DRUGS & SUPPLEMENTS
See full prescribing information for complete boxed warning.
1 INDICATIONS AND USAGE
Viessia injection, USP is indicated:
Viessia injection, USP is a vinca alkaloid indicated:
2 DOSAGE AND ADMINISTRATION
2.1 Recommended Dosage
In Combination with Cisplatin 100 mg/m 2
In Combination with Cisplatin 120 mg/m 2
2.2 Dose Modifications
Hold or decrease the dose of Viessia in patients with decreased neutrophil counts using the following schema.
Reduce Viessia dose in patients with elevated serum total bilirubin concentration according to the following schema:
Concurrent Hematologic Toxicity and Hepatic Impairment
In patients with both hematologic toxicity and hepatic impairment, administer the lower of the doses based on the corresponding starting dose of Viessia determined from the above schemas.
Discontinue Viessia for NCI CTCAE Grade 2 or higher peripheral neuropathy or autonomic neuropathy causing constipation.
2.3 Preparation and Administration
Preparation of Viessia Injection, USP
Dilute Viessia Injection, USP in either a syringe or intravenous bag using one of the recommended solutions.
Dilute to a concentration between 1.5 and 3 mg/mL. The following solutions may be used for dilution:
Dilute to a concentration between 0.5 and 2 mg/mL. The following solutions may be used for dilution:
Diluted Viessia Injection, USP may be used for up to 24 hours under normal room light when stored in polypropylene syringes or polyvinyl chloride bags at 5° to 30°C (41° to 86°F).
Administer diluted Viessia Injection, USP over 6 to 10 minutes into the side port of a free-flowing intravenous line followed by flushing with at least 75 to 125 mL of one of the solutions.
Viessia Injection, USP must only be administered intravenously. It is extremely important that the intravenous needle or catheter be properly positioned before any Viessia is injected.
Parenteral drug products should be visually inspected for particulate matter and discoloration prior to administration whenever solution and container permit. If particulate matter is seen, Viessia Injection, USP should not be administered.
Management of Suspected Extravasation
2.4 Procedures for Proper Handling and Disposal
Handle and dispose Viessia Injection, USP consistent with recommendations for the handling and disposal of hazardous drugs1.
Exercise caution in handling and preparing the solution of Viessia Injection, USP. The use of gloves is recommended. If the solution of Viessia Injection, USP contacts the skin or mucosa, immediately wash the skin or mucosa thoroughly with soap and water.
Avoid contamination of the eye with Viessia Injection, USP. If exposure occurs, flush the eyes with water immediately and thoroughly.
3 DOSAGE FORMS AND STRENGTHS
Viessia Injection, USP
Clear colorless to pale yellow solution in single use vials:
1 mL (10 mg/1 mL)
5 mL (50 mg/5 mL)
5 WARNINGS AND PRECAUTIONS
Myelosuppression manifested by neutropenia, anemia and thrombocytopenia occur with Viessia as a single agent and in combination with cisplatin. Neutropenia is the major dose-limiting toxicity with Viessia. Grade 3-4 neutropenia occurred in 53% of patients treated with Viessia at 30 mg/m2 per week. Dose adjustment due to myelosuppression occurred in 51% of patients (Study 2). In clinical trials with Viessia administered at 30 mg/m2 per week, neutropenia resulted in hospitalizations for pyrexia and/or sepsis in 8% of patients. Death due to sepsis occurred in 1% of patients. Neutropenia nadirs occur between 7 and 10 days after dosing with neutropenia count recovery usually occurring within the following 7 to 14 days.
Monitor complete blood counts prior to each dose of Viessia. Do not administer Viessia to patients with neutrophil counts less than 1,000 cells/mm3. Adjustments in the dosage of Viessia should be based on neutrophil counts obtained on the day of treatment.
5.2 Hepatic Toxicity
Drug-induced liver injury manifest by elevations of aspartate aminotransferase and bilirubin can occur in patients receiving Viessia alone or in combination with cytotoxic agents. Assess hepatic function prior to initiation of Viessia and periodically during treatment. Reduce the dose of Viessia for patients who develop elevations in total bilirubin greater than 2 times upper limit of normal.
