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The FDA has flagged a theoretical immunogenicity risk for compounded Selank in some contexts, based on limited FDA-regulated safety data not on a documented Russian clinical signal

10.1093/hmg/ddt619 274

And then we always like to screen for alcohol because alcohol overuse can also contribute

The chronic use of any of these medications has the potential to cause complications related to vitamin B12 deficiency, which includes impaired DNA synthesis, impaired cell division, hematopoiesis, hyperhomocysteinemia, and metabolism of odd-chain fatty acids that is necessary in preventing demyelination of nerves

Vitamin B12 , often known as cobalamin, is naturally found in animal food products