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Adding a medication that powerfully affects these systems could create unpredictable interactions

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ZO-1 links transmembrane tight junction proteins to the actin cytoskeleton, and its expression and phosphorylation status are important for junction assembly and maintenance (6466).Recent studies show that the expression of these tight junction proteins follows circadian oscillations (67)

Though rare, it can be serious

Some patients report that by varying the dose and missing a couple of days they have experienced better results, due to drug tolerance issues