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Contraindications and Precautions Absolute Contraindications: Known hypersensitivity to ALC or formulation components Active chemotherapy with taxanes (may worsen CIPN)[10][21] Relative Contraindications/High-Risk Groups: Poorly controlled epilepsy (may lower seizure threshold)[20] Concurrent warfarin therapy (requires close INR monitoring)[18] Established cardiovascular disease (theoretical TMAO concerns)[14] Severe hepatic encephalopathy[19] Bipolar disorder (may worsen mania in some patients)[20] DETAILED REVIEWS BY CONDITION 1