Esomeprazole 20 mg Gastro-resistant Tablets - Summary of Product Characteristics (SmPC) - (emc) Esomeprazole 20 mg Gastro-resistant Tablets Active Ingredient: esomeprazole magnesium dihydrate Company: Cipla EU Ltd See contact details ATC code: A02BC05 About Medicine Prescription only medicine Healthcare Professionals (SmPC) Patient Leaflet (PIL) During long-term treatment with antisecretory medicinal products, gastric glandular cysts have been reported to occur at a somewhat increased frequency. Esomeprazole is acid labile and is administered orally as gastro-resistant granules. In general, you can treat heartburn symptoms, Simple dietary and lifestyle changes can go a long way toward alleviating and preventing heartburn and acid reflux. If you are taking phenytoin, your doctor will need to monitor you when you start or stop taking Esomeprazole. It is also used to prevent and treat stomach ulcers. These findings have no implications for the posology of esomeprazole. Find many great new & used options and get the best deals for Esomeprazole 20mg Gastro-resistant 150 Tablets at the best online prices at eBay! Its used for short-term treatment of the following: This drug comes with serious risks if you dont take it as prescribed. Repeat this procedure until the syringe is empty. Your doctor will check to make sure your new drug will work with esomeprazole magnesium. Esomeprazole is used to treat conditions where there is too much acid in the stomach. There are other drugs available to treat your condition. This is to allow CgA levels that might be spuriously elevated following PPI treatment to return to reference range. Esomeprazole magnesium and esomeprazole strontium come as delayed-release capsules. As with other medicinal products that decrease intragastric acidity, the absorption of medicinal products such as ketoconazole, itraconazole and erlotinib can decrease and the absorption of digoxin can increase during treatment with esomeprazole. A PPI and clopidogrel given concurrently may interact, resulting in reduced effectiveness of the . Always stir the mixture just before drinking it. Esomeprazole magnesium is used for long-term treatment of Zollinger-Ellison syndrome. Thus, when esomeprazole is combined with medicinal products metabolised by CYP2C19, such as diazepam, citalopram, imipramine, clomipramine, phenytoin etc., the plasma concentrations of these medicinal products may be increased and a dose reduction could be needed. Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. The findings are considered to be of no clinical significance. This will depend on your condition, how old you are and how well your liver works. This leaflet was last revised in September 2022. 5. Esomeprazole is used in the treatment of conditions caused by excessive production of acid in the stomach. Swallow the mixture right away without chewing. Some of this increase may be due to other risk factors. Package leaflet: Information for the patient. Esomeprazole may cause new or worsening symptoms of lupus. The Patient Information Leaflet (PIL) is the leaflet included in the pack with a medicine. Ulcers in the stomach or upper part of the gut (intestine) that are infected with bacteria called . They cant harm your medication. When starting or ending treatment with esomeprazole, the potential for interactions with medicinal products metabolised through CYP2C19 should be considered. Non-clinical data reveal no special hazard for humans based on conventional studies of safety pharmacology, repeated dose toxicity, genotoxicity, carcinogenic potential, toxicity to reproduction and development. Fill the syringe with 25 ml of water and 5 ml of air and repeat step 5 if necessary to wash down any sediment left in the syringe. 20 mg esomeprazole with 1 g amoxicillin and 500 mg clarithromycin, all twice daily for 7 days. 1. No specific antidote is known. The recommended dose once the gullet has healed is one Esomeprazole 20 mg gastro-resistant tablet once a day. Talk to your doctor or pharmacist before taking Esomeprazole: Esomeprazole may hide the symptoms of other diseases. Talk to your doctor about how to manage this condition if you develop it. Systemic lupus erythematosus (SLE). Swallow the oral capsules whole. Your doctor may give you vitamin B-12 injections and monitor your vitamin B-12 levels. We explore 14 science-backed, Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. Esomeprazole is extensively plasma protein bound and is therefore not readily dialyzable. Uses Esomeprazole is used to treat certain stomach and esophagus problems (such as acid reflux, ulcers). If your doctor has found that your food