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Ipamorelin acts on ghrelin receptors with high selectivity, producing GH release without raising cortisol or prolactin

The cardiovascular and respiratory side effects include chest pain, tachycardia (increased heart rate), heart palpitations, low blood pressure, and chest tightness, cough with or without production of pink frothy sputum, wheezing and difficulty breathing

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PMID 10448523

These are uncommon, but they suggest a need for caution in people with known high hematocrit, clotting disorders or myeloproliferative conditions