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Metformin has a different safety profile and is generally well tolerated, including during pregnancy and breastfeeding, but should be avoided in individuals with severe kidney impairment or conditions that increase the risk of lactic acidosis
165 Deficiency of the enzyme has been observed only rarely and appears to be essentially innocuous or possibly associated with mild hemolysis
In certain cases, underlying health conditions might also affect how the body metabolizes the drug, prompting either an increase or decrease in dose
In each cycle, the protective group (usually Fmoc or Boc) is removed from the amino acid, exposing its reactive amine group
Subsequent Courses Community protocols typically include 1-2 courses per year, with each course consisting of 3-6 weekly cycles
Dose adjustments may be necessary when initiating or discontinuing concomitant medications
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