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Bisubstrate inhibitors of nicotinamide N -methyltransferase (NNMT) with enhanced activity

The biggest difference is bioavailability , which is how much of the vitamin enters your bloodstream

Who should avoid this combination Individuals with a history of thyroid cancer or MEN 2 syndrome should not use tirzepatide, and therefore should not use this combination

Otherwise they require a Therapeutic Use Exemption

Nevertheless, use of metformin may decrease vitamin B 12 status: a meta-analysis of four short-term intervention trials (up to 4 months duration) in patients with type 2 diabetes found that metformin use decreased serum cobalamin concentrations by 57 pmol/L, which could have clinical implications if such patients have suboptimal vitamin B 12 status (146)

Metabolites 14 , 343 (2024)