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After first puncture, the 28-day multi-dose window starts, and refrigeration at 2-8C is consistently cited as the documented best practice in community and pharmaceutical references

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The similarity between overlap in the pathophysiology of ME/CFS and FM was demonstrated by Schutzer et al

11 One recent analysis of 66 patients who had originally been prescribed clomiphene citrate prior to being switched to enclomiphene citrate did note significantly more reported adverse effects while the patients were on clomiphene citrate