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The lack of independent replication or detailed data means these findings, while encouraging, are not considered high-quality evidence by todays standards

The relationship between dose and cost is roughly linear for brand-name products: higher doses cost proportionally more due to the amount of active compound per injection pen

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Conditions or therapies that predispose patients to acidosis, such as kidney disease, severe pulmonary disease, status epilepticus, diarrhea, ketogenic diet, or certain drugs, may be additive to the bicarbonate lowering effects of topiramate

the risk of unintended apoptosis remains