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Dose adjustments should be guided by pre-dialysis levocarnitine trough levels

Although gut microbes produce only small amounts of thiamine, its availability significantly influences the competitive microbial ecosystem in the gut

This dual mechanism provides enhanced appetite suppression and metabolic benefits

This conversation should cover: The medical necessity of both treatments The expected duration of prednisolone therapy (short-term versus long-term) Individual risk factors, particularly regarding diabetes or prediabetes Realistic expectations about weight loss outcomes whilst on corticosteroids Monitoring requirements for blood glucose and other metabolic parameters The decision to use both medications should be individualised , weighing the clinical benefits of each treatment against potential complications