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Routine B12 monitoring is not mandated for tirzepatide, but baseline and periodic testing should be considered for high-risk patients, including those over 65, on concurrent metformin, with gastrointestinal disorders, or experiencing symptoms such as fatigue, neuropathy, or cognitive changes

Seek Care When Needed Severe symptoms, chest pain, shortness of breath, fainting, allergic reactions, neurologic symptoms, or acute illness require medical care

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A B12 injection may be worth discussing if: You have absorption problems: Conditions like Crohn's disease, celiac disease, or atrophic gastritis can reduce how well your body absorbs B12 from food, and past gastric surgery can have a similar effect