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The reduction in AUC after oral administration can result from numerous mechanisms including: pH or bacterial-mediated metabolism of the drug within the GI tract, incomplete drug absorption from the GI tract, metabolism within the GI epithelium (which contains CYP3A4), excretion back into the GI tract by P-glycoprotein in the GI epithelium, hepatic metabolism, or biliary excretion into the GI tract
Patients with pre-existing severe motility issues may experience worse symptoms
Unfortunately, this means it can be disregarded until the condition has progressed
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