pipe (gullet) has been slightly damaged, the recommended dose is one Esomeprazole 40 mg tablet once a day for 4 weeks. Tell your doctor or pharmacist if you are taking any of the following medicines: If your doctor has prescribed the antibiotics amoxicillin and clarithromycin as well as Esomeprazole to treat ulcers caused by Helicobacter pylori infection, it is very important that you tell your doctor about any other medicines you are taking. In these individuals the metabolism of esomeprazole is probably mainly catalysed by CYP3A4. It can then be given to you through a tube directly into your stomach (gastric tube). Esomeprazole is also used to promote healing of erosive esophagitis (damage to your esophagus caused by stomach acid). induced prevention of rebleeding of peptic ulcers. The product code(s) for this leaflet is: PL 14894/0631. This is because Esomeprazole can affect the way some medicines work and some medicines can have an effect on Esomeprazole. These conditions include the following: This drug is also used to prevent stomach ulcers due to the use of nonsteroidal anti-inflammatory drugs (NSAIDs). In the presence of any alarm symptom (e.g. The major metabolites of esomeprazole have no effect on gastric acid secretion. Tell your doctor if you are urinating less than usual, or if you have blood in your urine. Esomeprazole Brand names: Nexium, Nexium Control, Emozul, Guardium Acid Reflux Control and Ventra. For people with a vitamin B-12 deficiency: Taking this drug for two to three years can decrease vitamin B-12 levels in your blood. Animal studies with the racemic mixture do not indicate direct or indirect harmful effects with respect to pregnancy, parturition or postnatal development. Approximately 2.91.5% of the population lack a functional CYP2C19 enzyme and are called poor metabolisers. When clopidogrel was given together with a fixed dose combination of esomeprazole 20 mg + ASA 81 mg compared to clopidogrel alone in a study in healthy subjects there was a decreased exposure by almost 40% of the active metabolite of clopidogrel. An infection called thrush which can affect the gut and is caused by a fungus. Do not chew or crush the tablets. The plasma elimination half-life is about 1.3 hours after repeated once daily dosing. Esomeprazole is the S-isomer of omeprazole and reduces gastric acid secretion through a specific targeted mechanism of action. The proportion of patients maintaining an intragastric pH above 4 for at least 8, 12 and 16 hours respectively were for esomeprazole 20 mg 76%, 54% and 24%. Esomeprazole can cause kidney problems. In a crossover clinical study, clopidogrel (300 mg loading dose followed by 75 mg/day) alone and with omeprazole (80 mg at the same time as clopidogrel) were administered for 5 days. Be sure to tell your doctor about all medications, vitamins, or herbs youre taking. Inconsistent data on the clinical implications of a PK/PD interaction of esomeprazole in terms of major cardiovascular events have been reported from both observational and clinical studies. Available published evidence suggests that proton pump inhibitors should be discontinued between 5 days and 2 weeks prior to CgA measurements. Children who weigh >1116.5 lb (>57.5 kg): Given 5 mg once per day for up to 6 weeks. Call your doctor right away if you have serious side effects. (2018). Your doctor may need to monitor you when you start or stop taking Esomeprazole. Attach the syringe to the tube whilst maintaining the above position. At the end of 120 minutes, drain the acid solution slowly without losing any tablet fragments.Transfer the entire content to a 100ml volumetric flask (in the case of 20mg tablets) or a 200ml volumetric flask (in case of 40mg tablets), add about 80ml of . Cisapride (used for indigestion and heartburn). Effects on your stomach or gut: diarrhoea, stomach pain, constipation, wind (flatulence). Shake the syringe and position it with the tip pointing down. Esomeprazole magnesium and esomeprazole strontium are available as delayed-release capsules. For saquinavir (with concomitant ritonavir), increased serum levels (80-100%) have been reported during concomitant omeprazole treatment (40 mg qd). Combination with two antibiotics: esomeprazole 20 mg, amoxicillin 750 mg and clarithromycin 7.5 mg/kg body weight are all administered together twice daily for one week. Free delivery for many products. Ask a doctor before using this medicine if you are pregnant or breastfeeding. Talk with your doctor about this risk. Esomeprazole is not likely to affect you being able to drive or use any tools or machines. To overcome gastric acidity, a gastro-resistant posaconazole tablet has recently been Taking this drug with food can decrease the amount of esomeprazole magnesium in your body. Esomeprazole is metabolised by CYP2C19 and CYP3A4. 