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This is the most common pattern in dermatology editorial guidance

The longer someone uses tirzepatide, the greater their risk of developing B12 insufficiency or outright deficiency

doi: 10.1002/14651858.CD008990.pub3 58 DoessingSHeinemeierKMHolmLMackeyALSchjerlingPRennieMet al

Similarly, the quinolinium containing parent analogue 1-MQ also lacked passive diffusion properties (Table 1), suggesting that the lipophilicity and drug-like permeability properties of analogues within the methylquinolinium series had to be improved via chemical modification

Some might need injections every two weeks to keep B12 levels right