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This can be due to reduced calorie intake, changes in metabolism, or mild dehydration from side effects like nausea

J Heart Lung Transplant 31(9):913933 Lewis GD et al (2022) Developments in exercise capacity assessment in heart failure clinical trials and the rationale for the design of METEORIC-HF

The medication is available in both brand-name and compounded forms, although the compounded forms are not FDA approved