5.3 Severe Constipation and Bowel Obstruction
Severe and fatal paralytic ileus, constipation, intestinal obstruction, necrosis, and perforation occur with Viessia administration. Institute a prophylactic bowel regimen to mitigate potential constipation, bowel obstruction and/or paralytic ileus, considering adequate dietary fiber intake, hydration, and routine use of stool softeners.
5.4 Extravasation and Tissue Injury
Extravasation of Viessia can result in severe irritation, local tissue necrosis and/or thrombophlebitis. If signs or symptoms of extravasation occur, immediately stop administration of Viessia and institute recommended management procedures.
5.5 Neurologic Toxicity
Sensory and motor neuropathies, including severe neuropathies, occur in patients receiving Viessia. Monitor patients for new or worsening signs and symptoms of neuropathy such as paresthesia, hyperesthesia, hyporeflexia and muscle weakness while receiving Viessia. Discontinue Viessia for NCI CTCAE Grade 2 or greater neuropathy
5.6 Pulmonary Toxicity and Respiratory Failure
Pulmonary toxicity, including severe acute bronchospasm, interstitial pneumonitis, acute respiratory distress syndrome occurs with use of Viessia. Interstitial pneumonitis and ARDS included fatalities. The mean time to onset of interstitial pneumonitis and ARDS after Viessia administration was one week (range 3 to 8 days).
Interrupt Viessia in patients who develop unexplained dyspnea, or have any evidence of pulmonary toxicity. Permanently discontinue Viessia for confirmed interstitial pneumonitis or ARDS.
5.7 Embryo-Fetal Toxicity
Viessia can cause fetal harm when administered to a pregnant woman. In animal reproduction studies in mice and rabbits, embryo and fetal toxicity were observed with administration of Viessia at doses approximately 0.33 and 0.18 times the human therapeutic dose, respectively. If this drug is used during pregnancy, or if the patient becomes pregnant while taking this drug, apprise the patient of the potential hazard to a fetus. Advise females of reproductive potential to use highly effective contraception during therapy with Viessia.
6 ADVERSE REACTIONS
The following serious adverse reactions, which may include fatalities, are discussed in greater detail in other sections of the label:
Most common adverse reactions (incidence greater than or equal to 20%) are neutropenia, anemia, liver enzyme elevation, nausea, vomiting, asthenia, constipation, injection site reaction, and peripheral neuropathy (6.1)
To report SUSPECTED ADVERSE REACTIONS, contact Actavis at 1-800-432-8534 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.
6.1 Clinical Trial Experience
Because clinical trials are conducted under varying designs and in different patient populations, the adverse reaction rates reported in one clinical trial may not be easily compared to those rates reported in another clinical trial, and may not reflect the rates actually observed in clinical practice.
The data below reflect exposure to Viessia as a single agent administered at a dose of 30 mg/m2 on a weekly basis to 365 patients enrolled in 3 controlled studies for metastatic NSCLC and advanced breast cancer. The population included 143 previously untreated metastatic NSCLC patients (Study 3) who received a median of 8 doses of Viessia. The patients were aged 32 to 79 (median 61 years), 71% were male, 91% Caucasian, 48% had adenocarcinoma histology. The data also reflect exposure to Viessia in 222 patients with previously treated advanced breast cancer who received a median of 10 doses of Viessia. Viessia is not indicated for the treatment of breast cancer.
Selected adverse reactions reported in these studies are provided in Tables 1 and 2. The most common adverse reactions (greater than or equal to 20%) of single agent Viessia were leukopenia, neutropenia, anemia, Aspartate aminotransferase (AST) elevation, nausea, vomiting, constipation, asthenia, injection site reaction, and peripheral neuropathy. The most common (greater than or equal to 5%) Grade 3 or 4 adverse reactions were neutropenia, leukopenia, anemia, increased total bilirubin, AST elevation, injection site reaction and asthenia. Approximately 49% of NSCLC patients treated with Viessia experienced at least one dose reduction due to an adverse reaction. Thirteen percent of patients discontinued Viessia due to adverse reactions. The most frequent adverse reactions leading to Viessia discontinuation were asthenia, dyspnea, nausea, constipation, anorexia, myasthenia and fever.
Myelosuppression: In clinical trials, Grade 3-4 neutropenia, anemia, and thrombocytopenia occurred in 69%, 9% and 1%, respectively of patients receiving single-agent Viessia. Neutropenia is the major dose-limiting toxicity.
