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Despite this promise, several critical limitations remain: No large-scale, randomized controlled human trials to confirm efficacy, safety, or long-term impact Toxicology and pharmacokinetic data are lacking, especially for chronic use or high-dose regimens Only one stereoisomer (all-L form) has been tested

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The management of autonomic dysfunction in ME/CFS incorporates a multi-modal approach, including fluid/salt intake, compression garments, GET, and targeted pharmacotherapy

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