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Individuals with the following cardiac conditions should exercise caution and may require thorough cardiovascular assessment before treatment: Uncontrolled tachyarrhythmias : Patients with poorly controlled atrial fibrillation, atrial flutter, or ventricular tachycardia may experience worsening symptoms due to the heart rate-increasing effects of these medications

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slower dose escalation (extending time between increases) often yields better tolerance while maintaining steady progress toward your weight loss goals