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Januvia Skin Rash

Januvia Side Effects By Likelihood And Severity

Januvia Side Effects By Likelihood And Severity

are allergic to dapagliflozin or any of the ingredients in FARXIGA. Symptoms of a serious allergic reaction may include skin rash, raised red patches on your skin (hives), swelling of the face, lips, tongue, and throat that may cause difficulty in breathing or swallowing. If you have any of these symptoms, stop taking FARXIGA and contact your healthcare provider or go to the nearest hospital emergency room right away have severe kidney problems or are on dialysis. Your healthcare provider should do blood tests to check how well your kidneys are working before and during your treatment with FARXIGA Dehydration (the loss of body water and salt), which may cause you to feel dizzy, faint, lightheaded, or weak, especially when you stand up (orthostatic hypotension). You may be at a higher risk of dehydration if you have low blood pressure; take medicines to lower your blood pressure, including water pills (diuretics); are 65 years of age or older; are on a low salt diet, or have kidney problems Ketoacidosis occurred in people with type 1 and type 2 diabetes during treatment with FARXIGA. Ketoacidosis is a serious condition which may require hospitalization and may lead to death. Symptoms may include nausea, tiredness, vomiting, trouble breathing, and abdominal pain. If you get any of these symptoms, stop taking FARXIGA and call your healthcare provider right away. If possible, check for ketones in your urine or blood, even if your blood sugar is less than 250 mg/dL Kidney problems. Sudden kidney injury occurred in people taking FARXIGA. Talk to your doctor right away if you reduce the amount you eat or drink, or if you lose liquids; for example, from vomiting, diarrhea, or excessive heat exposure Serious urinary tract infections (UTI), some that lead to hospitalization, occu Continue reading >>

Drug-induced Generalized Skin Eruption In A Diabetes Mellitus Patient Receiving A Dipeptidyl Peptidase-4 Inhibitor Plus Metformin

Drug-induced Generalized Skin Eruption In A Diabetes Mellitus Patient Receiving A Dipeptidyl Peptidase-4 Inhibitor Plus Metformin

Go to: A 66-year-old male with untreated type 2 diabetes mellitus [3] was admitted to the authors’ hospital following the advice of the patient’s daughter. The patient’s hemoglobin A1c (HbA1c) level had been 7.4% in a general health check-up 3 years before. One year prior to admission, the patient’s fasting glucose had risen to 126 mg/dL and his HbA1c level rose up to 8.6%. The patient had a history of urticaria several years earlier. A diet and exercise regimen was introduced, and sitagliptin phosphate 50 mg and metformin 500 mg were started. Two months later, the patient’s HbA1c level had improved to 7.0% and the patient continued on the medication, and diet and exercise therapy. Six months later, a rash with a locus on the upper limb began to appear. The patient applied antihistamine ointment on the skin rash, which continued to spread gradually from chest to back, and abdomen to thigh (Figs. 1a, 2a, 3a, b). In some areas of the back and chest, lichenification also appeared. The itching associated with the rash also worsened, interfering with sleep during the night. The patient consulted a dermatologist, and oral and ointment steroids were started. However, the rash was unchanged and pruritus gradually increased. Since there is a possibility of skin malignancy in eczematous skin rashes lasting for a long period of time, a skin biopsy was scheduled. Four months after the eruption first appeared, and just before the skin biopsy, the authors stopped the dipeptidyl peptidase-4 (DPP-4), sitagliptin, to rule out the possibility of a drug reaction, although metformin was continued. Itching caused by the rash was significantly relieved immediately after discontinuation of the drug. The emergence of new rash ended, and the rash itself withered after 1 week. The spre Continue reading >>

Januvia Side Effects

Januvia Side Effects

Januvia is the brand name of the drug sitagliptin, which is used to treat type 2 diabetes. Type 2 diabetes is a disease in which the body doesn't make or use the hormone insulin normally, so it can't properly control your blood sugar levels. Januvia belongs to a class of drugs called dipeptidyl peptidase-4 (DPP-4) inhibitors. It works by increasing levels of substances in the body that help lower blood sugar. Januvia may be taken alone or with other diabetes medications. It's often prescribed as a combination medicine called Janumet (which contains the drugs sitagliptin and metformin). Taking Januvia, along with adopting a healthy lifestyle, can reduce your risk of developing serious or life-threatening complications from diabetes, which may include heart disease, stroke, nerve damage, kidney problems, or eye problems. The U.S. Food and Drug Administration (FDA) approved Januvia in 2006. It's manufactured by Merck & Co. Januvia Warnings Januvia shouldn't be taken by people with type 1 diabetes (a disease in which the body doesn't produce any insulin) or diabetic ketoacidosis (a dangerous condition that can occur if high blood sugar is untreated). Before taking Januvia, tell your doctor if you have, or have ever had: Kidney disease Angioedema (swelling of the face, lips, tongue, throat, arms, or legs) Januvia may increase the risk of developing pancreatitis (swelling and inflammation of the pancreas). Be sure to tell your doctor if you've ever had any problems with your pancreas, or if you experience any of the following symptoms while taking Januvia: Severe pain in your upper stomach that spreads to your back Loss of appetite Fast heartbeat Severe nausea and vomiting Also, tell your doctor you're taking this medicine before having any type of surgery, including a dental Continue reading >>

