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A reasonable titration schedule might look like this: Week 1: 200mcg once daily Week 2: 300mcg once daily Week 3 onward: 300-500mcg based on response and tolerance Optimizing injection technique Poor injection technique contributes to injection site reactions and potentially to other effects like nausea from anxiety around the process

Pre-existing b12 deficiency or low-normal levels Anyone starting semaglutide with documented b12 deficiency or levels in the low-normal range (200 to 400 pg per milliliter) should receive supplementation

This means youll need to take oral supplements at different times

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Pharmacokinetics of high doses of cyanocobalamin administered intramuscularly