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By day 4 after a missed dose, drug levels have dropped enough that adding a late dose on top of what remains could create unpredictable effects

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Triggers include genetic susceptibility (HLA-DR3/DR4) and environmental factors (viral infections, gut microbiome alterations)

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If you are still experiencing significant nausea, vomiting, or diarrhea at the end of a 4-week dose block, stay at the current dose for another 2-4 weeks before attempting the next increase