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Possible adverse effects may include: Injection site reactions : Redness, swelling, irritation, or discomfort Gastrointestinal symptoms : Nausea, vomiting, stomach cramps, or diarrhea Headaches or dizziness Allergic reactions : Rash, itching, shortness of breath, or facial swelling (rare) Increased heart rate or anxiety (typically temporary from B-vitamins) Fatigue or weakness if used improperly Elevated liver enzymes when taken in excess particularly with methionine or choline Insomnia if taken late in the day due to increased energy levels Who should avoid or use caution

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Other Services Proposed for Addition to the Medicare Telehealth Services List (1) Preexposure Prophylaxis (PrEP) of Human Immunodeficiency Virus (HIV) As outlined in Section II.E