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These patients typically have low levels of folate in both plasma and CSF, and they may exhibit abnormally high urinary metformin glutamate excretion [115]

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Step 5: Monitor and adjust Document baseline condition before starting

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In clinical trials: Semaglutide: Approximately 7% discontinued due to adverse events Tirzepatide: Approximately 4-7% discontinued due to adverse events (dose dependent) Retatrutide: Approximately 6-10% discontinued due to adverse events (dose dependent) These rates are relatively close, suggesting that despite the differences in mechanism and side effect profiles, all three medications are tolerable for the vast majority of people who start them