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Pre-restart assessment should include: Review of the reason for discontinuation and whether it has been adequately addressed Current weight and glycemic status (if diabetic) Assessment of gastrointestinal symptoms and any contraindications Medication reconciliation to identify potential drug interactions For patients taking insulin or sulfonylureas, consider dose reductions to prevent hypoglycemia For women of childbearing potential using oral contraceptives, recommend backup contraception for 4 weeks after restarting and after each dose increase Discussion of realistic expectations and commitment to continued treatment Patient counseling is essential