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Larger stones, and stones that fail to pass or cause especially severe pain or obstruction and infection may require more aggressive therapies such as antibiotics, lithotripsy (therapy utilizing ultrasound shock waves to break stones into smaller fragments), or surgery to remove stones (Antonelli 2015)

Conversely, lowering the dose may render the treatment ineffective

While neither tirzepatide nor niacinamide requires routine dose adjustment for hepatic impairment, patients with severe liver disease should be monitored closely if treatment is deemed necessary by the prescribing provider

Additionally, health conditions like anemia can be addressed with vitamin B12 injections

Nevertheless, its effectiveness remains limited by the intestinal mucosa's low permeability, which restricts drug absorption and overall bioavailability