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Concomitant Illness Patients with concurrent disease or on multiple concomitant medications may require dosage adjustments [see Clinical Pharmacology (12.4) and Warnings and Precautions (5.12)]

Areas Without Adequate Human Evidence Cardiovascular safety Neurological and psychiatric effects Liver and kidney safety Effects on blood glucose in humans Effects on methylation pathways Genotoxicity Carcinogenicity Reproductive and developmental toxicity Use during pregnancy or breastfeeding Interactions with prescription medicines Interactions with supplements or research compounds Long-term exposure Product-Quality Risks Incorrect quinolinium compound Wrong substitution position Incorrect counterion Incorrect active-content calculation Residual starting materials Residual solvents Degradation products Heavy-metal or inorganic contamination Mismatched certificate of analysis Uncontrolled storage and transport Absence of published harm is not proof of safety A compound without routine regulated human exposure may generate very few formal safety reports simply because there is no organised pharmacovigilance system

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Schulman J, Davis R, Nanes M

In another investigation, warm needle acupuncture combined with vitamin and drug injections produced excellent results