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Intravesical Instillations Guideline Statement 17 DMSO, heparin, and/or lidocaine may be administered as intravesical treatments (listed in alphabetical order

The combination is most useful for patients with one or more of the following: BMI of 30 or higher , or BMI 27 with at least one weight-related condition such as type 2 diabetes, hypertension, or sleep apnea History of fatigue, low mood, or brain fog on previous diets or weight loss attempts Metformin use for type 2 diabetes or pre-diabetes (chronic metformin reduces B12) Long-term proton pump inhibitor use such as omeprazole, pantoprazole, or lansoprazole Vegetarian or vegan diet with limited animal protein intake Adults over 50 , where B12 absorption naturally declines Active strength training or higher physical demands while on a calorie deficit Patients who dont fit any of these profiles can still take semaglutide alone, then add B12 if symptoms suggest it

If you can grasp only 1 inch of skin, give the injection at a 45 degree angle

At Onus, a B12 Shot is $30