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While eating too much fiber can lead to constipation in rare cases, that's much less of an issue than getting too little, says Saidman

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Combination with Metformin or Metformin with SGLT-2 Inhibitors In a 26-week, double-blind, double-dummy trial (Trial 4, NCT02863419), 711 adult patients with type 2 diabetes mellitus on metformin alone or metformin with SGLT-2 inhibitors were randomized to semaglutide tablets 14 mg orally once daily, liraglutide 1.8 mg subcutaneous injection once daily or placebo

While this interaction primarily affects dietary B12 absorption rather than injected cyanocobalamin, patients on long-term acid suppression therapy may have depleted B12 stores that require consideration when initiating treatment