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[5] Avoid B12 shots if: You have kidney or liver disease

simply take the next regular dose to avoid discomfort caused by overdosage

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Potential Hormonal Effect Gynecomastia Unlike the transient effects above, breast tissue development may be permanent if excessive tissue growth occurs

Warnings and Precautions 5.1 Risk of Thyroid C-Cell Tumors In both sexes of rats, tirzepatide caused a dose-dependent and treatment-duration-dependent increase in the incidence of thyroid C-cell tumors (adenomas and carcinomas) in a 2-year study at clinically relevant plasma exposures [see Nonclinical Toxicology (13.1)]