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In cases where the source of the bleed is unclear, but melena is present, an upper endoscopy is recommended, to try to ascertain the source of the bleed
Rarely, allergic reactions or changes in liver and kidney function may occur with high doses
The dominant adverse events in both are gastrointestinal nausea, diarrhea, vomiting, and constipation and in both they are dose-dependent and tend to ease as the body adapts to gradual dose escalation
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