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160 Even when a product is removed from formal shortage lists, local pharmacy availability can remain unevencreating forced gaps in therapy, unplanned dose changes, and additional safety risks during reinitiation or switching

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In addition, due to its protein nature it is inactivated in the gastrointestinal tract, not being absorbed (practically null oral bioavailability), which hinders or prevents the passage into plasma of the infant from ingested breast milk (Serrano 2015), except in premature infants and during the immediate neonatal period, in which there may be greater intestinal permeability

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