Sublingual or liquid forms absorbed through mucous membranes in the mouth, particularly under the tongue and along the cheeks, allow for faster and more efficient absorption compared to standard capsules
Non-pharmacological interventions should be emphasized as initial management strategies
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Contact your GP, study team, or supervising clinician if fatigue: Is severe enough to significantly impair daily functioning, work, or personal care Persists without any improvement despite the dose stabilising Is accompanied by dizziness, fainting, or palpitations , which may suggest dehydration or electrolyte disturbance Occurs alongside unexplained weight loss beyond expected levels , pallor, or breathlessness which could indicate nutritional anaemia Is associated with low mood, persistent sadness, or loss of motivation , as these may suggest depression rather than drug-related tiredness Develops alongside jaundice, dark urine, or abdominal pain , which warrant urgent assessment to exclude hepatic or pancreatic causes Seek urgent medical attention (call 999 or go to A&E) if you experience: Severe, persistent upper abdominal pain, particularly if it radiates to the back and is accompanied by vomiting these are potential symptoms of pancreatitis and require immediate assessment [12] Chest pain, severe dizziness, confusion, or an inability to keep any fluids down For urgent advice that does not require emergency services , contact NHS 111 (online at 111.nhs.uk or by telephone)

Notably, Desulfovibrio was enriched in the non-immunized group during the peak phase, while it was enriched in the immunized group at the chronic phase (13, 14)