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Furthermore, pro-inflammatory cytokines raise the synthesis of i-NOS, which in turn elevates NO levels that has several neurotoxic pathways, such as peroxynitrite generation, DNA damage, glutamate excitotoxicity, and apoptosis signaling cascade activation (Dawson and Dawson 2018)

If your medication arrives warm, if the cold pack in the package is fully melted, or if your medication sat on a hot porch for hours before you retrieved it, the potency may be compromised

Prog Neuropsychopharmacol Biol Psychiatry 113:110476