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Rights and permissions About this article Cite this article Uzan, S., Acay, H., Baran, M.F

(ii) changes in energetic metabolites, with upregulation of methylmalonate and malate, and a decrease in glucose

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Short-term use of the lowest effective dose may be a reasonable option for patients with occasional or infrequent need or those who have not responded to safer therapies, but close monitoring for augmentation and other side effects is essential (Winkelman 2025)