As a class of drugs, benzodiazepines are among the drugs most commonly prescribed in the western hemisphere because of their efficacy, safety, low addiction potential, minimal side effects, and high public demand for sedative and anxiolytic agents. Seal Beach, CA: Biomedical Publications; 2017.2. The .gov means its official. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). When was the patients last dose? Stamford, CT: PharmaCom Group, Inc.; 2015:1-32.12. [84], Coma can be cyclic, with the individual alternating from a comatose state to a hyper-alert state of consciousness, which occurred in a four-year-old boy who overdosed on clonazepam. Epub 2006 Jun 30. The mechanism of tolerance includes receptor desensitization, down regulation, receptor decoupling, and alterations in subunit composition and in gene transcription coding. This limits the utility of the comprehensive drug screen for monitoring compliance or for confirming the results of screening immunoassays. Some people have thoughts about suicide while taking clonazepam. Drugs of Abuse: Note: This product is intended for research and manufacturing uses only. These values do not apply to results that are converted to other units of measure. BZ are weakly acidic and are therefore excluded from OF, resulting in low OF concentrations [7]. Clonazepam. Kacirova I, Grundmann M, Silhan P, Brozmanova H. Medicine (Baltimore). [86], Overdose symptoms may include extreme drowsiness, confusion, muscle weakness, and fainting. Although the impact of urine pH would not likely be so significant to cause unexpected negative results, providers may consider that an elevated urine pH may be a natural physiologic response to regulate the bodys acid-base balance, or it may also be elevated if the urine was not stored properly prior to shipment. Pain Physician. Your test results may be different depending on the lab used. A 1982 double-blinded, placebo-controlled study found clonazepam increases violent behavior in individuals with chronic schizophrenia. Vindenes V, Strand DH, Kokster P, Gjerde H. J Anal Toxicol. Federal government websites often end in .gov or .mil. . Last updated on Dec 13, 2021. Bethesda, MD 20894, Web Policies An official website of the United States government. bruising, or feeling dizzy. These stability issues along with as-needed dosing and/or low doses may further increase the likelihood of unexpected negative results. [10] Long-term use may result in tolerance, dependence, and withdrawal symptoms if stopped abruptly. We investigated the effects of ACZP on the GABA(A) receptor-mediated currents (I(GABA)) in neurons from the nucleus reticularis thalami (NRT) of the . It is not a diagnostic device. Your family or caregivers should also watch for sudden changes in your behavior. Bethesda, MD 20894, Web Policies Keywords: It differs from other anticonvulsant drugs it was compared to in a study. arm. 2017;20:SE1-9.21. . In blood, especially, the period of detection is generally limited to very recent use. Overdose symptoms may include extreme drowsiness, confusion, muscle weakness, or coma. [10] In 2020, it was the 44th most commonly prescribed medication in the United States, with more than 14million prescriptions. The objective of this paper was to determine how long after administration of benzodiazepine clonazepam (CLO), its major metabolite 7-aminoclonazepam (7-ACLO) could be detected in urine collected from 10 healthy volunteers who received a single 3-mg dose of Klonopin (clonazepam). It's often prescribed to adults and children who suffer from partial seizures and spasms. Vomiting and diarrhea can disrupt normal absorption and metabolism of medications and reduce excreted amounts to undetectable levels. Flurazepam is detected as the metabolite hydroxyethyl-flurazepam. The challenges of LC-MS/MS analysis of opiates and opioids in urine. Disclaimer. 0000011260 00000 n 2012;413(15-16):1199-202. Class/Isotype: IgG: Cross Reactivity: 7-aminoclonazepam, 7-aminoflunitrazepam, Delorazepam >10%; N-Desalkylflurazepam, Flunitrazepam >1%; Nitrazepam, Desmethyldiazepam, Diazepam : 1% Supplied In: . Mikel C, West R, Crews B, et al. When the needle pricks your arm, you may feel a slight Bookshelf Further information regarding specimen tampering is available in the Aegis Clinical Reference Guide at https://www.aegislabs.com/resources/clinical-reference-guide/. Your results [81][82][83] Sudden withdrawal may also induce the potentially life-threatening condition, status epilepticus. Hegstad et al. The comprehensive drug screen was designed to rapidly detect the presence of a broad array of compounds in patients presenting with a possible overdose. 