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The feeling of the trough is real, but it represents a relative decline from a higher steady-state baseline not a drop to zero

Cell 157 , 12921308 (2014)

Naltrexone/bupropion (Mysimba) is contraindicated in end-stage renal disease and requires dose reduction in moderate renal impairment, as specified in its Summary of Product Characteristics

This may cause: Bloating and gas Abdominal cramping Loose stools or diarrhea Nausea If you notice these symptoms shortly after starting a high-dose regimen, it is often a sign that your gut is struggling to process the volume of the supplement

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