Problems with systemic anti-melasma agents Although most of these systemic agents are devoid of serious adverse effects, probably with the exception of glutathione, their use as a skin-whitening agent for the treatment of melasma is not yet approved by the United States Food and drug administration (USFDA).[] However, their unregulated use by untrained people may lead to several lethal complications such as sepsis, air embolism, transmission of human immunodeficiency virus and Hepatitis B (parenteral formulations)
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These drug supply issues are a great opportunity to have patient management reviews, emphasise principles around healthy lifestyle, and review therapies including prescribing options or even de-prescribing if possible. Alternative treatment options suggested by the RACGP include: Liraglutide, which is administered once daily and has evidence of cardiovascular benefit, but is not subsidised by PBS SGLT-2 inhibitors, especially in those who also have cardiovascular disease, multiple cardiovascular risk factors and/or kidney disease DPP-4 inhibitors, which may be useful in those who do not have cardiovascular disease, multiple cardiovascular risk factors or kidney disease, and are unable to achieve optimal blood glucose levels Sulphonylureas or insulin (initiation or titrated doses), but these may lead to risks for hypoglycaemia and weight gain The twice daily exenatide (Byetta) is not recommended as a potential substitute, as it has been discontinued and is also no longer available

The needle-free medication formats, including drops, lozenges, and the oral Wegovy pill, make Shed particularly relevant for people who want GLP-1 treatment but are averse to injections
Mistake 6: combining timing changes with other protocol changes Changed your injection day AND started a new supplement AND switched injection sites AND began a new diet all in the same week