0000002060 00000 n Some withdrawal symptoms may last up to 12 months or longer after stopping this medicine suddenly. An overdose of clonazepam can be fatal if you take it with alcohol, opioid medicine, or other drugs that cause drowsiness or slow your breathing. 7-Aminoclonazepam; Addiction management; Clonazepam; Compliance; Oral fluid. Clipboard, Search History, and several other advanced features are temporarily unavailable. 0000005469 00000 n Acetaminophen (Tylenol) is a non-narcotic analgesic with antipyretic . Clonazepam, marketed as Klonopin and Rivotril, is a long-acting benzodiazepine with anxiolytic, anticonvulsant, muscle relaxant, and hypnotic properties. 0 Results: Take clonazepam exactly as prescribed by your doctor. Epub 2012 Nov 10. Some commonly prescribed benzodiazepines have unique metabolites, which make identification more straightforward: Alprazolam (Xanax): Metabolizes to alpha-hydroxyalprazolam; reported as AlprazolamClonazepam (Klonopin): Metabolizes to 7-aminoclonazepam; reported as ClonazepamFlurazepam: Metabolizes to 2-hydroxyethylflurazepam; reported as FlurazepamLorazepam (Ativan): Metabolizes to lorazepam glucuronide; reported as Lorazepam. 0000001237 00000 n Your child's dose needs may change if the child gains or loses weight. Urinary analyses of the metabolite 7-aminoclonazepam (7-AC) can be helpful in monitoring drug abuse and in the context of suspected drug-facilitated sexual assaults (DFSA). suicidal thoughts, and drowsiness. Unexpected benzodiazepine results may be indicative of noncompliance, drug misuse, or diversion, and we welcome your calls and e-mails for assistance in interpreting these results. Negrusz A, Bowen AM, Moore CM, Dowd SM, Strong MJ, Janicak PG. In: Levine B, ed. Deliberate Self-Poisoning: Real-Time Characterization of Suicidal Habits and Toxidromes in the Food and Drug Administration Adverse Event Reporting System. government site. 14263 | ISO60181). Keep the medication in a place where others cannot get to it. It can cause side effects such as drowsiness, problems with coordination, and . Patients who drink a lot of water, consume caffeine, take diuretic medications, have disorders of antidiuretic hormone, or other physiologic disturbances affecting urinary concentration may produce less concentrated urine. Qriouet Z, Qmichou Z, Bouchoutrouch N, Mahi H, Cherrah Y, Sefrioui H. J Anal Methods Chem. 2007 Sep;31(7):369-76. doi: 10.1093/jat/31.7.369. The test requires a blood sample, which is drawn through a needle from a vein in your The GC/MS comprehensive screen drugs are listed with the minimum concentration of a spiked drug that was detected in a urine sample during the validation of the analytical method. MeSH This test measures the amount of clonazepam in your blood. Unauthorized use of these marks is strictly prohibited. Drugs of abuse in oral fluid collected by two different sample kitsstability testing and validation sing ultra performance tandem mass spectrometry. In humans, tolerance to the anticonvulsant effects of clonazepam occurs frequently. Eur J Drug Metab Pharmacokinet. Therapeutic medicine levels 2013:416:80-58. 2021 Mar;46(2):205-223. doi: 10.1007/s13318-020-00661-1. [10] It is a tranquilizer of the benzodiazepine class. Tell your doctor right away if you become pregnant. 7-aminoclonazepam is superior to clonazepam for detection of clonazepam use in oral fluid by LC-MS/MS It is important to use the correct nomenclature for chemical substances as although experts would understand that 7-aminoclonazolam and 8-aminoclonazolam are actually the same molecule with the amino group in the same position, this difference may cause confusion to lay people such as judges, lawyers and juries. Intentional dilution may occur either with intentional ingestion of copious amounts of water or by adding water to the urine sample from the restroom sink or toilet. Hospitalization/Emergency Department Visit: Patients who arrive at the emergency room with a suspected poisoning or overdose may be given benzodiazepines depending on their presenting symptoms and the source of the toxicity. Using LC-MS/MS, clonazepam was detected in 297 traffic cases, 92 criminal cases (perpetrators or victims of a