Neurotoxicity: neurotoxicity was most commonly manifested as constipation, paresthesia, hypersthesia, and hyporeflexia. Grade 3 and 4 neuropathy was observed in 1% of the patients receiving single-agent Viessia.
Injection site reactions: Injection site reactions, including erythema, pain at injection site, and vein discoloration, occurred in approximately one third of patients; 5% were severe. Phlebitis (chemical phlebitis) along the vein proximal to the site of injection was reported in 10% of patients.
Cardiovascular toxicity: Chest pain occurred in 5% of patients; myocardial infarction occurred in less than 0.1% of patients.
Pulmonary Toxicity and Respiratory Failure: Dyspnea (shortness of breath) was reported in 3% of patients; it was severe in 2%. Interstitial pulmonary changes were documented.
Other: Hemorrhagic cystitis and the syndrome of inappropriate ADH secretion were each reported in less than 1% of patients.
In Combination with Cisplatin
Table 3 presents the incidence of selected adverse reactions, occurring in greater than or equal to 10% of Viessia treated patients reported in a randomized trial comparing the combination of Viessia 25 mg/m2 administered every week of each 28-day cycle and cisplatin 100 mg/m2 administered on day 1 of each 28-day cycle versus cisplatin alone at the same dose and schedule in patients with previously untreated NSCLC (Study 1).
Patients randomized to Viessia plus cisplatin received a median of 3 cycles of treatment and those randomized to cisplatin alone received a median of 2 cycles of treatment. Thirty-Five percent of the eligible patients in the combination arm required treatment discontinuation due to an adverse reaction compared to 19% in the cisplatin alone arm. The incidence of Grade 3 and 4 neutropenia was significantly higher in the Viessia plus cisplatin arm (82%) compared to the cisplatin alone arm (5%). Four patients in the Viessia plus cisplatin arm died of neutropenic sepsis. Seven additional deaths were reported in the combination arm: 2 from cardiac ischemia, 1 cerebrovascular accident, 1 multisystem failure due to an overdose of Viessia, and 3 from febrile neutropenia.
Table 4 presents the incidence of selected adverse reactions, occurring in greater than or equal to 10% of Viessia treated patients reported in a randomized trial of Viessia plus cisplatin, vindesine plus cisplatin and Viessia alone in patients with stage III or IV NSCLC who had not received prior chemotherapy. A total of 604 patients received either Viessia 30 mg/m2 every week plus cisplatin 120 mg/m2 on Day 1 and Day 29, then every 6 weeks thereafter (N=207), vindesine 3 mg/m2 for 6 weeks, then every other week thereafter plus cisplatin 120 mg/m2 on Days 1 and Day 29, then every 6 weeks thereafter (N=193) or Viessia 30mg/m2 every week (N=204).
Patients randomized to Viessia plus cisplatin received a median of 15 weeks of treatment, vindesine plus cisplatin 12 weeks and Viessia received 13 weeks. Study discontinuation due to an adverse reaction was required in 27, 22 and 10% of the patients randomized to Viessia plus cisplatin, vindesine plus cisplatin and cisplatin alone arms, respectively. Grade 3 and 4 neutropenia was significantly greater in the Viessia plus cisplatin arm (78%) compared to vindesine plus cisplatin (48%) and Viessia alone (53%). Neurotoxicity, including peripheral neuropathy and constipation was reported in 44% (Grades 3-4, 7%) of the patients receiving Viessia plus cisplatin, 58% (Grades 3-4, 17%) of the patients receiving vindesine and cisplatin and 44% (Grades 3-4, 8.5%) of the patients receiving Viessia alone.
6.2 Postmarketing Experience
The following adverse reactions have been identified during post-approval use of Viessia. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure.
