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There is no official contraindication to using tirzepatide and sermorelin concurrently, but there is also limited clinical evidence specifically evaluating this combination

R Amino acid conjugation: The two-step reaction involves: (1) mitochondrial medium-chain acyl-CoA ligase (HXM-A and HXM-B) activating the carboxylic acid substrate with CoA in an ATP-dependent reaction to form an acyl-CoA thioester, and (2) GLYAT (glycine N-acyltransferase) transferring the acyl group from CoA to the alpha-amino group of glycine via a ping-pong mechanism

According to Mayo Clinic, a common side effect of methotrexate is an increased heartbeat

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doi: 10.1016/j.cgh.2019.07.045 3 Van CutsemESagaertXTopalBHaustermansKPrenenH