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Nausea (most common, typically dose-dependent and transient) Diarrhea or constipation during dose escalation Vomiting, especially when starting or increasing dose Reduced appetite and early satiety Injection site reactions (redness, bruising) Fatigue, particularly in early weeks Rare: Pancreatitis discontinue immediately with severe abdominal pain Rare: Thyroid C-cell effects (contraindicated with MEN2 or thyroid cancer history) Small-molecule NNMT inhibitor often discussed with metabolic protocols

Adequate vitamin B12 levels are crucial for producing healthy red blood cells

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Orphanet J Rare Dis

When deficiency is suspected based on clinical features (fatigue, paraesthesia, cognitive changes) or risk factors (vegan diet, gastric surgery, certain medications), serum B12 measurement guides appropriate intervention