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The decrease in MMP can lead to the opening of pores thus increasing mitochondrial membrane permeability (121), and a large amount of H+ pumped into the mitochondrial matrix causes a disruption of proton concentration on both sides of the mitochondrial membrane to inhibit ATP synthesis and accelerate ATP hydrolysis

Brunelli, M

Direct pharmacologic damage to muscle tissue is unlikely because tirzepatide acts on metabolic receptors rather than on muscle cells, and injection-site reactions are usually local rather than generalized

And the line between pink and red matters more than most people realize