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If you experience any of the following, remain at your current dose for an additional 2 to 4 weeks before escalating: Nausea lasting more than 3 days after injection Vomiting more than once per week Inability to maintain adequate caloric intake (under 1,000 calories daily) Signs of dehydration despite increased fluid intake New onset of significant fatigue that interferes with daily function Slowing escalation is not failure

When to speak to your GP or rheumatologist If low mood, anxiety, or thoughts of self-harm last for more than a couple of weeks, speak to your GP