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One study showed decreased levels in post-bariatric surgery patients, but this high-risk group had multiple confounding factors

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

As with any injection, there may be slight bruising, redness, and soreness at the injection site.

Okabe, K., Yaku, K., Tobe, K., & Nakagawa, T