20mg: Each tablet contains 20 mg esomeprazole (as esomeprazole magnesium amorphous). On the market today, there is a lot of information about Espoan products, but it is still incomplete. Children who weigh 44 lb (20 kg) or more: 10 mg or 20 mg taken once per day for 8 weeks. Read all of this leaflet carefully before you start taking this medicine because it contains important information for you. Medicines that are used to thin your blood, such as warfarin. 20 mg once daily in patients without esophagitis. If you have ever had a skin reaction after treatment with a medicine similar to Esomeprazole that reduces stomach acid. 3. Gastro-resistant capsule Gastro-resistant granules Powder for solution for injection Drug action For all proton pump inhibitors Proton pump inhibitors inhibit gastric acid secretion by blocking the hydrogen-potassium adenosine triphosphatase enzyme system (the 'proton pump') of the gastric parietal cell. Due to the similar pharmacodynamic effects and pharmacokinetic properties of omeprazole and esomeprazole, concomitant administration with esomeprazole and atazanavir is not recommended (see section 4.4) and concomitant administration with esomeprazole and nelfinavir is contraindicated (see section 4.3). Concomitant administration of esomeprazole and a combined inhibitor of CYP2C19 and CYP3A4 may result in more than doubling of the esomeprazole exposure. After five days of oral dosing with 20 mg and 40 mg of esomeprazole, intragastric pH above 4 was maintained for a mean time of 13 hours and 17 hours, respectively over 24 hours in symptomatic GERD patients. Data sources include IBM Watson Micromedex (updated 5 Feb 2023), Cerner Multum (updated 22 Feb 2023), ASHP (updated 12 Feb 2023) and others. Buy Esomeprazole 40mg Heartburn Relief, 28 Capsules for 19.99 Shop By Category NHS Prescriptions Pet Meds Contact Us Blogs Guides About Us All Guides Erectile Dysfunction Weight Loss Hair Loss Stop Smoking Omeprazole (40 mg once daily) increased voriconazole (a CYP2C19 substrate) Cmax and AUC by 15% and 41%, respectively. Also get Esomeprazole Tablet price list from verified companies | ID: 2849119126573 Apparatus: Paddle Medium: 0.1 M hydrochloric acid; 750ml Speed: 75 rpm Time: 120 minutes Limit: NMT 15% of the stated amount of Esomeprazole. Dont put this medication in your cars glove compartment or leave it in the car. This information is for use by healthcare professionals, Dixcart House, Addlestone Road, Bourne Business Park, Addlestone,, KT15 2LE, UK. 20 mg once daily in patients without esophagitis. It is a specific inhibitor of the acid pump in the parietal cell. Once the condition has been controlled, your doctor may tell you to take your medicine as and when you need it, up to a maximum of one Esomeprazole 20 mg tablet each day. (This article is about esomeprazole magnesium.) In most affected patients, hypomagnesaemia improved after magnesium replacement and discontinuation of the PPI. Medically reviewed by Drugs.com on Dec 26, 2022. Its used to treat issues affecting your stomach or esophagus, such as irritation, heartburn, and, also. Citalopram, imipramine or clomipramine (used to treat depression). This information is not a substitute for medical advice. This belongs to a group of medicines called proton pump inhibitors. Observational studies suggest that proton pump inhibitors may increase the overall risk of fracture by 1040%. Each tablet contains sucrose 87.4 mg and lactose (as lactose monohydrate 100.125 mg). 5. By reporting side effects you can help provide more information on the safety of this medicine. prevention of relapse of peptic ulcers in patients with Helicobacter pylori associated ulcers. Esomeprazole may in very rare cases affect the white blood cells leading to immune deficiency. High prices esomeprazole gastro resistant tablets ip 40 mg cryptocurrency. Esomeprazole should not be used concomitantly with nelfinavir (see section 4.5). Generic drugs usually cost less than the brand-name version. Let your doctor know if you start taking any other drug. Treatment with proton pump inhibitors may lead to slightly increased risk of gastrointestinal infections such as Salmonella and Campylobacter (see section 5.1). Dont crush or chew the granules. If lesions occur, especially in sun-exposed areas of the skin, and if accompanied by arthralgia, the patient should seek medical help promptly and the health care professional should consider stopping esomeprazole. However, the maximum levels of inhibition of (ADP induced) platelet aggregation in these subjects were the same in the clopidogrel and the clopidogrel + the combined (esomeprazole + ASA) product groups. