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Niacin can also have an antagonistic effect on gout medications: it elevates uric acid levels, which may counteract drugs like allopurinol or pegloticase that are meant to lower uric acid

Zinc is involved in other signaling pathways in addition to MAPK and NF-B pathways

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If normal, start 1000 mcg oral b12 daily as prevention given multiple risk factors (age, metformin, PPI, now semaglutide)

For context, when choosing between semaglutide and tirzepatide , the decision should ideally involve your medical history, current medications, and specific health goals