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in this form it is essential for conversion of methylmalonate to succinate and synthesis of methionine from homocysteine (a reaction which also requires folate)

When the conversion of propionyl-CoA to succinyl-CoA in the mitochondria fails due to Vitamin B 12 deficiency, elevated blood levels of methylmalonic acid (MMA) occur

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(PubMed) 139

Frequently Asked Health Questions Who Should Avoid B12 Injections

Since tirzepatide may slow gastric emptying as part of its mechanism of action, patients with pre-existing severe gastroparesis could experience worsening of symptoms, including nausea, vomiting, and potential complications related to delayed gastric emptying