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In rats, the reported elimination half-life is short

In addition, the bald scalp of AGA patients shows a marked elevation in prostaglandin D2 (PGD2) expression, which has been shown to inhibit hair growth in isolated human hair follicles, with similar inhibitory effects observed upon topical application in mice [55]

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Yes, regular monitoring is essential including kidney function tests, electrolytes, bicarbonate levels (to detect metabolic acidosis), blood glucose if diabetic, weight tracking, and blood pressure checks