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Phentermine-topiramate should be used cautiously in women of childbearing age because this drug combination may increase risk of oral cleft in children (Alfaris 2015)

It is also important for the normal functioning of the nervous system

Many of this studys subjects also had ligament sprains and tendon issues, which often heal on their own over time, so its unclear if these improvements were due to the peptide or just the passage of time (the study had no control group)