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The primary long-term considerations are GI tolerability (which tends to improve over time), liver function monitoring (berberine can occasionally elevate liver enzymes, particularly at higher doses), and the persistent CYP450 inhibition that requires ongoing awareness of medication interactions whenever the medication list changes

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"There's going to be a higher risk associated with compounded drugs regardless because they're made in an environment that is different" than drugmakers making FDA-approved products, Kastango said