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It is a normal reaction as the body adjusts without the medication

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Due to their inhibitory effects on T cell activation and function, DPP-4 inhibitors (DPP-4i) have been successfully evaluated in vivo as immunosuppressive therapies using animal models of rheumatoid arthritis (RA), multiple sclerosis (MS), and transplantation

Small amounts of L-carnitine have been given to infants in breast milk and formula with no reported side effects