Inhibits the degradation of incretins such as GLP-1 by inhibiting the enzyme dipeptidyl peptidase IV (DPP-IV). The incretin effect is prolonged, enhancing glycemic control through various mechanisms, primarily by stimulating insulin synthesis and secretion in a glucose-dependant manner and by reducing glucagon secretion. brand name preparation manufacturer route form dosage^ cost* Januvia sitagliptin phosphate Merck oral tablet 25 mg $885 for 90 tabs oral tablet 50 mg $885 for 90 tabs oral tablet 100 mg $295 for 30 tabs Onglyza saxagliptin Bristol-Myers Squibb oral tablet 2.5 mg $295 for 30 tabs oral tablet 5 mg $885 for 90 tabs Tradjenta linagliptin Eli Lilly oral tablet 5 mg $870 for 90 tabs Janumet sitagliptin phosphate + metformin hydrochloride Merck Sharp & Dohme Corp. oral tablet 50/500 mg $885 for 180 tabs oral tablet 50/1000 mg $885 for 180 tabs Nesina alogliptin Takeda oral tablet 6.25 mg $374 for 30 tabs oral tablet 12.5 mg $374 for 30 tabs oral tablet 25 mg $374 for 30 tabs **Patient Assistant Programs: ** Information gathered by Heather Tran and Gladimir Elysee *Prices represent cost per unit specified, are representative of "Average Wholesale Price" (AWP). ^Dosage is indicated in mg unless otherwise noted. Continue reading >>
Diabetes Management Medications
DIABETES MANAGEMENT MEDICATIONS Annette Hess, PhD, FNP-BC, CNS University of Alabama at Birmingham School of Nursing Diabetes â€¢ 25.8 million children and adults (8.3% of the population) have diabetes in the U.S. â€¢ Disproportionately affects older people â€“ prevalence is higher among racial and ethnic minority populations â€¢ Annual economic burden of diabetes is estimated to be $174 billion â€“ $116 billion for direct medical costs â€“ $58 billion for indirect costs (disability, work loss, premature mortality) Diabetic Retinopathy Leading cause of blindness in adults Diabetic Nephropathy Major cause of kidney failure Cardiovascular Disease Stroke Diabetic Neuropathy Major cause of lower extremity amputations CV Disease & Stroke account for ~65% of deaths in T2D patients Type 2 Diabetes Associated with Serious Complications CV = cardiovascular. National Institute of Diabetes and Digestive and Kidney Diseases. National Diabetes Statistics fact sheet: general information and national estimates on diabetes in the United States, 2005. Bethesda, MD: U.S. Department of Health and Human Services, National Institute of Health, 2005. Background: Management â€¢ Management of hyperglycemia â€“ Crucial â€“ Improved macrovascular & microvascular outcomes â€¢ Controlling blood glucose levels â€“ Nutritional therapy â€“ MODERATION!! â€“ Weight loss, if needed â€“ Increased physical activity â€“ Antidiabetes medications Source: 2007â€“2009 National Health Interview Survey. Targets for Diabetes Control Biochemical Index ADA Goal ACE Goal A1C < 7% < 6.5% Preprandial Glucose 90-130 mg/dl <110 mg/dl Peak Postprandial Glucose <180 mg/dl ----- 2 Hour Postprandial Glucose --- <140 mg/dl Breakdown of Treatments for Continue reading >>
Combining a GLP-1 Agonist and a DPP-4 Inhibitor for Type 2 Diabetes Introduction Clinicians are curious about the utility of combining the incretin-based therapies GLP-1 agonists (e.g., exenatide [Byetta, Bydureon-U.S.], liraglutide [Victoza]) and DPP-4 inhibitors (e.g., linagliptin [Tradjenta-U.S., Trajenta-Canada], saxagliptin [Onglyza], sitagliptin [Januvia]). This combination might seem useful for patients who need multiple drugs to manage type 2 diabetes but want to avoid side effects such as weight gain or hypoglycemia with other medications like sulfonylureas or insulin. This document reviews the evidence for using a GLP-1 agonist with a DPP-4 inhibitor in patients with type 2 diabetes. Mechanisms of Incretin-Based Therapies Patients with diabetes have lower levels and impaired action of glucagon-like peptide-1 (GLP-1).1 GLP-1 agonist drugs (“incretin mimetics”) mimic the action of this incretin hormone. They are structurally similar, but not exactly the same as endogenous GLP-1.2 (Liraglutide is more similar to endogenous GLP-1 than exenatide.) Endogenous GLP-1 is quickly broken down by the enzyme dipeptidyl peptidase-4 (DPP-4). Modification of the structure of these GLP-1 analogs is a strategy to increase the half-life while retaining the physiologic effects of endogenous GLP-1.1 Endogenous GLP-1 is produced in response to food intake. It stimulates glucose-dependent insulin release and suppresses postprandial glucagon secretion. It also delays gastric emptying, which helps increase satiety. GLP-1 agonists not only help reduce A1C by approximately 1% to 1.5%, but they also can help patients lose weight.3,4 DPP-4 inhibitor drugs (“gliptins”) reduce the breakdown of endogenous GLP-1 by inhibiting the action of DPP-4. DPP-4 rapidly degrades endogenous GLP- Continue reading >>
