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Severe or persistent gastrointestinal side effectsincluding intractable nausea, vomiting, or diarrhoea leading to dehydrationmay necessitate stopping the medication

Current evidence suggests the changes are more likely due to rapid weight loss, hormonal shifts, microbiome disruption, and dehydration rather than a direct drug effect

Carnitine also participates in the metabolic transport of branched-chain acyl groups

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