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While there are no head-to-head trials specifically designed to compare tirzepatide plus metformin versus tirzepatide alone for weight loss, the available evidence suggests the combination is safe and effective, with metformin providing additional metabolic benefits without diminishing tirzepatide's weight loss effects

doi:10.1007/s40262-015-0338-3 194

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In addition, L-carnitine may help improve metabolic efficiency and reduce fat accumulation