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The step from 0.25 to 0.5 mg doubles your dose, which is the largest relative increase in the entire titration schedule

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[PUBMED Abstract] Avril MF, Aamdal S, Grob JJ, et al.: Fotemustine compared with dacarbazine in patients with disseminated malignant melanoma: a phase III study

The clinical differences are real but modest

However, we primarily obtain L-carnitine through meat consumption