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While these appear to be isolated incidents, they are frustrating when they occur
The common pattern: The reasoning reported by community sources for re-titrating: GI tolerance can reset during the off-cycle, and jumping back to a 2-4 mg ceiling without re-titration tends to reproduce week-1 nausea
They help the nervous system transition from the on alert state of the sympathetic nervous system to the calming, restorative state of the parasympathetic system
In this pathway, (CDCA) is first oxidized to 3-oxo-CDCA, followed by reduction to iso- or allo-bile acid intermediates, culminating in 7-dehydroxylation to yield hyocholic acid (HCA) or hyodeoxycholic acid (HDCA)
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