5 Things Everyone Taking Diabetes Medications Should Do
Diabetes can definitely be a challenging condition to manage, especially when it comes to medications. If you are diabetic, there are five key things you need to do to get the most health benefits from your prescriptions. Guest post by: Mike Shelley Fourth Year Pharmacy Student Northeast Ohio Medical University As I approach the start of my career as a pharmacist at a community pharmacy, I look forward to the opportunity to help people understand and use their medications as wisely as possible. If you or someone you love is diabetic, I’d like to offer these tips, guidelines and recommendations for managing this condition. #1 — Keep a list of your medications with you. Keeping track of your medications can be a difficult task. Making a list is a great way to help you remember which medications you are taking and how you take them. Here are some things you should include for each medication on your list: Medication name (brand and/or generic) Medication strength Directions Prescriber For example, you might write down: Metformin (Glucophage) 500 mg, 1 tablet twice a day, Dr. Smith; or Lantus insulin, inject 30 units daily at bedtime, Dr. Wheeler. You may also want to add your emergency contact information, as well as the pharmacies you go to in case of an emergency. Also, make sure you update your list as changes are made to your medications! #2 — Be familiar with the medications you take. There are many medication options available to help lower your blood sugar; your doctor decides which medications are best for you based on your lifestyle, physical condition, how you respond to medications, and insurance coverage. Below are examples of each class of oral anti-diabetes medications and generic and brand names of each. Medication Class Medications Sulfonylureas Chlor Continue reading >>
Dpp-4 Inhibitors Januvia, Onglyza, Trajenta, Combiglyze, Janumet, And Jentadueto
The image I've chosen for this page is the Roman god, Janus, whose prime characteristic of facing in two directions seems very appropriate for the similarly named drug Januvia, which can be extremely effective and extremely dangerous. Januvia was the first of a family of diabetes drugs that works by increasing the levels of GLP-1 in the bloodstream. Newer drugs in this family include Onglyza and Trajenta, as well as combination drugs which mix the incretin drug in the same pill as metformin. These drugs are Janumet, Kombiglyze, and Jentadueto. GLP-1 is an incretin hormone that stimulates insulin secretion. Another kind of incretin drug, which includes Byetta and Victoza are artificially synthesized molecules that behave just like GLP-1 in the body but last longer. The DPP-4 inhibitors are quite different. They are pills that cause the GLP-1 your body secretes on its own to rise to a higher than normal level by inhibiting the action of DPP-4. DPP-4 is an enzyme (a.k.a. protease) which when it is left to its own devices, chops up GLP-1 and another hormone, GIP. When DPP-4 is inhibited, GLP-1 does not get chopped up and remains active in the body. When GLP-1 is active, it stimulates insulin secretion when blood sugars rise. The Fatal Flaw with These Drugs: They Cause Abnormal Cell Growth and Pre-cancerous Tumors in the Pancreas For several years the FDA has been getting reports that drugs in both families of incretin drugs were causing pancreatitis, a painful inflammation of the pancreas that can destroy large portions of it and lead to full-fledged Type 1 diabetes or even death. They recently decided to study the issue, though, in typical FDA fashion they merely asked for more research without warning doctors to take patients off these dangerous drugs. A study run by a bi Continue reading >>
Onglyza - Uses, Side Effects, Interactions - Canoe.com
