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This increased energy expenditure contributes to weight loss
Dosing is titrated gradually over weeks to minimize side effects like nausea, and the pace of titration matters significantly for both tolerability and results
Avoid Desvenlafaxine (Pristiq), Duloxetine (Cymbalta), and Venlafaxine (Effexor) which fall into this SNRI category as they increase norepinephrine in the synapse and can increase sympathetic drive, already a problem for many POTS patients
Another established risk factor is immunosuppression, especially with chemotherapy and HIV
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