Now they hurt
Abstract Many patients with pernicious anemia are treated with lifelong intramuscular (IM) vitamin B12 replacement
Source data are provided with this paper

Medical history and medication review to flag any interactions or contraindications before prescribing Goal-specific protocol selection based on injury location, duration, and severity rather than a one-size-fits-all 500 mcg recommendation Written reconstitution and injection instructions with the exact mL and unit markings for the patients specific vial and prescribed dose Injection training for self-administration patients, either in-clinic or via telehealth video walkthrough Week-four check-in to assess response, adjust dose or frequency if needed, and confirm the patient is completing the cycle correctly Pharmacy-grade 503A product with verified purity, sterility, and potency from an FDA-registered compounding pharmacy For patients who have never injected a peptide before, we also review the BPC-157 benefits and mechanism in detail before starting the protocol so the patient understands what the peptide does, what to expect during the cycle, and what results realistically look like at four, eight, and twelve weeks

Its mechanism of action is thought to involve anti-inflammatory pathways, promotion of endothelial cell function, and modulation of fibrosis
According to American Diabetes Association guidelines, this risk increases when tirzepatide is combined with insulin or sulfonylureas