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Animal studies found no deaths even at doses 1,000 times higher than typical therapeutic use (Sikiric et al., 2014)

Dehydration makes nausea significantly worse For diarrhea: Increase fiber intake gradually, not suddenly Stay hydrated with electrolyte solutions, not just plain water Avoid sugar alcohols and artificial sweeteners, which can worsen GI symptoms For constipation: Increase water intake to at least 2-3 liters daily Add magnesium citrate if needed (a gentle, effective option) Include high-fiber vegetables and fruits in your diet When to slow the escalation If you experience side effects that significantly impact your daily function, extend the current dose phase by 2-4 additional weeks before escalating

Additional increases may be made for glycemic purposes after appropriate time intervals, depending on the clinical situation and provider judgment