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If you take B12 supplements and your level is high, thats almost always the explanation

The demand has given rise to a burgeoning gray market, where wellness spas, multilevel marketers and telehealth websites ply the public with vials of research grade peptides labeled not for human use. More people want to use them, said Lauren Colenso-Semple, a muscle physiology researcher and science communication specialist who follows scientific studies of peptides as part of her work

Gastrointestinal effects lead: nausea, diarrhea, constipation, and vomiting, dose-dependent and clustered during escalation, mostly mild. Tirzepatide also produces a modest chronic heart-rate rise with a larger escalation-phase peak. Oral-contraceptive absorption can fall after starting and after each increase, so use backup or non-oral contraception for 4 weeks each time. What is known about concurrent metformin and tirzepatide use

The agency would have to solicit public comment and an advisory committee of health and pharmacy experts would have to review the FDAs research