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Because adequate, well-controlled studies in pregnant individuals are lacking, use should be limited to circumstances in which the potential maternal benefit clearly outweighs theoretical fetal risk-such as treatment of documented systemic carnitine deficiency

Shisler JL, Senkevich TG, Berry MJ, Moss B

However, in vivo models are not without limitations

The fundamental chemical instability of the peptide chain in a liquid solution at room temperature remains, making refrigeration essential regardless of preservatives