why is tirzepatide dose higher than semaglutide vs. Tirzepatide: What's the Difference and Which Right for You?: Envizion Medical: Wellness Center Early Dose Escalation of Tirzepatide

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The following is a high-level overview - not a complete list of risks or precautions

However, lactate levels can increase up to 10 mM in inflammatory pathologies (for example, rheumatic synovial fluid) 48

Without adequate folic acid, hyperhomocysteinemia can occur which is linked to increases in miscarriage and neural tube defects in the fetus (Carrell 2015)