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Moreover, -ketoglutarate generated from glutamine catabolism within the cell can also enter the TCA cycle to produce succinate, which is subsequently converted back to fumarate by SDH

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Alternatively, some people do better on a lower maintenance dose long term rather than pushing to the maximum dose

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Drug Metab Dispos 51(1):8194 Gex-Fabry M, Balant-Gorgia AE, Balant LP, Garrone G (1990) Clomipramine metabolism

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