How does this medication work? What will it do for me? Saxagliptin belongs to the group of diabetes medications called DPP-4 inhibitors. It works by increasing the amount of incretin available in the body. Incretin is a hormone that is released by the intestines. It raises insulin levels when blood sugar is high and decreases the amount of sugar made by the body. Saxagliptin is used in combination with metformin, a sulfonylurea (e.g., gliclazide, glyburide), or insulin to improve blood sugar levels in adults with type 2 diabetes. This medication should be used as part of an overall diabetes management plan that includes a diet and exercise program. This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here. Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor. Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it. What form(s) does this medication come in? Each pale yellow, biconvex, round, film-coated tablet, with 2.5 printed on one side and 4214 printed on the other side in blue ink, contains saxagliptin 2.5 mg as saxagliptin hydrochloride. Nonmedicinal ingredients: croscarmellose sodium, lactose monohydrate, magnesium stear Continue reading >>
New Fda Warning That Januvia, Onglyza, Tradjenta, And Nesina Are Associated With "joint Pain That Can Be Severe And Disabling"
Label Changes About Side Effects For These Type 2 Diabetes Medicines In The Drug Class Called Dipeptidyl Peptidase-4 (DPP-4) Inhibitors In August 2015 the FDA announced that it has found indications of a new side effect for a class of diabetes drugs -- dipeptidyl peptidase-4 (DPP-4) inhibitors -- that includes Januvia, Onglyza, Tradjenta, and Nesina. The FDA found drug adverse event reports of arthralgia, or severe pain in one or more joints, associated with the use of DPP-4 inhibitor diabetes drugs, with Januvia being the one implicated most often, followed by Onglyza. According to the FDA, patients started having symptoms of the new side effect from one day to years after they started taking Januvia, Onglyza, Tradjenta, Nesina or one of the "combination" DPP-4 inhibitors, e.g., Janumet (sitagliptin and metformin). In more detail, the FDA reported that after the DPP-4 inhibitor medicine was discontinued, the patients' symptoms were usually relieved within less than a month of stopping the subject drug. Furthermore, some patients developed severe joint pain again when they restarted the same medicine or another DPP-4 inhibitor. This last fact provides some substantiation for linking this severe joint pain side effect with Januvia, Onglyza, Tradjenta, Nesina, and the other drugs in this DPP-4 inhibitors class. ____________________________________________________ Januvia / Onglyza / Tradjenta / Nesina Free Case Evaluation Strictly Confidential, No Obligation. _____________________________________________________ We get the following more detailed information from the "FDA Drug Safety Communication: FDA warns that DPP-4 inhibitors for type 2 diabetes may cause severe joint pain" document that was issued on August 28, 2015: In a search of the FDA Adverse Event Reporting Sys Continue reading >>
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Onglyza Drug Interactions - Drugs.com
Do not stop taking any medications without consulting your healthcare provider. Disclaimer: Every effort has been made to ensure that the information provided by Multum is accurate, up-to-date and complete, but no guarantee is made to that effect. In addition, the drug information contained herein may be time sensitive and should not be utilized as a reference resource beyond the date hereof. This material does not endorse drugs, diagnose patients, or recommend therapy. Multum's information is a reference resource designed as supplement to, and not a substitute for, the expertise, skill, knowledge, and judgement of healthcare practitioners in patient care. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate that the drug or combination is safe, effective, or appropriate for any given patient. Multum Information Services, Inc. does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. Copyright 2000-2018 Multum Information Services, Inc. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse, or pharmacist. Some mixtures of medications can lead to serious and even fatal consequences. Continue reading >>
Which Diabetes Drug Is Best?