crime) and in 140 postmortem cases. trailer . Using molecular similarity to highlight the challenges of routine immunoassay-based drug of abuse/toxicology screening in emergency medicine. [136], It is marketed under the trade name Rivotril by Roche in Argentina, Australia, Austria, Bangladesh, Belgium, Brazil, Bulgaria, Canada, Colombia, Costa Rica, Croatia, the Czech Republic, Denmark, Estonia,[137] Germany, Hungary, Iceland, Ireland, Italy, China, Mexico, the Netherlands, Norway, Portugal, Peru, Pakistan, Romania, Serbia, South Africa, South Korea, Spain, Turkey, and the United States; Emcloz, Linotril, Lonazep and Clonotril in India and other parts of Europe; under the name Riklona in Indonesia and Malaysia; and under the trade name Klonopin by Roche in the United States. Determination of bromazepam, clonazepam and metabolites after a single intake in urine and hair by LC-MS/MS. The central nervous system depressing effects of the drug can be intensified by alcohol consumption, and therefore alcohol should be avoided while taking this medication. Clonazepam's mode of action is to decrease abnormal electrical energy in the brain. Clonazepam in particular is more prone to stability issues. Stability of pain-related medications, metabolites, and illicit substances in urine. 8600 Rockville Pike Use all medications as directed by your doctor. A review of medical records may be necessary to determine the medications given to the patient prior to or during a procedure. published a procedure using LC/MS/MS for the detection of some benzodiazepines in urine, including 7-aminonitrazepam, 7-aminoclonazepam, 7-aminoflunitrazepam, alprazolam, alpha-hydroxyalprazolam, oxazepam, 3-OH-diazepam, and nordiazepam [4]. You don't need to prepare for this test. 215 23 3494-2. Brahm NC, Yeager LL, Fox MD, Farmer KC, Palmer TA. Is the patient on dialysis?If testing a dialysis patient, testing prior to dialysis is recommended or at least on a non-dialysis day to reduce the possibility of unexpected negative results. Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. 0000001741 00000 n Unable to load your collection due to an error, Unable to load your delegates due to an error. Following a single dose of Clonazepam is a medicine used to treat seizures. 2004 Oct 29;145(2-3):123-30. doi: 10.1016/j.forsciint.2004.04.066. Urine samples with such a low creatinine level are less concentrated, and urine drug concentrations may fall below the reporting threshold in such samples. 2015;11(1):618.17. 7-aminoclonazepam is superior to clonazepam for detection of clonazepam use in oral fluid by LC-MS/MS 7AC should be the analyte measured in OF for the detection of CLON use. A considerable amount of 7-aminoclonazepam (ACZP), a major metabolite of clonazepam (CZP), is present in the brain during CZP treatment, yet the pharmacological properties of ACZP remain unknown. Avoid driving or hazardous activity until you know how clonazepam will affect you. Bethesda, MD 20894, Web Policies The detection time may be less in all specimen types in cases of as-needed dosing or ingestion of low doses. Please enable it to take advantage of the complete set of features! may not be accurate if the sample is not handled properly. But be sure your healthcare provider knows 0000009216 00000 n startxref Ask your doctor before using opioid medication, a sleeping pill, a muscle relaxer, or medicine for anxiety or seizures. It consists of screening immunoassays for several drugs or drug classes, a quantitative enzymatic assay for ethanol and a gas chromatography-mass spectrometry (GC/MS) assay for a wide variety of therapeutic and abused drugs, as listed below. official website and that any information you provide is encrypted Swallow the regular tablet whole, with a full glass of water. [107][108], Benzodiazepines do not have any effect on the levels of GABA in the brain. Test Result Name. 1983;23:369-765. 