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The titration started at 0.25 mg of each compound and stepped up every 4 weeks

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Switching from retatrutide to tirzepatide This direction is simpler because you are removing a receptor pathway rather than adding one: Stop retatrutide and allow 1-2 weeks washout Start tirzepatide at 2.5 mg per standard protocol Escalate normally every 4 weeks Expect potentially faster tolerance since your GLP-1 and GIP receptors already have exposure history Some researchers report smoother GI tolerance when switching from a triple to a dual agonist, which makes pharmacological sense

The cyanocobalamin (B12) does not need to be refrigerated, however it is the least ideal form of B12