TUESDAY, July 19, 2016 -- No single drug to treat type 2 diabetes stands out from the pack when it comes to reducing the risks of heart disease, stroke or premature death, a new research review finds. The analysis of hundreds of clinical trials found no evidence that any one diabetes drug, or drug combination, beats out the others. Researchers said the results bolster current recommendations to first try an older, cheaper drug -- metformin (Glumetza, Glucophage) -- for most patients with type 2 diabetes. "There are very few things experts agree on, but this is one of them," said Dr. Kevin Pantalone, a diabetes specialist at the Cleveland Clinic and a member of the Endocrine Society. "Metformin, in the absence of contraindications or intolerability, should be the first-line agent to treat patients with type 2 diabetes," he said. Metformin can cause upset stomach and diarrhea, so some patients are unable to stick with it day to day, explained Pantalone, who wasn't involved in the study. And people with kidney disease generally shouldn't take it, he said. More than 29 million Americans have diabetes -- mostly type 2, according to the U.S. Centers for Disease Control and Prevention. The disease, which is often linked to obesity, causes blood sugar levels to be chronically high. Over time, that can lead to complications, such as heart disease, stroke, kidney failure and nerve damage, the CDC says. There are numerous classes of medications that lower blood sugar levels. What's been unclear is whether any of those drugs work better than others in warding off diabetes complications and extending people's lives. The new analysis found no obvious winners. But the researchers also cautioned against drawing conclusions: The trials in the review were not specifically designed to see Continue reading >>
Onglyza: Just Like Januvia But With More Serious Side Effects?
NOTE (April 2, 2013): Before you take Onglyza or Januvia please read about the new research that shows that they, and probably all incretin drugs, cause severely abnormal cell growth in the pancreas and precancerous tumors. You'll find that information HERE. When the FDA approves a new drug it requires no proof that the drug is more effective than similar, existing drugs, only that it is better than placebo. Which is something to keep in mind as Bristol-Myers Squibb unveils what is sure to be a saturation advertising campaign for its new DPP-4 inhibitor, Onlgyza. This mellifluous moniker is the brand name for Saxagliptin, which alert followers of drug news remember as the Januvia clone developed at the same times as Januvia whose release has been blocked due to its ability to cause "skin lesions" some of which necrotized (i.e. died and fell off) in monkeys. I have read through the Prescribing Information for Onglyza and cannot see any benefit it offers in comparison to Januvia, the other DPP-4 inhibitor currently on the market. Setting aside for the time being the advisability of controlling your blood sugar by turning off a tumor suppressor gene Onglyza offers nothing not offered by Januvia. Both inhibit the expression of the DPP-4 gene for a full 24 hours--which means that if your body was fighting a new, very small DPP-4 sensitive tumor, like ovarian cancer, melanoma, prostate cancer or lung cancer, the drug would keep DPP-4 from killing off the tumor cells. 1. Feeble impact on blood sugar: Onglyza lowered A1cs that averaged 8% by .5%, which does not bring them anywhere near a safe level even by the anemic standards of the ADA. When the highest dose of Onglyza was compared to a placebo, it allowed only 14% more of those taking it to achieve 7% A1cs. To better underst Continue reading >>
Steps: Saxagliptin (onglyza) For Type 2 Diabetes Mellitus - American Family Physician
