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If your nausea persists, I strongly encourage you to speak to your doctor to see if there needs to be an adjustment or change in medication

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This substantial deacetylation is the reason that high plasma levels of acetyl-l-carnitine are not observed after its oral intake, unlike after parenteral administration, during which the substance bypasses the gut and enters the bloodstream directly

They can advise whether the medication is likely still effective or if a replacement is needed