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There is also a theoretical concern observed in rodent studies with GLP-1 agonists regarding thyroid C-cell changes, though this has not been confirmed in humans and is not established as a contraindication in UK GLP-1 receptor agonist prescribing information

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Finally, topiramate is contraindicated in patients undergoing concomitant metformin therapy in advanced renal failure, as both agents rely on renal clearance and share the risk of lactic acidosis

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