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Anyone with significant medical conditions, anyone pregnant or breastfeeding, and anyone on multiple medications needs a careful review first not because problems are expected, but because limited human data means we don't assume
Drop back to the last tolerated dose and stay there for 6-8 weeks before attempting escalation again
Several Lactobacillus species require nicotinamide or nicotinic acid for growth 94
Practice management software like Pabau helps here too
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