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Conversely, lowering the dose may render the treatment ineffective

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Larger stones, and stones that fail to pass or cause especially severe pain or obstruction and infection may require more aggressive therapies such as antibiotics, lithotripsy (therapy utilizing ultrasound shock waves to break stones into smaller fragments), or surgery to remove stones (Antonelli 2015)

Additionally, health conditions like anemia can be addressed with vitamin B12 injections

Nevertheless, its effectiveness remains limited by the intestinal mucosa's low permeability, which restricts drug absorption and overall bioavailability

Multicenter, double-blind, vehicle-controlled trial of topical isotretinoin 0.05% gel (N = 268)