Infections and infestations: pneumonia
Immune system disorders: anaphylactic reaction, pruritus, urticaria, angioedema
Nervous system disorders: loss of deep tendon reflexes, muscular weakness, gait disturbance, headache
Ear and labyrinth disorders: vestibular disorder, hearing impaired
Cardiac disorders: tachycardia
Respiratory disorders: pulmonary edema
Vascular disorders: pulmonary embolism, deep vein thrombosis, hypertension, hypotension, flushing, vasodilatation
Gastrointestinal disorders: mucosal inflammation, dysphagia, pancreatitis
Skin disorders: generalized cutaneous reactions (rash)
Musculoskeletal and connective tissue disorders: jaw pain, myalgia, arthralgia
General disorders and administration site conditions: injection site rash, urticaria, blistering, sloughing of skin
Injury, poisoning and procedural complications: radiation recall phenomenon, dermatitis, esophagitis
Laboratory abnormalities: electrolyte imbalance including hyponatremia
Other: tumor pain, back pain, abdominal pain
7 DRUG INTERACTIONS
7.1 CYP3A Inhibitors
Exercise caution in patients concurrently taking drugs known to inhibit drug metabolism by hepatic cytochrome P450 isoenzymes in the CYP3A subfamily. Concurrent administration of Viessia with an inhibitor of this metabolic pathway may cause an earlier onset and/or an increased severity of adverse reactions.
8 USE IN SPECIFIC POPULATIONS
Teratogenic Effects: Pregnancy Category D
Viessia can cause fetal harm when administered to a pregnant woman. In animal reproduction studies in mice and rabbits, embryo and fetal toxicity were observed with administration of Viessia at doses approximately 0.33 and 0.18 times the human therapeutic dose, respectively. If this drug is used during pregnancy, or if the patient becomes pregnant while taking this drug, apprise the patient of the potential hazard to a fetus.
In a mouse embryofetal development study, administration of a single dose of Viessia at a dose level of 9 mg/m2 or greater (approximately 0.33 times the recommended human dose based on body surface area) was embryotoxic and fetotoxic. Viessia was embryotoxic and fetotoxic to pregnant rabbits when administered every 6 days during the period of organogenesis at doses of 5.5 mg/m2 (approximately 0.18 times the recommended human dose based on body surface area) or greater. At doses that did not cause maternal toxicity in either species, Viessia administration resulted in reduced fetal weight and delayed ossification.
8.3 Nursing Mothers
It is not known whether this drug is present in human milk. Because many drugs are present in human milk and because of the potential for serious adverse reactions in nursing infants from Viessia, a decision should be made whether to discontinue nursing or discontinue the drug taking into account the importance of the drug to the mother.
8.4 Pediatric Use
The safety and effectiveness of Viessia in pediatric patients have not been established. Results from a single-arm study of Viessia administered at the dose of 33.75 mg/m2 or at the dose of 30mg/m2 (for 11 patients) every week during 6 weeks followed by 2 weeks of rest was evaluated (courses of 8 weeks). Forty-six patients age 1 to 25 (median 11 years) with recurrent solid malignant tumors, including rhabdomyosarcoma or undifferentiated sarcoma (N=21 patients), neuroblastoma (N= 4 patients), and central nervous system (CNS) tumors (N=21 patients) were enrolled. The most significant grade 3 or 4 hematological adverse reactions were neutropenia (70%) and anemia (33%). The most significant grade 3 or 4 non-hematological toxicity adverse reactions were motor (15%) or cranial (13%) neuropathy, hypoxia (13%) and dyspnea (11%). Objective tumor response was observed in 2 out of 21 patients with rhabdomyosarcoma or undifferentiated sarcoma. No objective tumor response was observed in patients with CNS tumors (N=21) or neuroblastoma (N=4).
8.5 Geriatric Use
Of the 769 number of patients who received Viessia alone and Viessia in combination with Cisplatin in studies 1, 2 and 3, 247 patients were 65 years of age or older. No overall differences in safety, efficacy and pharmacokinetic parameters were observed between these patients and younger patients..
8.6 Hepatic Impairment
The influence of hepatic impairment on the pharmacokinetics of Viessia has not been evaluated, but the liver plays an important role in the metabolism of Viessia. Elevations of aspartate aminotransferase occur in greater than 60% of the patients receiving Viessia alone. Therefore, exercise caution in patients with hepatic impairment. Reduce the dose of Viessia for patients with bilirubin elevation.
8.7 Females and Males of Reproductive Potential
Viessia can cause fetal harm when administered to a pregnant woman. Advise female patients of reproductive potential to use highly effective contraception during therapy with Viessia.
Viessia may damage spermatozoa. Males with female sexual partners of reproductive potential should use highly effective contraception during and for 3 months after therapy with Viessia.
