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If you have pernicious anemia, any kind of digestive condition, or you've had gastric surgery, your gut may not absorb B12 the way it should

The shelf life varies by specific product, and all medications should be used before the expiration date printed on the packaging when stored according to the manufacturer's instructions: Semaglutide (Ozempic, Wegovy) : Unopened pens may be stored in the refrigerator until the expiration date on the label Dulaglutide (Trulicity) : Remains stable when refrigerated until the printed expiration date Liraglutide (Victoza, Saxenda) : Maintains potency when refrigerated continuously until expiration Tirzepatide (Mounjaro, Zepbound) : Stable under refrigeration until the manufacturer's expiration date Exenatide (Byetta, Bydureon BCise) : Requires refrigeration and remains effective until expiration when stored properly It is important to note that permitted room-temperature storage periods as specified in the prescribing information do not invalidate the expiration date

It also explains why B12 deficiency symptoms (like fatigue, brain fog, numbness, or mood changes) can take time to return once levels are restored

Even brief episodes can have lasting effects on mood, energy, and quality of life

doi: 10.1056/nejm197902153000726 142

Increased El Nio frequency in a climate model forced by future greenhouse warming