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Concurrently, PPIs, frequently prescribed to diabetic patients for gastroesophageal reflux disease management, impair protein-bound vitamin B12 release from dietary sources in the non-acidic gastric environment, with prolonged use ( 2 years) conferring a 65% increased risk of deficiency [159]

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Tricyclic antidepressants (TCAs) independently slow gastric emptying and should not be combined with tirzepatide without close medical supervision due to compounded nausea risk

The American Diabetes Association recommends starting GLP-1 medications at the lowest dose and titrating gradually to minimize side effects

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