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These protocols should include detailed pain history, menstrual pattern assessment, and evaluation of functional impact using validated instruments

Patients with cardiac history, hypertension, or hyperthyroidism face serious safety concerns

The interaction is indirect: both drug classes alter physiological systems (gastrointestinal motility, sympathetic nervous system tone, appetite regulation) that affect how patients tolerate and respond to the other medication

This could be due to an additional effect on hepatic glucose production (245)

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