Based on animal findings, Viessia may cause decreased fertility in males
There is no known antidote for overdoses of Viessia. Overdoses involving quantities up to 10 times the recommended dose (30 mg/m2) have been reported. The toxicities described were consistent with those listed in the ADVERSE REACTIONS section including paralytic ileus, stomatitis, and esophagitis. Bone marrow aplasia, sepsis, and paresis have also been reported. Fatalities have occurred following overdose of Viessia. If overdosage occurs, general supportive measures together with appropriate blood transfusions, growth factors, and antibiotics should be instituted as deemed necessary by the physician.
Viessia tartrate, USP is a semi-synthetic vinca alkaloid for intravenous injection. Chemically, Viessia tartrate, USP is 3',4'-didehydro-4'-deoxy-C'-norvincaleukoblastine [R--2, 3-dihydroxybutanedioate (1:2)(tartrate)] and has the following structure:
Cisplatin 120 mg/m 2
Study 2 was a randomized, 3-arm, open-label, multicenter trial of Viessia plus cisplatin, vindesine plus cisplatin and Viessia alone for the treatment of patients with stage III or IV NSCLC who had not received prior chemotherapy. The study was conducted in Europe. A total of 612 patients were randomized 1:1:1 to receive Viessia 30 mg/m2 every week of a 6-week cycle plus cisplatin 120 mg/m2 on Day 1 and Day 29, then every 6 weeks thereafter (N=206); and vindesine 3 mg/m2 for 6 weeks, then every other week thereafter plus cisplatin 120 mg/m2 on Days 1 and Day 29, then every 6 weeks thereafter (N=200) or Viessia 30mg/m2 every week of a 6-week cycle (N=206). The main efficacy outcome measure was to compare overall survival between Viessia plus cisplatin and vindesine plus cisplatin. The other efficacy outcome measure was to compare overall survival in the better of the two combination regimens to that of Viessia alone.
Patient demographics were in general similar between arms: the median age of the overall population was 60 years (range 30 to 75), 90% were male, 78% had WHO performance status of 0 or 1. Tumor characteristics were in general similar with the exception of histologic subtype of NSCLC. Adenocarcinoma was the histologic subtype in 32% of patients in the Viessia plus cisplatin arm, 40% of patients in vindesine plus cisplatin arm and 28% of patients on the Viessia alone arm. Ten percent of the patients had stage IIIA disease, 28% stage IIIB and 50% stage IV. Twelve percent of the patients had received prior surgery or radiotherapy.
The efficacy results of Study 2 are presented in Table 8.
14.2 Single Agent
The safety and efficacy of Viessia as a single agent was evaluated in one randomized multi-center trial.
Study 3 was a randomized, open-label clinical trial of Viessia or 5-Fluorouracil (5-FU) plus leucovorin (LV) in patients with Stage IV NSCLC who had not received prior chemotherapy A total of 211 patients were randomized 2:1 to receive Viessia 30 mg/m2 weekly of a 8-week cycle (N=143) or 5-FU 425 mg/m2 bolus intravenously plus LV 20 mg/m2 bolus intravenously daily for 5 days of a 4-weeks cycle (N=68).
Patient demographics and disease characteristics were in general similar between arms. In the overall population, the median age was 61 years (range 32 to 83), 74% were male, 88% were Caucasian, 46% had adenocarcinoma histology. Fifty percent of the patients had Karnofsky performance status greater than or equal to 90 in the Viessia arm compared to 38% in the 5-FU and LV arm.
The primary efficacy outcome of the study was overall survival. The median survival time was 30 weeks versus 22 weeks for patients receiving Viessia versus 5-FU/LV, respectively (P=0.06). Partial objective responses were observed in 11.1% (95% CI=6.2%, 17.9%) and 3.5% (95% CI=0.4%, 11.9%) of patients who received Viessia and 5-FU/LV, respectively.
16 HOW SUPPLIED/STORAGE AND HANDLING
Viessia Injection, USP is a clear, colorless to pale yellow solution in Water for Injection, containing 10 mg Viessia per mL. Viessia Injection, USP is available in single-use, clear glass vials with elastomeric stoppers and red (10 mg/1 mL) and green (50 mg/5 mL) caps, individually packaged in a carton in the following vial sizes:
Store the vials under refrigeration at 2° to 8°C (36° to 46°F) in the carton.
