac) Infections & surgical interventions Pregnancy & neonates Pharmaceutical interactions Nitrous oxide abuse Age greater than 65 years Signs and symptoms of B12 deficiency Anaemia (weakness, tiredness, dyspnoea on exertion) Gastrointestinal (loss of appetite, sore tongue and mouth, epigastric discomfort, nausea, vomiting, heartburn) Neurological (numbness, pins and needles, impaired fine finger movements) Developmental delay in infants Positive Rombergs sign Impaired vibration or position sense, impaired vision Orthostatic dizziness Loss of taste or smell Psychological & psychiatric disturbance When to test for B12 deficiency If a patient has at least 1 risk factor and 1 or more signs, then B12 assessment is warranted

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However, tirzepatides package insert, for example, warns that use of this medication may reduce the efficacy of hormonal contraceptives and advocates for non-oral contraceptive methods