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This is why the NICE guidelines are very explicit: lifelong intramuscular vitamin B12 therapy

or who had received more than 30 Gy of thoracic radiation within the prior 26 weeks were ineligible [see Clinical Studies (14.1)]

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Watch for: Unusual injection site reactions (excessive redness, swelling, pain, or injection site reactions beyond normal ) Gastrointestinal symptoms that seem disproportionate to your dose ( unexpected diarrhea , severe nausea, headaches ) Signs of inadequate blood sugar control (for diabetes patients) Allergic-type reactions (hives, difficulty breathing, rapid heartbeat) Most people who use recently expired tirzepatide experience nothing more than slightly reduced effectiveness