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However, up to 40% of patients do not achieve satisfactory relief, prompting investigation of combination therapy, most commonly adding a second agent (e.g., duloxetine plus pregabalin), which can yield incremental pain reduction of 1020% but with increased risk of sedation, dizziness and drug interactions [64]

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These findings resulted in a boxed warning in the prescribing information for Ozempic, Wegovy, and Rybelsus, the strongest warning the FDA can require

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