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Nevertheless, although off-target inhibition of DPP-9 could be one potential explanation for the association between saxagliptin and heart failure in an experimental setting, it is uncertain whether mean exposure levels of saxagliptin reach a high enough level to affect DPP-9 activity when used at its therapeutic dose in humans

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Beta carotene increased lung cancer in smokers(ATBC,CARET), vitamin E ( specifically alpha tocopherol) increased prostate cancer and selenium ( if nml levels) increased cancer and diabetes

In these situations, dosing is conservative, and symptoms are monitored closely