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The injection itself is typically painless, using a fine 29-gauge needle similar to insulin pens

Clinical Therapeutics, 38 (5), 1013-1029

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Some pharmaceutical medications may increase the need for ALC, including AZT, certain antibiotics, isotretinoin, and some anti-seizure medications (carbamazepine, phenobarbital, phenytoin, and valproic acid)

Their analysis of seized products found bacterial contamination, incorrect chemical structures, and impurity levels that could cause serious adverse reactions