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In the US, sales declined by 18% due to a slowing pace of reaching unvaccinated populations and changes in pharmacy reimbursement processes under new CMS rules

Contraindications and Precautions Absolute Contraindications: Known hypersensitivity to ALC or formulation components Active chemotherapy with taxanes (may worsen CIPN)[10][21] Relative Contraindications/High-Risk Groups: Poorly controlled epilepsy (may lower seizure threshold)[20] Concurrent warfarin therapy (requires close INR monitoring)[18] Established cardiovascular disease (theoretical TMAO concerns)[14] Severe hepatic encephalopathy[19] Bipolar disorder (may worsen mania in some patients)[20] DETAILED REVIEWS BY CONDITION 1

Understanding which medications can be safely continued or should be paused before surgery is key to providing comprehensive and effective care. # # # 2025 AAOS Annual Meeting Disclosure Statement About the AAOS With more than 39,000 members, the American Academy of Orthopaedic Surgeons is the worlds largest medical association of musculoskeletal specialists

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