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These include: Large disc extrusions or sequestered fragments requiring surgical intervention Severe spinal stenosis with significant canal narrowing Bone spurs (osteophytes) compressing nerve structures Advanced degenerative disc disease with complete disc height loss Spondylolisthesis (vertebral slippage) beyond grade 1 Cauda equina syndrome (medical emergency requiring immediate surgery) Users with these conditions typically report minimal improvement from peptide therapy alone

They might start with higher doses to fill up their B12 stores

In placebo-controlled adjunctive epilepsy trials in adults receiving topiramate 200 to 1,000 mg/day, hot flashes (1% to 2%), drug-induced body odor (0% to 1%), skin disorder (1% to 2%), hyperhidrosis (1% or less), and erythematous rash (1% or less) were reported with equal or greater frequency than placebo

No validated human dose has been established