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If nausea persists, trying pre-bed dosing is an option, though this may slightly reduce efficacy by separating the peptide from morning cortisol elevation

Medical conditions associated with elevated B12: Liver disease: Hepatocellular damage (cirrhosis, hepatitis, hepatocellular carcinoma) releases stored B12 into circulation

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Metformin, though not a GLP-1 agonist, shares the property of reducing stomach acid and interfering with b12 absorption

Fatal hypokalemia may occur when severe megaloblastic anemia is treated intensively with vitamin B12, as a result of increased erythrocyte potassium requirements