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Elderly patients on long-term PPIs should have their B12 status monitored periodically and may require injectable B12 if deficiency develops

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Slowing the ramp to the label cadence (2.5 mg start, 2.5 mg steps, four-week holds) dropped that to mid-single digits at every maintenance dose, at no cost to the 12-week result, and the dedicated slow-titration trial reached placebo range. Reaching 15 mg is not the problem