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The study also reported inconsistent potency among the compounded tirzepatide samples, with some containing as little as 43 percent of the drug amount listed on the label

Additional risk factors include: Chronic kidney disease : Reduced renal clearance may impair B12 excretion Liver disease : Hepatic dysfunction can disrupt B12 metabolism and storage Myeloproliferative disorders : Certain blood cancers increase B12-binding proteins Concurrent medication use : Some drugs may interact with B12 metabolism, including metformin, proton pump inhibitors, and H2 antagonists Patients with these conditions should have B12 supplementation carefully monitored by their healthcare team

As you can see, the choice boils down to free, needs-based treatment versus paying for immediate access