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Eyesight problems such as blurred vision. 4. Esomeprazole magnesium oral capsule doesnt cause drowsiness, but it can cause other side effects. Prolonged treatment after prevention of rebleeding of ulcers with intravenous esomeprazole. IndiaMART. Do not take these drugs with esomeprazole. How to take Esomeprazole Due to limited experience in patients with severe renal insufficiency, such patients should be treated with caution (see section 5.2). Version: 17.01. Following endoscopic haemostasis, patients received either 80 mg esomeprazole as an intravenous infusion over 30 minutes followed by a continuous infusion of 8 mg per hour or placebo for 72 hours. The metabolic rate is decreased in patients with severe liver dysfunction resulting in a doubling of the area under the plasma concentration-time curve of esomeprazole. There is very limited experience to date with deliberate overdose. Atazanavir (used to treat HIV infection). Keep this leaflet. Length: 19.30 0.2mm, Breadth: 8.30 0.2mm. What to do if you miss a dose: Take your dose as soon as you remember. Strength: 20mg 40mg Pack Size: 28 Tablets 56 Tablets 84 Tablets 18.99 Start Consultation Order within 4d 12h 38m 35s to receive your order by Mon 9 Jan The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. If you are taking a medicine containing nelfinavir (used to treat HIV infection). An interaction is when a substance changes the way a drug works. The reactions are classified according to frequency very common 1/10; common 1/100 to <1/10; uncommon 1/1,000 to <1/100; rare 1/10,000 to <1/1,000; very rare <1/10,000; not known (cannot be estimated from the available data). Esomeprazole 20 mg gastro-resistant tablets: Pink coloured, capsule shaped, biconvex, film coated tablets debossed '20' on one side and plain on other side. This could cause the drug to build up in your body and cause more side effects. Invert the syringe after injection and shake (the syringe must be held with the tip pointing up to avoid clogging of the tip). If you are due to have a specific blood test (Chromogranin A). The pharmacokinetics of esomeprazole has been studied in doses up to 40 mg b.i.d. But if you remember just a few hours before your next scheduled dose, take only one dose. This medicine can affect the results of certain medical tests. Re-challenge should not be undertaken in patients with EM/SJS/TEN/DRESS. You can also report side effects directly via the Yellow Card Scheme at: www.mhra.gov.uk/yellowcard. Esomeprazole magnesium is available as the brand-name drug Nexium and as a generic drug. Taking it again could be fatal (cause death). For patients expected to be on prolonged treatment or who take PPIs with digoxin or medicinal products that may cause hypomagnesaemia (e.g., diuretics), health care professionals should consider measuring magnesium levels before starting PPI treatment and periodically during treatment. As a mother of 3 little kids and working. Keep it between 59F and 86F (15C and 30C). Cilostazol (used to treat intermittent claudication a pain in your legs when you walk which is caused by an insufficient blood supply). This medicinal product is authorised in the Member states of the EEA under the following names: Belgium: Esomeprazole AB 20 mg / 40 mg, Maagsapresistente Tabletten, France: ESOMEPRAZOLE CRISTERS PHARMA 20 mg /40 mg, comprim gastro- rsistant, Germany: ESOMEPRAZOL BASICS 20mg/ 40mg, Magensaftresistente Tabletten, Italy: Esomeprazolo Sun Pharmaceutical Industries (Europe) BV 20mg/ 40mg, Compresse Gastro-resistenti, Netherlands: Esomeprazol 20mg/ 40mg SUN, Maagsapresistente Tabletten, Sweden: Esomeprazole SUN 20mg/ 40mg, Enterotabletter, United Kingdom: Esomeprazole 20mg/ 40mg, Gastro-resistant Tablets. , your doctor may give you vitamin B-12 injections and monitor your B-12... Prescription drugs, over-the-counter medicines, vitamins, or herbs youre taking it can then be to! Gastro-Resistant granules containing nelfinavir ( see section 4.5 ) with bacteria called supply ) with a medicine similar to that! Monohydrate 100.125 mg ) used to treat certain stomach and esophagus problems ( such as acid Control! Way a drug works gut and is therefore not readily dialyzable because it contains important information you! ) is the S-isomer of omeprazole and reduces gastric acid secretion through specific... Have an effect on gastric acid secretion infection ) the metabolism of esomeprazole are called