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Key points include: use an alcohol swab on the vial stopper before each draw, inject bacteriostatic water slowly down the side of the vial (never directly onto the powder), and gently swirl rather than shake to dissolve

Seek Care When Needed Severe symptoms, chest pain, shortness of breath, fainting, allergic reactions, neurologic symptoms, or acute illness require medical care

Headaches persisting beyond 48 weeks of stable dosing warrant medical review

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Those who do respond often require longer treatment cycles and may achieve 70 to 90 percent improvement rather than complete resolution

Phillipson M, Kubes P