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Certain people should have extra screening, tighter monitoring, or alternative strategies: pregnancy or trying to conceive active cancer or recently treated cancer without oncology clearance uncontrolled autoimmune disease with high inflammatory burden severe allergic history or unpredictable reactions to injectables complex medication regimens that increase interaction concerns advanced liver or kidney disease that alters clearance and risk Cautious does not automatically mean no. It means individualized planning

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Doses above 5 mg/kg risk toxicity, including methemoglobinemia or serotonin syndrome, especially with serotonergic drugs