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At that point, potency is likely compromised regardless of refrigeration

Cisplatin was administered intravenously at a dose of 75 mg/m 2 approximately 30 minutes after pemetrexed administration on Day 1 of each cycle, gemcitabine was administered at a dose of 1,250 mg/m 2 on Day 1 and Day 8, and cisplatin was administered intravenously at a dose of 75 mg/m 2 approximately 30 minutes after administration of gemcitabine, on Day 1 of each 21-day cycle

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Despite this, chemotherapy (chemo), ionizing radiation, and viral infections also contribute to this disease [57]

Furthermore, many patients prescribed tirzepatide for type 2 diabetes are concurrently taking metformin, which independently increases the risk of vitamin B12 deficiency through impaired calcium-dependent B12-intrinsic factor uptake in the ileum