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The most commonly reported side effects of L-carnitine supplements are gastrointestinal, including nausea, stomach cramps, diarrhoea, and a distinctive fishy body odour caused by the production of trimethylamine during gut metabolism

Furthermore, the presence of these inflammatory markers in seminal plasma serves not only as a diagnostic tool but also as a potential target for therapeutic interventions aimed at reducing oxidative stress and improving fertility outcomes (168)

Therefore, the use of PDE5 inhibitors in conjunction with riociguat is contraindicated.1416 ,77 Rare cases of haemoptysis have been reported with riociguat therapy in patients with PAH and CTEPH

Further information on our findings is presented below

Pregnant and breastfeeding women should avoid use due to insufficient safety data [26]