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The post says the ceiling is not universal and is set by gastrointestinal tolerance, metabolic response, baseline kidney and liver function, concurrent medications, and individual receptor sensitivity

If cost is the primary barrier, I often recommend maximizing the dose of low-cost generic metformin and adding a sulfonylurea like glimepiride or glipizide, while closely monitoring for hypoglycemia. Regardless, an alternative to Synjardy is only viable if a healthcare professional thinks its a good fit for you

Any new or worsening depression, anxiety, or thoughts of self-harm warrant immediate discussion with your healthcare provider