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Some users choose to take additional B12 sublingually rather than relying solely on the injected form in their tirzepatide

Food-cobalamin (vitamin B 12 ) malabsorption, first described by Carmel in 1995,30 is the most common cause of vitamin B 12 deficiency in the elderly and accounts for about 40% to 70% of cases.26 29 31 It is characterised by the inability to release vitamin B 12 from food or from its binding protein and thus, preventing vitamin B 12 from being taken up by intrinsic factor for absorption

Lithium NSAIDs have produced an elevation of plasma lithium levels and a reduction in renal lithium clearance

You will need to boost your B12 supply to address this situation