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Medications with narrow therapeutic windows (thyroid hormones, anticoagulants, certain antibiotics) may be absorbed differently when gastric emptying is slowed

However, bacterial contamination in expired multi-dose vials can cause serious infections, and peptide aggregates from degradation can potentially trigger immune responses

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Compounding pharmacies assign BUDs based on United States Pharmacopeia (USP) guidelines, specifically USP Chapter 797 for sterile preparations

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