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When combined, patients may experience: Excessive appetite suppression , leading to inadequate caloric intake Unintended weight loss beyond therapeutic targets Nutritional deficiencies if dietary intake becomes severely restricted Difficulty maintaining energy for daily activities Hypoglycemia risk in patients also taking insulin or sulfonylureas, due to reduced food intake Gastrointestinal effects may also be compounded

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Carnitine to TMAO conversion varies widely between individuals with reports that, for some, as much as ~50% of ingested carnitine is eventually excreted in the urine as TMAO (Rebouche 1991)

Second class: vildagliptin, saxagliptin (more active than vildagliptin)

Boehmer BH, Brown LD, Wesolowski SR, Hay WW, Rozance PJ