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According to the equation, when the denominator (plasma concentration) is very small relative to the numerator (total amount of drug in the body), the resulting Vd must be very large to maintain the mathematical relationship

Of course, its also possible that these medications could worsen depressive symptoms in people with obesity who already have severe depression

Timing of administration may influence interaction dynamics

Kidney Dysfunction: While the kidneys do not directly excrete vitamin B12 efficiently, impaired renal function may lead to elevated serum B12 levels by reducing the clearance of B12-binding proteins or altering their metabolism, thereby contributing to B12 accumulation 8

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