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5%10% show a familial predisposition (Ghasemi and Brown, 2018), a gene encoding an essential copper/zinc antioxidant enzyme which is likely involved in both familiar and sporadic presentations (Tafuri et al., 2015)
Kidney injury, particularly with exenatide, can occur due to dehydration from severe gastrointestinal side effects like nausea and vomiting
Patients with ME/CFS, Long COVID, and heavy toxic burdens should be aware of the potential for a Herxheimer (die-off) reaction
Avoid in pregnant or breastfeeding individuals due to a lack of appropriate data
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