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Aggressive handling, like shaking the vial, can shear the peptide bonds, a process called denaturing

Payers require proof of severity, lab values, and the amount of blood given

Dosing typically begins at a lower dose, suggested initiation of 20 units (0.2 mL) weekly for the first 4 weeks, then escalates according to a titration schedule: Weeks 14: Inject 20 units (0.2 mL) one time per week Weeks 58: Inject 40 units (0.4 mL) one time per week Weeks 912: Inject 70 units (0.7 mL) one time per week Weeks 1316: Inject 90 units (0.9 mL) one time per week Weeks 1720: Inject 120 units (1.2 mL) one time per week Week 21+: Inject 140 units (1.4 mL) one time per week Dosing may deviate from this pattern to accommodate patient-specific needs

However, clinical evidence for significant weight loss from lipotropics alone is modest

Peeling, dryness, redness, sun sensitivity that doesn't let up for weeks