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Areas Without Adequate Human Evidence Cardiovascular safety Neurological and psychiatric effects Liver and kidney safety Effects on blood glucose in humans Effects on methylation pathways Genotoxicity Carcinogenicity Reproductive and developmental toxicity Use during pregnancy or breastfeeding Interactions with prescription medicines Interactions with supplements or research compounds Long-term exposure Product-Quality Risks Incorrect quinolinium compound Wrong substitution position Incorrect counterion Incorrect active-content calculation Residual starting materials Residual solvents Degradation products Heavy-metal or inorganic contamination Mismatched certificate of analysis Uncontrolled storage and transport Absence of published harm is not proof of safety A compound without routine regulated human exposure may generate very few formal safety reports simply because there is no organised pharmacovigilance system

Tesofensine is generally contraindicated for patients with uncontrolled hypertension, a history of arrhythmias, or severe anxiety disorders

*Correspondence: Shuang Chen, [email protected]

Because these conditions prevent adequate oral uptake, intramuscular injection bypasses the digestive system entirely and delivers B12 directly into muscle tissue for reliable absorption