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Even mild renal impairment (eGFR 6089) can elevate homocysteine

Tolerance Changes the Arithmetic Even setting safety aside, the durability case is weak

Common reasons include side effects (particularly nausea and vomiting), cost of ongoing private prescription, insufficient weight loss at tolerated doses, or switching to Mounjaro after learning about the SURMOUNT-5 trial results showing tirzepatides greater average efficacy

Agarwal S, Varghese RT, Savian R, Low Wang CC, Galindo RJ

Several other factors may also contribute to raised homocysteine and impaired methylation