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This should change when you bring your B12 levels to normal

Mechanism of Action Nitric Oxide Synthase Pathway : L-citrulline works by converting to arginine through the urea cycle via argininosuccinate synthase and argininosuccinate lyase enzymes, then interacting with nitric oxide synthase (NOS) enzymes to generate nitric oxide and support the relaxation of blood vessel smooth muscle

When Zepbound and Metformin are taken together, common side effects often involve the gastrointestinal system, such as nausea, vomiting, diarrhea, and constipation

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Food and Drug Administration (2025) Compounding when drugs are on FDAs drug shortages list, U.S