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Documented side effects are usually mild to moderate: Injection-site pain, redness, or bruising Flushing Increased heart rate Nausea or gastrointestinal upset Headache Urinary changes or a fishy body odor at higher choline doses Because these are compounded products, sterile technique, pharmacy sourcing, and formulation verification matter

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The 2012 New England Compounding Center outbreak documented what happens when even professional compounding environments fall short of sterility standards contaminated injectable methylprednisolone resulted in 751 fungal infections and 64 deaths across 20 states