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The aging process affects the stomachs ability to produce intrinsic factor, a protein necessary for B12 absorption, explains why older adults need regular shots

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A vitamin B12 deficiency in humans can also cause anemia, neurological problems, and even developmental delays in children

About 10% of tirzepatide participants had a heart-rate increase above 20 bpm during escalation, compared with 3% on placebo. A lean Japanese cohort reached +10 to +13 bpm, and 23% of Japanese participants at 15 mg crossed the abnormal-pulse threshold versus 7% of other participants, despite only 17% higher exposure. Lean and East Asian bodies showed greater cardiovascular sensitivity than exposure alone predicted

But for most purposes (like weekly maintenance injections), IM is the preferred route at home because its simpler (the vitamins absorb quickly from muscle into the bloodstream over a few hours)