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These include some heartburn medicines, including esomeprazole (Nexium), famotidine (Pepcid AC), lansoprazole (Prevacid), omeprazole (Prilosec OTC), pantoprazole (Protonix), rabeprazole (Aciphex), as well as some diabetes, gout, and chemotherapy drugs

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It's just one of the causes of B12 deficiency

After starting and after each dose increase, tirzepatide can cut the peak absorption of an oral contraceptive by more than half, so the label guidance is a non-oral method or added barrier protection for four weeks after starting and four weeks after each increase. It is a first-dose-and-escalation effect, not a permanent block on all oral drugs

It is also important to remember that not every tired or low-energy feeling is caused by B12