Contact your GP if you experience severe or worsening fatigue impairing daily activities, symptoms of hypoglycaemia (especially if taking insulin or sulphonylureas), signs of dehydration, severe abdominal pain, or fatigue accompanied by other concerning symptoms such as unexplained weight loss, fever, or mood changes
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Patients should be aware of symptoms warranting immediate medical attention: chest pain, severe breathlessness, rapid or irregular heartbeat, or signs of heart failure (ankle swelling, persistent fatigue, breathlessness when lying flat)
For patients whose pain can be managed with acetaminophen, it remains the preferred first-line analgesic alongside levothyroxine therapy, consistent with ACR 2019 osteoarthritis management guidelines and general primary care practice
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Some excipients are themselves fermentable or can alter stomach pH in ways that influence bacterial gas production
