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It cannot be legally prescribed off-label, and the FDA has explicitly stated it cannot be used in compounding pharmacies under federal law

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doi:10.1016/j.euroneuro.2005.10.005 14

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Cholinesterase inhibitors prescribed for dementia or mild Alzheimers disease keep acetylcholine in a neuronal synapse, as do medications treating myasthenia gravis and many eye conditions.42 Acetylcholine-influencing compounds are extremely common in nootropic supplements

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