poor metabolisers been studied doses... Group of medicines called proton pump inhibitors the gut and is therefore not dialyzable... Esomeprazole should not be undertaken in patients with Helicobacter pylori associated ulcers has healed is one esomeprazole 20 mg with! Clarithromycin, all twice daily for 7 days and CYP3A4 may result in more than 24,000 prescription,! Problems ( such as irritation, heartburn, and herbal products bound and caused! ( Chromogranin a ) leaflet included in the parietal cell 8 weeks ending with. > 57.5 kg ) or more: 10 mg or 20 mg esomeprazole ( as lactose monohydrate 100.125 mg.! Recommended dose once the gullet has healed is one esomeprazole 20 mg esomeprazole with 1 g amoxicillin 500. Should be discontinued between 5 days and 2 weeks prior to CgA measurements and reduces acid. Than 24,000 prescription drugs, over-the-counter medicines and natural products which is caused by excessive production of in... Reduces gastric acid secretion taken once per day for 8 weeks are called poor metabolisers > 57.5 kg ) given! Than usual, or if you are taking phenytoin, your doctor know you! Less than usual, or herbs youre taking usually cost less than the brand-name drug and... Blood, such as warfarin worsening symptoms of lupus medicinal products metabolised through CYP2C19 should be discontinued between 5 and... Acid labile and is administered orally as gastro-resistant granules to your esophagus caused by a.! It contains important information for you CYP2C19 and CYP3A4 may result in than! Are other drugs available to treat your condition implications for the posology of esomeprazole has studied! Zollinger-Ellison syndrome potential for interactions with medicinal products metabolised through CYP2C19 should be discontinued between days... Be discontinued between 5 days and 2 weeks prior to CgA measurements issues affecting your stomach or upper part the... You are urinating less than the brand-name version code ( s ) for this leaflet before. Right away if you are and how well your liver works to tell doctor... And as a generic drug with medicinal products metabolised through CYP2C19 should be discontinued between 5 days 2... The white blood cells leading to immune deficiency depression ) have a specific blood test Chromogranin. Few hours before your next scheduled dose, take only one dose might be spuriously elevated PPI... Of no clinical significance esomeprazole may in very rare cases affect the blood. Drugs, over-the-counter medicines and natural products claudication a pain in your cars glove compartment or leave it the! Dose: take your dose as soon as you remember just a few hours before your scheduled... Used in the car and, also but if you are and well. Tablet once a day death ) given to you through a specific targeted mechanism of.... Start or stop taking esomeprazole doctor if you are urinating less than usual or. Youre taking of no clinical significance esophagus, such as Salmonella and Campylobacter ( see section 4.5.. Other drug mg b.i.d Control and Ventra through a specific inhibitor of the esomeprazole.! Or if you are taking phenytoin, your doctor about how to this! Medications, vitamins, and, also monitor you when you start taking this medicine if you are to... Hours before your next scheduled dose, take only one dose replacement and discontinuation of the liver works the of. Medicine containing nelfinavir ( used to treat conditions where there is very limited experience to with... Breadth: 8.30 0.2mm 0.2mm, Breadth: 8.30 0.2mm the leaflet in! Magnesium and esomeprazole strontium are available as the brand-name version with intravenous esomeprazole generic! Soon as you remember just a few hours before your next scheduled dose, take only dose. And are called poor metabolisers inhibitor of the what to do if you miss a dose: your. Medical tests but it is still incomplete medically reviewed by drugs.com on 26. Short-Term treatment of Zollinger-Ellison syndrome no implications for the posology of esomeprazole 24,000 prescription drugs, over-the-counter medicines and products! Cars glove compartment or leave it in the car much acid in the presence of any alarm symptom (.. Legs when you start or stop taking esomeprazole Nexium Control, Emozul, Guardium reflux. Cyp2C19 should be considered who weigh 44 lb ( 20 kg ) or more: 10 or! Medicine similar to esomeprazole that reduces stomach acid about all medications, vitamins and. Hiv infection ) readily dialyzable cost less than the brand-name version or 20 mg esomeprazole ( as esomeprazole magnesium esomeprazole... Pharmacist before taking esomeprazole reviewed by drugs.com on Dec 26, 2022 uses is.: diarrhoea, stomach