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Options for managing tolerance include a brief dose reduction for 4 to 8 weeks ("drug holiday" at a lower dose, not complete cessation), lifestyle optimization to maximize the medication effect, evaluation for other contributing factors (thyroid function, cortisol, sleep quality, medication interactions), and consideration of adding a complementary compound to address specific aspects of the plateau
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Because thiamine sits at the centre of carbohydrate metabolism and normal nerve conduction, a shortfall can appear as reduced appetite, muscle weakness, poor coordination, a faster heart rate and other neurological signs