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COMPOUNDED MEDICATION DISCLOSURE: Compounded medications, including compounded semaglutide and tirzepatide, are not FDA-approved drugs and have not been evaluated by the U.S
4,5 Dietary insufficiency, pernicious anemia (i.e., an autoimmune process that reduces available intrinsic factor and subsequent absorption of vitamin B 12 1,2,6,7 ), and long-term use of metformin or acid-suppressing medications have been implicated in B 12 deficiency
The proposed mechanism is indirect modulation of the NO pathway rather than direct receptor agonism, though the precise molecular binding event has not been definitively characterized in peer-reviewed work
One key difference: tirzepatide is a dual GIP/GLP-1 receptor agonist, while semaglutide targets only GLP-1
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