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The heart, skeletal muscle, liver, kidneys, and epididymis have specific transport systems for carnitine that concentrate carnitine within these tissues

How do I know which treatment is right for me

**Contact your provider** Inform your healthcare team so they can advise on resuming your schedule ## Effects of Missing Doses on Weight Loss ### Short-Term Effects (1 Missed Dose) | Effect | Likelihood | Duration | |---|---|---| | Increased appetite | Moderate (4050% of patients) | 25 days until next dose | | Food cravings return | Moderate | 25 days | | Blood sugar fluctuation | Low to moderate (diabetic patients) | 25 days | | Weight regain | Very low | Negligible from one missed dose | | Overall progress impact | Minimal | No meaningful effect | ### Medium-Term Effects (24 Missed Doses) | Effect | Likelihood | Duration | |---|---|---| | Appetite fully returns | High (7080%) | Until dosing resumes | | Noticeable food noise | High | Until dosing resumes | | Weight regain (13 lbs) | Moderate | Reversible when dosing resumes | | Metabolic markers shift | Moderate | Reversible | | May need dose adjustment | Moderate | Provider-dependent | ### Long-Term Effects (More Than 1 Month Without Dosing) | Effect | Likelihood | Impact | |---|---|---| | Significant weight regain | High | STEP 4 data: ~67% of lost weight regained within 1 year of stopping | | Full appetite return | Very high | Returns to pre-treatment levels | | Metabolic improvements reverse | High | Blood sugar, lipids, blood pressure may return toward baseline | | Need to restart titration | Very likely | Must re-titrate from 0.25mg to avoid side effects | ## How to Change Your Injection Day Sometimes missing a dose is an opportunity to switch to a more convenient injection day

Others continue the pyridoxine formulation long-term for its general nutritional benefits during extended treatment