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Ethics declarations Human and Animal Rights and Informed Consent This article is a narrative review of previously published studies

Many patients tolerate the 2.5 mg starter dose fine, then run into severe GI side effects (nausea, vomiting, constipation) at the 5 mg or 7.5 mg step

doi: 10.12740/PP/OnlineFirst/136356 39

The test maps 14 metabolic pathways including genetic variants affecting how your body absorbs and utilizes vitamins B12, folate, iron, and vitamin D

Extend your current dose step if: Nausea persists beyond 10 days at the current dose You are experiencing vomiting more than twice per week Diarrhea is disrupting daily activities You have lost significant amounts of food intake due to GI symptoms Your quality of life is substantially affected Stay at the current dose for an additional 2 to 4 weeks, then attempt the escalation again