65044. Clonazepam, like other benzodiazepines, may impair a person's ability to drive or operate machinery. [30][31] Bruxism also responds to clonazepam in the short-term. If the medication was directly administered to the patient by the treating provider, record of this may not be part of the patients PDMP report. Confirmation Tests Benzodiazepine Confirmation, Random, Urine Approximate Detection Times %%EOF 237 0 obj <>stream [24], Abrupt or over-rapid withdrawal from clonazepam may result in the development of the benzodiazepine withdrawal syndrome, causing psychosis characterised by dysphoric manifestations, irritability, aggressiveness, anxiety, and hallucinations. [6][132] These metabolites are excreted by the kidney. High dosage and long-term use increase the risk and severity of dependence and withdrawal symptoms. Clonazepam is used to treat certain seizure disorders (including absence seizures or Lennox-Gastaut syndrome) in adults and children. Development of an LC-MS/MS method for the simultaneous determination of 25 benzodiazepines and zolpidem in oral fluid and its application to authentic samples from regular drug users. [102] Because the exact drug ingested may not be distinguishable due to the overlapping metabolic pathways, positive results for Nordiazepam, Oxazepam, and/or Temazepam are reported by Aegis as Benzodiazepine Metabolites. Extraction and analysis of clonazepam and 7-aminoclonazepam in whole blood using a dual internal standard methodology. Benzodiazepine metabolism: an analytical perspective. A Case Report of Clonazepam Dependence: Utilization of Therapeutic Drug Monitoring During Withdrawal Period. Clin Infect Dis. [123], Clonazepam is a 2'-chlorinated derivative of nitrazepam, which increases its potency due to electron-attracting effect of the halogen in the ortho-position. Gourlay DL, Heit HA, Caplan YH. Never share clonazepam with another person. [80] Many studies have found that tolerance develops to the anticonvulsant properties of clonazepam with chronic use, which limits its long-term effectiveness as an anticonvulsant. Use in very young children may be especially hazardous. Detection Times of Diazepam, Clonazepam, and Alprazolam in Oral Fluid Collected From Patients Admitted to Detoxification, After High and Repeated Drug Intake. [14][15] In many areas of the world it is commonly used as a recreational drug. sharing sensitive information, make sure youre on a federal Benzodiazepines have been shown to cause dependence. 2009 Apr 28;9:5. doi: 10.1186/1471-227X-9-5. Kempf J, Wuske T, Schubert R, Weinmann W. Pre-analytical stability of selected benzodiazepines on a polymeric oral fluid sampling device. sharing sensitive information, make sure youre on a federal [10] Effects begin within one hour and last between six and twelve hours. FOIA We measured CLON and its primary metabolite 7-aminoclonazepam (7AC) by liquid chromatography-tandem mass spectrometry in OF specimens over a 2 month period. Copyright and Disclaimer, Department of Laboratory Medicine & Pathology, ALPHA-HYDROXYALPRAZOLAM (Xanax metabolite), 7-AMINOCLONAZEPAM (Clonazepam metabolite), 7-AMINOFLUNITRAZEPAM (Flunitrazepam metabolite), 10, 11-CARBAMAZEPINE EPOXIDE (Carbamazepine metabolite), DESALKYLFLURAZEPAM (Flurazepam metabolite), DEXTRORPHAN (Dextromethorphan metabolite; see LEVORPHANOL), DIPHENHYDRAMINE / DIMENHYDRINATE (Benadryl/Dramamine), ECGONINE METHYL ESTER (Cocaine metabolite), LEVORPHANOL/DEXTRORPHAN (optical isomers). benzodiazepine. Tell your doctor about all other medicines you use. World Psychiatry. The .gov means its official. [135], In some countries, clonazepam is used by criminals to subdue their victims. doi: 10.1097/MD.0000000000002881. As a major metabolite, 7-aminoclonazepam may be used to monitor use of the parent drug, clonazepam. J Opioid Manag. 91 (91.0%) confirmed positive for 7AC (median, range: 4.2, 0.5-316.7 ng/ml) using the ion ratio test, while only 44 of the 100 (44.0%) samples confirmed positive for CLON (median, range: 3.7, 0.5-217.2 ng/ml) using the ion ratio test. Unauthorized use of these marks is strictly prohibited. The range of clonazepam+7-aminoclonazepam concentrations in these five cases ranged from 0.26 to 0.54 mg/kg (median 0.29 mg/kg). Clonazepam is a medicine used to treat seizures. Place the tablet in your mouth and allow it to dissolve, without chewing. Get emergency medical help if you have signs of an allergic reaction to clonazepam: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. In OF the levels of 7AC were approximately 2.4-fold higher than CLON. Results are given in micrograms per milliliter (mcg/mL). Version 2.73 58365-87-Aminoclonazepam [Presence] in Urine by Confirmatory methodActive Part Description LP28541-8 7-Aminoclonazepam 7-Aminoclonazepam is a metabolite of clonazepam, a benzdiazepine drug used to treat or control seizures, panic attacks, and akathisia. Keep the medication in a place where others cannot get to it. Continue