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Melatonin synthesis in the pineal gland and extrapineal sites such as the intestine, retina, placenta, and skin and their blood circulation
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The most common pattern involves dosing errors from patients self-administering from multi-dose vials, some serious enough to require hospitalization
Some patients report subjective improvements in energy levels and metabolic symptoms when using these medications, though such anecdotal reports cannot substitute for controlled clinical evidence
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