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These effects are typically dose-dependent, most prominent during dose escalation, and tend to diminish over time

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It is considered an uncommon but well-documented reaction that is almost always mild to moderate

Mingrone G, Panunzi S, De Gaetano A, Guidone C, Iaconelli A, Nanni G, Castagneto M, Bornstein S, Rubino F

Its usually a combination: hormone shifts plus low calories plus dehydration plus medication adjustment
