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These may include mild reactions at the injection site, fatigue, or nausea

However, someone who has already lost a significant amount of weight might find that their skin is looser or that they have less fat in certain areas, requiring them to switch to the thighs or arms to ensure they are still hitting the fat layer rather than the muscle

Liver Disease or Tumors Women with severe liver disease or liver tumors should not use Mirena

8.5 Geriatric Use Spironolactone oral suspension is substantially excreted by the kidney, and the risk of adverse reactions to this drug may be greater in patients with impaired renal function

This does not necessarily mean the dose is insufficient