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In *in vitro* experiments, durian extract can effectively suppress the levels of inflammatory factors such as tumor necrosis factor-alpha (TNF-), interleukin-6 (IL-6), interleukin-1 (IL-1), NO, and the transcription factor nuclear factor-kappa B (NF-B), while increasing the levels of anti-inflammatory factors such as IL-10

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And for those who want to avoid injections entirely, oral semaglutide or phentermine-topiramate are the strongest oral options

Extra provider scrutiny is warranted for patients with hepatic impairment (Child-Pugh B or C), significant renal impairment (eGFR below 30), high-dose zinc supplementation (above 50 mg/day), active infection at the intended injection site, or age under 18

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7 , a016600 (2015)