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Major drug Interactions: May potentiate the CNS-depressive effects of alcohol, barbiturates or other sedating drugs

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SMD can be caused by germline mutations in non-OXPHOS genes, accompany various hereditary non-mitochondrial diseases, or may be acquired secondary to adverse environmental factors which can cause oxidative stress

Metformin reduces plasma glucose and has been shown to increase glucagon-like peptide 1 (GLP-1) secretion

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Some individuals require slower escalation, extending each phase beyond four weeks if side effects remain problematic