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When we don't get enough vitamin B12, it can: Reduce ATP production, potentially contributing to mitochondrial dysfunction and insulin resistance Cause megaloblastic anemia, characterized by abnormally large, hemoglobin-poor red blood cells that die prematurely

Alcohol: Both fluoxetine and alcohol affect the central nervous system, causing sedation

For systemic effects, the abdomen is standard

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Tell your healthcare provider right away if you have nausea, vomiting, or diarrhea that does not go away severe stomach problems