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Their dosing schedules vary by manufacturer and should always follow the specific product label

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Itching that persists, worsens, or appears weeks into stable treatment may indicate a separate issue unrelated to the medication

SL Hazen et al

Because acyl-carnitine is derived from the metabolism of fatty acids and organic acids, it is reasonable that abnormal systemic fatty acid oxidation readily leads to gut-specific toxicity after the introduction of a metabolic challenge with enteral feeding