2.5 or 5.0 mg once daily; 2.5 mg in patients with moderate to severe renal dysfunction * Estimated retail price of one month's treatment based on information obtained at (accessed May 18, 2010). Few adverse effects have been associated with saxagliptin. Unlike some other oral hypoglycemics, when saxagliptin is used alone it does not increase the likelihood of hypoglycemia. 1 , 3 , 4 When used as monotherapy or add-on therapy with metformin or thiazolidinediones, saxagliptin has an incidence of hypoglycemia that is comparable with placebo. 1 , 3 7 The manufacturer states that hypoglycemia is more common when saxagliptin is combined with glyburide (formerly Micronase), although the frequency is not significantly higher than with glyburide alone (13.3 to 14.6 percent versus 10.1 percent, respectively). 2 , 3 In 0.5 to 1.5 percent of patients, saxagliptin decreases lymphocyte count and causes lymphocytopenia (i.e., lymphocyte count of 750 cells per L [0.75 109 per L] or less). Decreases in lymphocyte count have not caused any clinical sequelae; however, the effects of saxagliptin in patients with preexisting lymphocyte abnormalities (e.g., human immunodeficiency virus infection) are unknown. 3 Patients with moderate to severe renal dysfunction (creatinine clearance of less than 50 mL per minute per 1.73 m2 [0.83 mL per second per m2]) require a dosage reduction to 2.5 mg once daily. The lower dosage also should be used in patients receiving strong cytochrome P450 3A4 and 3A5 inhibitors, such as clarithromycin (Biaxin), ketoconazole, and the antivirals ritonavir (Norvir), nelfinavir (Viracept), and atazanavir (Reyataz). Saxagliptin is U.S. Food and Drug Administration pregnancy category B. 3 Saxagliptin is well tolerated and produces bothersome adverse effects to a similar Continue reading >>
Oral Diabetes Medications
A list of oral diabetes medications with advantages, disadvantages, and side effects. Click on the name of a drug for more information. Biguanides Glucophage (generic name: metformin) Glucophage XR (generic name: metformin hydrochloride) extended release Fortamet (generic name: metformin hydrochloride) extended release Glumetza (generic name: metformin hydrochloride) extended release Riomet (generic name: metformin hydrochloride liquid) What are Biguanides? Metformin is the only member of the biguanides family in use today. Metformin (met-FOR-min) helps lower blood glucose by making sure your liver does not put extra glucose into the system when it is not needed. The ADA Standards of Medical Care in Diabetes recommend the inclusion of metformin (along with diet and exercise) in initial diabetes treatment. A good thing about metformin is that it does not cause blood glucose to get too low (hypoglycemia) when it is the only diabetes medicine you take. Who can take this medicine? Adults with type 2 diabetes can take metformin with their doctor’s approval and supervision. You should avoid metformin if you have liver or kidney problems, lung or heart disease, or conditions that cause low blood oxygen levels. Who should not take this medicine? People with certain types of heart problems, such as congestive heart failure, should use caution with this medicine. People with reduced kidney function or kidney disease should probably not take metformin. It should be used with caution if you regularly consume more than two to three drinks daily, so check with your doctor about that. Advantages Metformin, when used alone, is unlikely to cause low blood sugar. It is one of those medicines that always seems to help even after people have had diabetes for a while, and, for this reason Continue reading >>
Dpp-4 Inhibitors Charts & Dosing Information For Special Populations
Forms, dosages and dosing considerations for pregnancy, breastfeeding, hepatic and renal. brand name preparation manufacturer route form dosage^ Januvia sitagliptin phosphate (Plus Metformin) Merck oral tablet 25 mg oral tablet 50 mg oral tablet 100 mg Onglyza Saxagliptin (Plus with metformin) Bristol-Myers Squibb oral tablet 2.5 mgD oral tablet 5 mg Tradjenta Linagliptin (Plus with metformin) Eli Lilly oral tablet 5 mg Janumet sitagliptin phosphate + metformin hydrochloride Merck Sharp & Dohme Corp. oral tablet 50/500 mg oral tablet 50/1000 mg Nesina alogliptin Takeda oral tablet 6.25 mg oral tablet 12.5 mg oral tablet 25 mg Dosing (Oral Tablet) Sitagliptin: recommended dose is 25-100 mg once a day. Can be taken with or without food. Saxagliptin: recommended dose is 2.5 or 5 mg once a day. Can be taken with or without food. Linagliptin: recommended dose is 5 mg once a day. Can be taken with or without food. Sitagliptin + metformin: co-formulated as Janumet 50/500 mg twice a day, with meals. Can increase to 50/1000 mg twice a day, with meals (maximum dose). Saxagliptin + metformin XR: co-formulated as Kombiglyze. 