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Immediate medical attention should be sought if adverse reactions occur

Dietary vitamin A equivalents like retinyl esters originating from animal-based products are being intestinally metabolized into retinol by triglyceride lipase or phospholipase B, associated into chylomicrons and secreted into the lymphatic system before reaching the systemic circulation and ultimately being delivered to the liver as the main storage for retinoids or to the side of action resulting in their binding to the retinol-binding protein receptor (RBPR), which enables oxidation of retinyl esters or retinol into ATRA upon entering the target cell

Psychiatry Res 229:447453

Most patients start during the dose escalation phase of tirzepatide (weeks 412) when oxidative stress from rapid fat loss is highest

Liver disease develops in stages starting with fatty liver then inflammation fibrosis and finally cirrhosis