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The FDA explains that compounded drugs are not FDA-approved , meaning the agency does not verify their safety, effectiveness, or quality before marketing (see Compounding and the FDA: Questions and Answers )

What are the possible causes

Curr Neurol Neurosci Rep 22:657674 Djaldetti R, Yust-Katz S, Kolianov V, Melamed E, Dabby R (2007) The effect of duloxetine on primary pain symptoms in Parkinson disease

However, after a certain period of time, they become less potent as the ingredients in vitamins break down over time

You can also see a clinician to rule out sleep apnea

However, improper usesuch as increasing the dosage too quicklycan reduce its effectiveness and lead to negative side effects