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Specifically, circulating ALCAR was found to be reduced in patients with severe osteoarthritis pain that did not improve after a total joint replacement (Costello et al., 2020)

10.3390/nu15143258 [DOI] [PMC free article] [PubMed] [Google Scholar] Xue C., Ge Y., Tang B., Liu Y., Kang P., Wang M., et al

The starting dose should be reduced in these patients, and dosage reductions or discontinuation should be considered in patients with excessive somnolence [see DOSAGE AND ADMINISTRATION ]