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Step 5: mix gently Once all the water is in the vial, do not shake it

The combination carries GI side effects from semaglutide (nausea, vomiting, diarrhea) plus potential naltrexone-related symptoms (dizziness, headache, insomnia) and requires liver monitoring because naltrexone can elevate enzymes

You may have read that niacinamide and vitamin C should never be used together this advice is outdated and largely irrelevant to modern, stabilised vitamin C formulas