2.5/1000 mg, 5/1000 mg, or 5/2000 mg once daily with evening meal. Alogliptin: recommended dose is 25 mg once daily. DPP-4 inhibitors are FDA approved for use as monotherapy in type 2 diabetes (T2DM). DPP-4 inhibitors can also be added to patients already on metformin, sulfonylureas, thiazolidinediones, or insulin. If adding DPP-4 inhibitors to sulfonylurea/insulin therapy, consider decreasing the sulfonylurea/insulin dose, to reduce hypoglycemia risk. DOSING IN SPECIAL POPULATIONS – RENAL Sitagliptin GFR ≥ 50 mL/min, no dosage adjustment needed GFR 30-50 mL/min, do not exceed 50 mg daily GFR < 30 mL/min, do not exceed 25 mg daily For patients on hemodialys Continue reading >>
New Diabetes Medications Cost 100 Times More Than Established Treatments
“New is not always better.” This caution seems reasonable when considering the value of the recently approved medications for treatment of Type 2 (adult type) diabetes. These drugs include three new classes of medication referred to as GLP-1 analogs, DPP-4 inhibitors and most recently SGLT-2 inhibitors. The focus of this discussion will be the most widely prescribed of the newcomers, the DPP-4 inhibitors. The first thing consumers will notice about the new diabetes medications are their TV commercial friendly names, Januvia, Onglyza, Tradjenta, and Nesina. Mix these newcomer drugs together into a single pill with the venerable low cost generic metformin and the names becomes Janumet, Kombiglyze, Jentadueto, and Kazano. The next thing a consumer will notice is the price tag. At the local pharmacy in Jupiter, Florida the retail prices of a 3 month supply of Januvia, Onglyza or Tradjenta are all about $1100. A three month supply of the established generic drug, glipizide, is $9.99 and metformin is between zero and $41. The new drugs are being heavily promoted by the biggest names in the pharmaceutical industry directly to consumers and to doctors. Merck, Bristol-Myers Squibb, Lilly, AstraZeneca, Boehringer Ingelheim and Takeda are behind the ad campaigns. The success of these promotions has been impressive with the percentage of diabetics receiving treatment with the new drugs rising rapidly. Data Monitor, a company tracking pharmaceutical trends reported in 2014 that DPP4 drugs now dominate the diabetes care market with 40% of sales in dollars, (with Januvia leading the pack. The rapid expansion of this class of diabetes medication should be an indication of their great advantage over the established generic drugs such as metformin and sulfonylureas (predominantly gli Continue reading >>
Dpp-4 Inhibitors - Dipeptidyl Peptidase-4 Inhibitor - Gliptins
The authors make no claims of the accuracy of the information contained herein; and these suggested doses and/or guidelines are not a substitute for clinical judgment. Neither GlobalRPh Inc. nor any other party involved in the preparation of this document shall be liable for any special, consequential, or exemplary damages resulting in whole or part from any user's use of or reliance upon this material. PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. Products alogliptin -NESINA® Linagliptin - Tradjenta™ Saxagliptin - Onglyza™ Sitagliptin - Januvia® Combination Products JANUMET® (sitagliptin and metformin HCl) tablets JANUMET ® XR (sitagliptin and metformin HCl extended-release) JENTADUETO® XR (linagliptin and metformin hydrochloride ER) KOMBIGLYZE XR (saxagliptin and metformin HCl ER) OSENI® (alogliptin and pioglitazone) --® Typical reductions in A1C values - DPP-4 INHIBITORS: ~ 0.74% (0.73 - 1.2) Background Overview Secretagogues Insulin sensitizers Alpha-glucosidase inh Peptide analogs INDICATIONS AND USAGE NESINA is a dipeptidyl peptidase-4 (DPP-4) inhibitor indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus. Limitation of Use: Not for treatment of type 1 diabetes or diabetic ketoacidosis. DOSAGE AND ADMINISTRATION •The recommended dose in patients with normal renal function or mild renal impairment is 25 mg once daily. •Can be taken with or without food. •Adjust dose if moderate or severe renal impairment or end-stage renal disease (ESRD). DOSAGE FORMS AND STRENGTHS Tablets: 25 mg, 12.5 mg and 6.25 mg CONTRAINDICATIONS History of a serious hypersensitiv Continue reading >>