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Gastrointestinal effects lead: nausea, diarrhea, constipation, and vomiting, dose-dependent and clustered during escalation, mostly mild.⁸ Tirzepatide also produces a modest chronic heart-rate rise with a larger escalation-phase peak.¹¹ Oral-contraceptive absorption can fall after starting and after each increase, so use backup or non-oral contraception for 4 weeks each time.⁹ ²² What is known about concurrent metformin and tirzepatide use

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To say that Vitamin B12 deficiency is the sole reason behind the white spots on the skin is incorrect