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Instead of asking 'why not stack them,' the question becomes 'what specific outcome justifies adding a second compound with incomplete human safety data?' For research exploring maximal metabolic intervention where single-agent tirzepatide has plateaued, the stack may be defensible

Neurosci Biobehav Rev 103:305315 Suzuki K, Miyamoto M, Miyamoto T, Uchiyama T, Watanabe Y, Suzuki S, Kadowaki T, Fujita H, Matsubara T, Sakuramoto H, Hirata K (2017) Istradefylline improves daytime sleepiness in patients with Parkinsons disease: an open-label, 3-month study

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The compounds in the class The growth hormone peptides fall into two functional categories defined by which receptor they act on, plus one mechanistically distinct outlier

As a result, homocysteine levels dropped (66)