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Severe or prolonged B12 deficiency can lead to a range of neurological manifestations, including peripheral neuropathy, which may present as pain, paraesthesia (pins and needles), or altered sensation in the extremities

J Neurosci 27:65526562

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Patients should not discontinue tirzepatide without medical guidance, except in cases of suspected severe allergic reactions or pancreatitis, where holding the medication pending urgent evaluation is appropriate