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Consider: Baseline blood pressure and heart rate measurement before starting combination therapy Regular monitoring during dose titration of either medication Prompt evaluation of palpitations, chest pain, or shortness of breath Caution in patients with pre-existing cardiovascular disease , including coronary artery disease, arrhythmias, or uncontrolled hypertension ECG evaluation if indicated by clinical history or symptoms Nutritional adequacy must be maintained

After 4 weeks, the dose is commonly increased to 0.5 mg once weekly

Much of the support comes from case series, retrospective studies, and physician experience