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Long term prescription of medications such as the following are likely to increase the cause of, or exacerbate the risk of B12 deficiency - the proton pump inhibitors (esomeprazole, lansoprazole, omeprazole, pantoprazole, rabeprazole), famotidine, ranitidine, metformin, glibenclamide, gliclazide, glimepiride, glipizide, sodium valproate, gabapentin, doxycycline, some oral contraceptives

[21] [22] This condition impairs B12 absorption in the terminal ileum and typically requires lifelong parenteral replacement therapy

This risk may be compounded by the unregulated manufacturing and distribution of peptides in the gray market, where purity and sterility cannot be assured. Long-Term Effects Finally, the long-term effects of many peptides remain poorly understood