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For most people, these are most pronounced when they first start the medication or after a dose increase

And then there are a bunch of toxin-derived medicines that seem promising, but don't have FDA approval: 1

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For patients in South Florida, the heat outside the refrigerator is an especially important factor: a peptide vial left on a counter in a Doral kitchen during summer is exposed to ambient temperatures that can reach the mid-80s Fahrenheit or higher, which meaningfully accelerates degradation for any reconstituted solution left out during injection preparation