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patients with these features should be strongly suspected of having MC4R -deficient obesity, and genetic evaluation should be considered

Its given once weekly via subcutaneous injection

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Subsequently, N-acetyl serotonin is ultimately converted into melatonin by the enzyme known as N-acylserotonin methyltransferase (ASMT) Tryptamine and 5-hydroxytryptophan are metabolized into serotonin through the activity of tryptamine 5-hydroxylase (T5H) and tryptophane decarboxylase (TDC) enzymes, respectively (175, 178, 179)

Patients who cannot tolerate 1.2 mg after one week may tolerate it after two or three weeks at 0.6 mg, possibly because GLP-1-driven central appetite suppression adapts over that window