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This subjective improvement could reflect placebo effect, improved overall nutritional status from paying more attention to diet, natural adaptation to the medication over time, or actual b12 repletion if deficiency existed

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4 48 In some countries, methyl- and adenosylcobalamin-containing preparations are available

Increases in resting heart rate are a recognised class effect of incretin-based therapies and have been reported with GLP-1 receptor agonists more broadly, as reflected in the Summary of Product Characteristics (SmPC) for licensed agents such as semaglutide (Wegovy) and liraglutide (Saxenda)