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Moreover, it is closely correlated to impaired levels of blood thiamine diphosphate (TDP), a crucial coenzyme of pyruvate dehydrogenase and -ketoglutarate dehydrogenase (KGDHC) enzymes allocated in the Krebs cycle (Sang et al., 2018)

Could theoretically amplify tricyclic side effects (orthostatic hypotension, anticholinergic burden) beyond tolerable thresholds