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Options for managing tolerance include a brief dose reduction for 4 to 8 weeks ("drug holiday" at a lower dose, not complete cessation), lifestyle optimization to maximize the medication effect, evaluation for other contributing factors (thyroid function, cortisol, sleep quality, medication interactions), and consideration of adding a complementary compound to address specific aspects of the plateau

doi: 10.1080/09168451.2017.1295801

Comment: Many commenters supported the inclusion of well-being and nutrition measures in the Hospital OQR, REHQR, and ASCQR Programs

GH & IGF-1 support Studied for stimulating pulsatile growth hormone release, pairing a ghrelin agonist with a GHRH analog to raise IGF-1

This minimizes particulate and microbial contamination and mirrors pharmaceutical cleanroom procedures