Monitor ammonia levels in patients w/ pre-cirrhotic & cirrhotic states of hyperammonemia. Require routine blood test in patients w/ anemia, liver disease, pregnancy or those w/ potential for vit deficiencies due to other illnesses or eating habits eg, vegans. Not recommended in patients w/ bipolar disorder. Concomitant use of SSRIs, TCAs eg, clomipramine & herbal supplements containing tryptophan. Continuous psychiatric support in patients at risk for suicide & other serious events. Transient or worsening anxiety. May cause false elevation of plasma homocysteine levels. May impair ability to drive or operate machinery. Renal impairment. Pregnancy (administer in the 1st 3 mth of pregnancy only if it is absolutely necessary). Lactation. Childn. Elderly ≥65 yr.
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