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Prescribers should counsel patients on these risks, document informed consent, and prescribe only from PCAB-accredited compounding pharmacies that validate potency and ingredient quality

showed that pre-treatment with vitamin B12 inhibited the increase in ALT serum levels in rats in which hepatotoxicity was induced by acetaminophen 31

These properties, along with the wide availability and relatively low cost, led to kratom becoming a substitute for opium in some countries (Brown et al., 2017)