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Special Precautions Administration of high doses of the oral formulations of levocarnitine for long periods of time is not recommended in patients with severely compromised renal function or in ESRD patients on dialysis due to the fact that major metabolites formed following oral administration trimethylamine (TMA) and trimethylamine-N-oxide (TMAO) will accumulate since they can not be efficiently removed by the kidneys

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"DMHC Independent Medical Review Data." gmlawyers.com Kaiser Permanente

the fat loss drug." At that point, Centers for Medicare and Medicaid Administrator Dr