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Documented side effects are usually mild to moderate: Injection-site pain, redness, or bruising Flushing Increased heart rate Nausea or gastrointestinal upset Headache Urinary changes or a fishy body odor at higher choline doses Because these are compounded products, sterile technique, pharmacy sourcing, and formulation verification matter

Overall, these findings suggest that ATXN3 aggregation may target directly or indirectly a metastable subproteome, thereby causing an increased susceptibility to multifactorial toxicity and, eventually, the collapse of many essential cellular functions, and this may help to explain the phenotypic complexities displayed in SCA3

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Medicare and most payers require clear documentation of the dose administered, the week preceding the first dose (if applicable), and related CPT codes for injection administration

Mar 2021;165:105413

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