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If you suspect degradation, replacing the medication is the safest path forward
But other possible causes include: Varices : This complication of portal hypertension leads to engorged blood vessels in the GI tract
10.1152/physrev.00034.2006 27 HrickovaM.AmchovaP.Ruda-KucerovaJ
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Individual concerns and expectations must be discussed because unrealistic aims could lead to greater frustrations ( Statements Author contributions MMB: Writing review & editing, Supervision, Conceptualization, Investigation, Resources, Writing original draft, Visualization, Data curation
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