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These studies demonstrated that fasting upregulates the plasma membrane OCTN2 carnitine transporter in the liver, heart, kidneys and in rats with strong caloric restriction, additionally in skeletal muscle [111]

Limitations Few studies evaluated newer medications (e.g., GLP-1 receptor agonists) with follow-up beyond 12 months

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A slower escalation schedule following FDA-approved titration guidelines may reduce side effects and allow better adaptation, though this must be balanced against therapeutic goals

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Once reconstituted, it becomes susceptible to hydrolysis, oxidation, and microbial contamination making correct handling and storage critically important for patient safety