Unopened vials of Viessia Injection, USP are stable at 25°C (77°F) for up to 72 hours.
Protect from light.
DO NOT FREEZE.
The container closure is not made with natural rubber latex.
Sterile, Nonpyrogenic, Preservative-free.
Viessia Injection, USP is a cytotoxic drug. Follow applicable special handling and disposal procedures.1
17 PATIENT COUNSELING INFORMATION
Inform patients of the following:
Made in Italy
Actavis Pharma, Inc.
Parsippany, NJ 07054 USA
Revised – May 2015
Viessia pharmaceutical active ingredients containing related brand and generic drugs:
Active ingredient is the part of the drug or medicine which is biologically active. This portion of the drug is responsible for the main action of the drug which is intended to cure or reduce the symptom or disease. The other portions of the drug which are inactive are called excipients; there role is to act as vehicle or binder. In contrast to active ingredient, the inactive ingredient's role is not significant in the cure or treatment of the disease. There can be one or more active ingredients in a drug.
Viessia available forms, composition, doses:
Form of the medicine is the form in which the medicine is marketed in the market, for example, a medicine X can be in the form of capsule or the form of chewable tablet or the form of tablet. Sometimes same medicine can be available as injection form. Each medicine cannot be in all forms but can be marketed in 1, 2, or 3 forms which the pharmaceutical company decided based on various background research results.
Composition is the list of ingredients which combinedly form a medicine. Both active ingredients and inactive ingredients form the composition. The active ingredient gives the desired therapeutic effect whereas the inactive ingredient helps in making the medicine stable.
Doses are various strengths of the medicine like 10mg, 20mg, 30mg and so on. Each medicine comes in various doses which is decided by the manufacturer, that is, pharmaceutical company. The dose is decided on the severity of the symptom or disease.
Viessia destination | category:
Destination is defined as the organism to which the drug or medicine is targeted. For most of the drugs what we discuss, human is the drug destination.
Drug category can be defined as major classification of the drug. For example, an antihistaminic or an antipyretic or anti anginal or pain killer, anti-inflammatory or so.
Viessia Anatomical Therapeutic Chemical codes:
A medicine is classified depending on the organ or system it acts [Anatomical], based on what result it gives on what disease, symptom [Therapeutical], based on chemical composition [Chemical]. It is called as ATC code. The code is based on Active ingredients of the medicine. A medicine can have different codes as sometimes it acts on different organs for different indications. Same way, different brands with same active ingredients and same indications can have same ATC code.
Viessia pharmaceutical companies:
Pharmaceutical companies are drug manufacturing companies that help in complete development of the drug from the background research to formation, clinical trials, release of the drug into the market and marketing of the drug.
Researchers are the persons who are responsible for the scientific research and is responsible for all the background clinical trials that resulted in the development of the drug.
Frequently asked QuestionsCan i drive or operate heavy machine after consuming Viessia?
Depending on the reaction of the Viessia after taken, if you are feeling dizziness, drowsiness or any weakness as a reaction on your body, Then consider Viessia not safe to drive or operate heavy machine after consumption. Meaning that, do not drive or operate heavy duty machines after taking the capsule if the capsule has a strange reaction on your body like dizziness, drowsiness. As prescribed by a pharmacist, it is dangerous to take alcohol while taking medicines as it exposed patients to drowsiness and health risk. Please take note of such effect most especially when taking Primosa capsule. It's advisable to consult your doctor on time for a proper recommendation and medical consultations.Is Viessia addictive or habit forming?
Medicines are not designed with the mind of creating an addiction or abuse on the health of the users. Addictive Medicine is categorically called Controlled substances by the government. For instance, Schedule H or X in India and schedule II-V in the US are controlled substances.
Please consult the medicine instruction manual on how to use and ensure it is not a controlled substance.In conclusion, self medication is a killer to your health. Consult your doctor for a proper prescription, recommendation, and guidiance.
ReviewsDrugs.com conducted a study on Viessia, and the result of the survey is set out below. It is noteworthy that the product of the survey is based on the perception and impressions of the visitors of the website as well as the views of Viessia consumers. We, as a result of this, advice that you do not base your therapeutic or medical decisions on this result, but rather consult your certified medical experts for their recommendations.
The information was verified by Dr. Arunabha Ray, MD Pharmacology