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In vivo dosing relies largely on intraperitoneal administration and exposure profiles that differ from oral human use, and interspecies differences in mitragynine metabolism and elimination complicate dose extrapolation

Elderly patients may be more sensitive to the medications effects and may require slower titration or lower maintenance doses, particularly if they have reduced renal function or are at higher risk for dehydration from gastrointestinal adverse effects

Limit Refined Carbohydrates and Sugary Foods: These can lead to rapid blood sugar spikes and contribute to insulin resistance