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constipation, reflux, or intermittent nausea may continue Persistent or progressive symptoms rather than gradual improvement After month 3 Symptoms may remain mild or infrequent at a tolerated regimen New severe symptoms should not automatically be blamed on the medication The most important pattern is not simply "week 1 is bad and month 3 is good." A more accurate pattern is initiation, adaptation, possible symptom flare during dose escalation, and reassessment based on tolerability