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First, conducting high-quality, rigorously designed controlled clinical trials are urgently needed to establish robust evidence for its efficacy and safety

18 Prevention Because of potential interactions from prolonged medication use, physicians should consider screening patients for vitamin B 12 deficiency if they have been taking proton pump inhibitors or H 2 blockers for more than 12 months, or metformin for more than four months

But in the case that this itching becomes chronic it can start affecting activities of daily living and start a wicked itch-scratch cycle

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