reading. Johnson-Davis KL, Sadler AJ, Genzen JR. A retrospective analysis of urine drugs of abuse immunoassay true positive rates at a national reference laboratory. Do not start or stop seizure medication during pregnancy without your doctor's advice. stinging sensation or pain. In these cases, the claimed sensitivity is inadequate to detect the presence of the drug in urine even after an overdose. Okuom MO, Wilson MV, Jackson A, Holmes AE. Seizures are often treated with a combination of drugs. [92], Clonazepam may aggravate hepatic porphyria. Generic name: clonazepam [kloe-NAZ-e-pam] Storhaug LW, Enger A, Hjelmeland K, iestad EL, Vindenes V. Forensic Sci Int. Online ahead of print. [32] Rapid eye movement sleep behavior disorder responds well to low doses of clonazepam. xb```b`` " ,@QU@CM^R2x_c The use of 7AC as an analyte for the detection of both CLON compliance and undisclosed use is also recommended. 0000001552 00000 n A review of the literature on sleep related disorders and abnormal sexual behaviors and experiences", "FDA expands Boxed Warning to improve safe use of benzodiazepine drug", "Get Some Sleep: Beware the sleeping pill hangover", "Recent advances in drug therapy for epilepsy", "The effects of neuroleptics on the GABA-induced Cl- current in rat dorsal root ganglion neurons: differences between some neuroleptics", "Interictal acute psychoses in temporal lobe epilepsy during withdrawal of anticonvulsant therapy", "Clonazepam, Prescription Marketed Drugs", "Sleep and aging: 2. Procedural Administration: Abenzodiazepine may be administered as an anxiolytic or sedative prior to medical procedures. WARNING This product is not for human or veterinary use. Drug monitoring of benzodiazepines is often performed in toxicology and pain management settings. Efavirenz treatment and false-positive results in benzodiazepine screening tests. One volunteer was still positive 28 days after administration. It may also be used to treat Clonazepam (CLON) is not only frequently prescribed in addiction management but is also commonly abused. PUGVIEW FETCH ERROR: 503 National Center for Biotechnology Information 8600 Rockville Pike, Bethesda, MD, 20894 USA Contact Policies FOIA HHS Vulnerability Disclosure National Library of Medicine National Institutes of Health An official website of the United States government. 2015 Aug;37(4):451-60. doi: 10.1097/FTD.0000000000000174. The concentrations were thus similar among the groups, although the median value was highest in the postmortem group. It is typically taken by mouth. Do not stop using clonazepam suddenly, even if you feel fine. Six of the volunteers had urine concentrations of 7-ACLO that peaked at 1 day after administration. J Chromatogr B Analyt Technol Biomed Life Sci. These data illustrate the limitations of using a 200 ng/ mL cutoff to monitor clonazepam compliance and suggest that a cutoff of 40 ng/mL or less is needed to reliably monitor use of this drug. 2016 May;40(4):310-2. doi: 10.1093/jat/bkw020. Determination of bromazepam, clonazepam and metabolites after a single intake in urine and hair by LC-MS/MS. Please see below for a list of drugs which may cause a false positive for benzodiazepines on POCT.6,11-15 Please refer to the package insert that came with the POCT device being used or contact the manufacturer for more information regarding which drugs may cause false positive results as this information may differ among devices and manufacturers. This site needs JavaScript to work properly. Due to the risks of tolerance and withdrawal seizures, clonazepam is generally not recommended for the long-term management of epilepsies. Before 7-Aminoclonazepam. treatment. Urinary analyses of the metabolite 7-aminoclonazepam (7-AC) can be helpful in monitoring drug abuse and in the context of suspected drug-facilitated sexual assaults (DFSA). PMC Ask your healthcare provider what your test results mean for you. 2023 University of Rochester Medical CenterRochester, NY, Clinical and Translational Sciences Institute, Monroe County Community Health Improvement Plan. Read the medication guide or patient instructions provided with each medication. [9], There is some medical evidence of various malformations (for example, cardiac or facial deformations when used in early pregnancy); however, the data is not conclusive. In some cases, as with fentanyl, drugs are included on this list because the assay is also used to detect the drug in pharmaceutical preparations. Coronavirus (COVID-19): Latest Updates | Visitation PoliciesVisitation PoliciesVisitation PoliciesVisitation PoliciesVisitation Policies | COVID-19 Testing | Vaccine InformationVaccine InformationVaccine Information. [9], Tolerance to the anticonvulsant effects of clonazepam occurs in both animals and humans. Urine drug testing in clinical practice: the art and science of patient care. and phenytoin. 