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Initiate the dosing regimen for each patient individually, taking into account the patients underlying cause and severity of pain, prior analgesic treatment and response, and risk factors for addiction, abuse, and misuse (see WARNINGS)

However, the energy deficit hypothesis fails to fully account for a key clinical feature of PEM: the significant decline in muscle strength (myasthenia) upon the initial contraction after sufficient rest, rather than solely following endurance activities (83)

Tokede OA, Onabanjo TA, Yansane A, Gaziano JM, Djouss L

In vivo formation of codeinone-glutathione adduct: Isolation and identification of a new metabolite in the bile of codeine-treated guinea pig