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Patients should be reviewed 812 weeks after commencing treatment to assess: Symptomatic improvement, particularly resolution of fatigue and neurological symptoms Haematological response (normalisation of haemoglobin and mean cell volume) Reticulocyte count typically rises within one week, indicating bone marrow response Repeat serum B12 testing is generally not useful after starting parenteral therapy, as levels remain elevated for months

Therefore, glycine injection should be avoided or used with great caution in those with advanced liver disease or disorders of ammonia metabolism

The coding landscape for tirzepatide has shifted considerably since the FDA approved Zepbound for chronic weight management alongside Mounjaro for type 2 diabetes

Evidence Boundary Most studied route in the Phase 2 program, but the OPTIONS trial missed its primary weight-loss endpoint and development was terminated in 2007