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Extended Monitoring: Schedule a 48-hour follow-up to check for unexpected reactions before proceeding with the regular treatment schedule 4

Even at this ratio, the pharmacodynamic response (actual GH release) is still lower for sublingual due to absorption variability and enzymatic degradation

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The VN is also believed to activate splenic sympathetic nerves via a vagal-sympathetic reflex, releasing NE that binds to splenic lymphocytes, promoting the release of ACh, which in turn inhibits the secretion of pro-inflammatory cytokines from splenic macrophages through a negative feedback loop, thereby exerting anti-inflammatory effects via the splenic sympathetic nerve pathway (103, 104)