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An in vitro study using GnRH neurons of adult male mice demonstrated that both GLP-1 and Ex4 might excite GnRH neurons, either directly or indirectly by modulating the nitric oxide (NO) and endocannabinoid pathways that control the presynaptic excitatory GABA-ergic inputs to GnRH neurons [36]

Dosing every 23 weeks is appropriate only during maintenance phases after initial weight loss has plateaued

However, adverse effects included fatigue, insomnia, and small increases in fasting glucose and insulin resistance

Pernicious anemia is associated with an increased incidence of carcinoma of the stomach, but this is believed to be related to the underlying pathology and not to treatment with vitamin B 12