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In patients with severe renal tubular acidosis or chronic diarrheal syndrome where urinary citrate may be very low (<100 mg/day)

rapid weight loss

If you get visual disturbances these usually get better over a few days or weeks and do not damage your eyes

even if they have the same condition as you

a combined treatment may cause gynecomastia

Uncommon side effects (may affect up to 1 in 100 patients): Allergic reaction - increased appetite

constipation & arthralgia

or other prostaglandin medicines or If you are a woman of childbearing age and you are not using an effective contraceptive method to avoid becoming pregnant

improves the sperm quality

peripheral coldness

Tribulus terrestris improves the spermatogenesis and increases the number of spermatogonia

Pressor amines (norepinephrine)