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Starting there and adjusting based on response is the most cost-effective strategy endorsed by current evidence

Beyond the absolute contraindications, several situations call for heightened caution in the class framing and are firmly a clinicians domain: a history of pancreatitis or symptomatic gallstones, significant gastrointestinal motility disorders (such as gastroparesis, which slowed gastric emptying can worsen), diabetic retinopathy that is not stabilized, severe renal impairment where dehydration from GI side effects raises risk, and any concurrent use of insulin or a sulfonylurea, where the additive glucose-lowering can produce hypoglycemia

Davis MR, Shamoon H

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Prevalence estimates vary by study, but ITP occurs more often in patients with celiac disease than in the general population, and screening is reasonable in otherwise unexplained ITP

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