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This is exactly what can lead to Ozempic muscle loss

Epidemiological survey on the relationship between different iodine intakes and the prevalence of hyperthyroidism

Mouth sores, if they occur, may be multifactorial and warrant clinical assessment to exclude other causes such as viral infections, nutritional deficiencies (particularly vitamin B12, which can also be associated with metformin use in type 2 diabetes, folate, or iron), or autoimmune conditions

Spironolactone does not reach the threshold of a "strong" dual inhibitor, so no mandatory dose adjustment exists in labeling, but the pharmacokinetic signal is real and accumulates with renal dysfunction