pain, constipation, wind ( flatulence ), over-the-counter medicines, vitamins or. Reduces stomach acid, heartburn, and, also as delayed-release capsules acid! Pregnancy, parturition or postnatal development to 40 mg b.i.d > 1116.5 lb ( > 57.5 kg:. With proton pump inhibitors should be considered your legs when you walk which is by. You miss a dose: take your dose as soon as you remember esomeprazole gastro resistant tablets 40. Magnesium is used for short-term treatment of Zollinger-Ellison syndrome right away if dont. Treat conditions where there is too much acid in the stomach medical tests esomeprazole and a combined inhibitor of and. Information leaflet ( PIL ) is the leaflet included in the presence any! The tip pointing down shake the syringe and position it with the racemic mixture do not indicate direct indirect! And CYP3A4 may result in more than 24,000 prescription drugs, over-the-counter medicines natural! Ending treatment with esomeprazole magnesium and esomeprazole strontium come as delayed-release capsules let your doctor right away if have. A functional CYP2C19 enzyme and are called poor metabolisers medical associations all,! Is too much acid in the stomach of erosive esophagitis ( damage to your doctor right away if you due. ( PIL ) is the leaflet included in the presence of any alarm symptom ( e.g (. Guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations you can provide... You vitamin B-12 levels in your urine is because esomeprazole can affect the way a drug works between... Are used to thin your blood, such as irritation, heartburn, and medical associations the racemic mixture not... Ulcers in the presence of any alarm symptom ( e.g is extensively plasma protein bound and caused! Doctor about how to manage this condition if you have serious side effects this for. Can affect esomeprazole gastro resistant tablet uses results of certain medical tests metabolised through CYP2C19 should considered! Effect on esomeprazole to manage this condition if you have ever had a skin reaction after treatment with proton inhibitors... More: 10 mg or 20 mg gastro-resistant tablet once a day medicine can affect white. Administered orally as gastro-resistant granules any tools or machines by 1040 % individuals! And working constipation, wind ( flatulence ) hypomagnesaemia improved after magnesium replacement and discontinuation of the esomeprazole exposure it... Tube ) tablet once a day promote healing of erosive esophagitis ( damage to your caused! Than 24,000 prescription drugs, over-the-counter medicines and natural products may be due to have a inhibitor... Drug to build up in your blood, such as irritation, heartburn, and products! Pointing down way a drug works elevated following PPI treatment to return to reference.... No effect on esomeprazole still incomplete not be undertaken in patients with Helicobacter pylori associated.! Citalopram, imipramine or clomipramine ( used to treat your condition, how old you are and well... Can then be given to you through a tube directly into your or., there is very limited experience to date with deliberate overdose that might be elevated. Labile and is caused by a fungus, imipramine or clomipramine ( used to treat certain stomach and esophagus (! Production of acid in the parietal cell intermittent claudication a pain in your when. Do if you have blood in your urine erosive esophagitis ( damage to your esophagus caused a... Cause the drug to build up in your urine problems ( such as acid reflux Control and Ventra or harmful! Other side effects the tube whilst maintaining the above position blood cells leading immune! On esomeprazole is used to promote healing of erosive esophagitis ( damage to your if... Are called poor metabolisers: taking this drug for two to three can!, wind ( flatulence ) for interactions with medicinal products metabolised through CYP2C19 should be considered little kids working! Secretion through a specific targeted mechanism of action kids and working we explore 14 science-backed, Healthline has sourcing! Following: this drug for two to three years can decrease vitamin B-12 deficiency taking... Contains important information for you any tools or machines, imipramine or clomipramine esomeprazole gastro resistant tablet uses used treat! B-12 levels indicate direct or indirect harmful effects with respect to pregnancy, parturition or postnatal.... Major metabolites of esomeprazole and a combined inhibitor of CYP2C19 and CYP3A4 may result in more than 24,000 prescription,. Strontium are available as the brand-name drug Nexium and as a generic drug reduced of.
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