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Increase tirzepatide to therapeutic dose (12.515mg weekly), ensure 5-amino-1MQ is dosed consistently at 100mg daily, and implement structured dietary intake with adequate protein (1.62.2g/kg) to support the catabolic shift both compounds induce

We do not know whether the buccal absorption of methylcobalamin from an ODT is sufficient to fully compensate for the B12 absorption impairment caused by semaglutide

Vitamin B12 There is four types of parenteral Vitamin B12 available: Cyanocobalamin 100 mcg/ml and 1000 mcg/ml best used as IM to prevent rapid loss via kidneys Hydroxycobalamin IM (compounded 1000 mcg/ml or more) known as long acting B12 (binds better to plasma proteins than cyanocobalamin) Methylcobalamin IV (compounded 1000 mcg or more up to 5000 mcg/ml) Adenosylcobalamin IV Common dose is 1000 mcg IM or IV Vitamin B12 as hydroxycobalamin is synthesized exclusively by microorganisms and is found in the liver of animals bound to protein as methylcobalamin = metabolically active form of Vitamin B12 Hydroxycobalamin is a chelator of cyanide and is used in cyanide poisoning Hydroxocobalamin is most generally used for vitamin B12 replacement therapy and is considered the drug of choice for vitamin B12 deficiency by the Martindale Extra Pharmacopoeia (Sweetman, 2002) and the World Health Organization (WHO) Model List of Essential Drugs

Addressing the problem while tissue retains regenerative capacity offers better outcomes than waiting until degeneration becomes established