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Many people with B12 deficiency or pernicious anemia naturally lack sufficient detoxifying methyl donors, and have trouble clearing out the cyanide

The BSH couldnt advocate patients being instructed on self-injection during the pandemic as it would involve medical professionals and patients risking cross infection of the virus, though this is something that can be considered once the pandemic is over

Tirzepatide is sold as Zepbound for chronic weight management and as Mounjaro for type 2 diabetes, working as a dual GLP-1/GIP receptor agonist that targets both the GLP-1 and GIP receptors instead of GLP-1 alone, which enhances fat metabolism and insulin sensitivity beyond a single-receptor peptide

The pharmacological form of B12 may also be relevant

If in doubt, one should consult the pharmacy or manufacturer for guidance or replace the vial with a fresh supply

You take metformin or a proton pump inhibitor, which can deplete B12 over time