7AC should be the analyte measured in OF for the detection of CLON use. scribed class of drugs in the USA. Detection of Nitrobenzodiazepines and Their 7-Amino Metabolites in Oral Fluid. It is thought that benzodiazepines work by enhancing the activity of certain neurotransmitters in the brain. Washington, D.C. AACC Press;2013:149-69.15. government site. Would you like email updates of new search results? Providers may consider the possibility of reduced absorption of drug and potential impact on unexpected negative results in these patients. and transmitted securely. Sadrabadi EA, Khosravi F, Benvidi A, Shiralizadeh Dezfuli A, Khashayar P, Khashayar P, Azimzadeh M. Biosensors (Basel). HHS Vulnerability Disclosure, Help Because of the intended primary use of the comprehensive drug screen, the GC/MS assay was designed for rapid detection of a wide range of drugs when present at overdose concentrations, rather than for high sensitivity for any specific drug. El cctel de pastillas que usaba una "viuda negra" para doblegar a sus incautos pretendientes", Poisons Information Monograph - Clonazepam, https://en.wikipedia.org/w/index.php?title=Clonazepam&oldid=1137276195, GABAA receptor positive allosteric modulators, Drugboxes which contain changes to watched fields, Articles with unsourced statements from December 2015, All Wikipedia articles needing clarification, Wikipedia articles needing clarification from February 2014, Wikipedia medicine articles ready to translate, Creative Commons Attribution-ShareAlike License 3.0, Clonazepam has also been found effective in treating other, Benzodiazepines, such as clonazepam, are sometimes used for the treatment of, Potential to exacerbate existing panic disorder upon discontinuation, This page was last edited on 3 February 2023, at 19:46. Background: Copyright 1996-2023 Cerner Multum, Inc. Some withdrawal symptoms may last up to 12 months or longer. [118][119] Clonazepam decreases release of acetylcholine in the feline brain[120] and decreases prolactin release in rats. However, negative results do not necessarily indicate the absence of the drug in question. Management of sleep disorders in older people", "Benzodiazepine Equivalency Table: Benzodiazepine Equivalency", "Effects of commonly used benzodiazepines on the fetus, the neonate, and the nursing infant", "Solubilization of peripheral benzodiazepine-binding sites from rat kidney", "What are the equivalent doses of oral benzodiazepines? [105], Clonazepam enhances the activity of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) in the central nervous system to give its anticonvulsant, skeletal muscle relaxant, and anxiolytic effects. 1B). Both the parent drug and 7-aminoclonazepam are unstable in biofluids, and therefore specimens should be preserved with sodium fluoride, stored at the lowest possible temperature and analyzed quickly to minimize losses. 0000000770 00000 n All urine samples (1 mL) were extracted following addition of the internal standard (D(5)-diazepam) and enzymatic hydrolysis ( beta-glucuronidase) using solid-phase extraction columns. Nordal K, iestad EL, Enger A, Christophersen AS, Vindenes V. Ther Drug Monit. Moosmann B, Link LA, Auwarter V. Designer benzodiazepines: a new challenge. 2004 Dec;62 Suppl 12:360-3. Clonazepam is detected as the metabolite 7-aminoclonazepam. Before National Library of Medicine Clonazepam can slow or stop your breathing, especially if you have recently used an opioid medication or alcohol. Withdrawal seizures and psychosis can occur in severe cases of withdrawal, and anxiety and insomnia can occur in less severe cases of withdrawal. The criteria for non-medical use in this study were purposefully broad, and include, for example, drug abuse, accidental or intentional overdose, or adverse reactions resulting from legitimate use of the medication.[134]. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. sharing sensitive information, make sure youre on a federal

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