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Side effects - primarily gastrointestinal (nausea, vomiting, constipation, and abdominal discomfort) - are well-documented in clinical trial populations and are typically most pronounced during the initial titration phase before the body adapts to rising drug concentrations, which is why the standard-of-care approach involves gradual dose escalation over several weeks or months rather than starting at full therapeutic dose

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doi: 10.1007/s00125-018-4654-7 23 HsiaDSGroveOCefaluWT