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Although high peripheral exposure may be required to obtain the fractional central exposure necessary to illicit a pharmacologic response, insufficient selectivity between MC1R and MC4R activity can lead to peripheral activation of MC1R (142, 143)

however, in cases such as in the metabolism of alcohol, the intermediates in xenobiotic metabolism can themselves be the cause of toxic effects

Bhagavathula AS, Vidyasagar K, Tesfaye W (2021) Efficacy and safety of tirzepatide in patients with type 2 diabetes mellitus: a systematic review and meta-analysis of randomized phase II/III trials

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