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For sermorelin specifically, the three main failure modes are: Vigorous Shaking: Shaking a reconstituted GHRH analog causes mechanical shear stress

If excess solute is present, the rate at which solute particles leave the surface of the solid equals the rate at which they return to the surface of the solid

In the subgroup analysis based on L-carnitine dose, when the treatment dose was more than 1 g/d, fasting blood glucose, triglycerides, and high-density lipoprotein-cholesterol were significantly improved

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These changes occur at the 2nd, 8th, 15th, and 27th positions and are believed to possibly enhance the peptides stability against enzymatic degradation, particularly from enzymes like dipeptidyl peptidase-4 (DPP-4)