Januviaâ® Sitagliptin Phosphate Monohydrate

Januviaâ® Sitagliptin Phosphate Monohydrate

Consumer Medicine Information What is in this leaflet This leaflet answers some common questions about JANUVIA. It does not contain all the available information. It does not take the place of talking to your doctor or pharmacist. All medicines have risks and benefits. Your doctor has weighed the risks of you taking JANUVIA against the benefits they expect it will have for you. If you have any concerns about taking this medicine, ask your doctor or pharmacist. Keep this leaflet with the medicine. You may need to read it again. What JANUVIA is used for JANUVIA is used to lower blood sugar levels in patients with type 2 diabetes mellitus alone or in combination with certain other medicines (metformin, medicines such as rosiglitazone and pioglitazone, a sulfonylurea medicine such as glimepiride, gliclazide and glibenclamide, or insulin), when diet plus exercise or the other medicine(s) do not provide adequate blood sugar level control. Type 2 diabetes mellitus Type 2 diabetes mellitus is a condition in which your body does not make enough insulin and the insulin that your body produces does not work as well as it should. Your body can also make too much sugar. When this happens, sugar (glucose) builds up in the blood. This can lead to serious medical problems. The main goal of treating diabetes is to lower your blood sugar to a normal level. Lowering and controlling blood sugar may help prevent or delay complications of diabetes, such as heart disease, kidney disease, blindness and amputation. High blood sugar can be lowered by diet and exercise and by certain medicines. How JANUVIA works JANUVIA is a member of a class of medicines you take by mouth called DPP-4 inhibitors (dipeptidyl peptidase-4 inhibitors) that lowers blood sugar levels in patients with type 2 diabetes m Continue reading >>

Januvia

Januvia

are allergic to dapagliflozin or any of the ingredients in FARXIGA. Symptoms of a serious allergic reaction may include skin rash, raised red patches on your skin (hives), swelling of the face, lips, tongue, and throat that may cause difficulty in breathing or swallowing. If you have any of these symptoms, stop taking FARXIGA and contact your healthcare provider or go to the nearest hospital emergency room right away have severe kidney problems or are on dialysis. Your healthcare provider should do blood tests to check how well your kidneys are working before and during your treatment with FARXIGA Dehydration (the loss of body water and salt), which may cause you to feel dizzy, faint, lightheaded, or weak, especially when you stand up (orthostatic hypotension). You may be at a higher risk of dehydration if you have low blood pressure; take medicines to lower your blood pressure, including water pills (diuretics); are 65 years of age or older; are on a low salt diet, or have kidney problems Ketoacidosis occurred in people with type 1 and type 2 diabetes during treatment with FARXIGA. Ketoacidosis is a serious condition which may require hospitalization and may lead to death. Symptoms may include nausea, tiredness, vomiting, trouble breathing, and abdominal pain. If you get any of these symptoms, stop taking FARXIGA and call your healthcare provider right away. If possible, check for ketones in your urine or blood, even if your blood sugar is less than 250 mg/dL Kidney problems. Sudden kidney injury occurred in people taking FARXIGA. Talk to your doctor right away if you reduce the amount you eat or drink, or if you lose liquids; for example, from vomiting, diarrhea, or excessive heat exposure Serious urinary tract infections (UTI), some that lead to hospitalization, occu Continue reading >>

Januvia - Uses, Side Effects, Interactions - Canoe.com

Januvia - Uses, Side Effects, Interactions - Canoe.com

Although most of these side effects listed below don't happen very often, they could lead to serious problems if you do not seek medical attention. Check with your doctor as soon as possible if any of the following side effects occur: symptoms of low blood sugar (e.g., headache, drowsiness, weakness, dizziness, confusion, irritability, hunger, fast heartbeat, sweating, and feeling jittery) symptoms of kidney problems (e.g., nausea, loss of appetite, weakness, shortness of breath, passing little or no urine) Stop taking the medication and seek immediate medical attention if any of the following occur: severe skin rash (blistering, peeling, spreading) symptoms of pancreatitis (e.g., prolonged, severe abdominal pain with or without vomiting) symptoms of a serious allergic reaction (such as swelling of the face, lips, tongue, or throat; skin rash; hives; or difficulty breathing) Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication. Are there any other precautions or warnings for this medication? Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication. Congestive heart failure: This medication is not recommended for people with congestive heart failure (CHF). If you have CHF, speak to your doctor. Immune system: Sitagliptin can reduce the number of cells that fight infection in the body (white blood cells). This side effect may be more of a concern for people who already have a weakened immune system. People who ha Continue reading >>

Important Safety Information

Important Safety Information

WHAT IS JANUVIA®? JANUVIA (jah-NEW-vee-ah) is a once-daily prescription pill that, along with diet and exercise, helps lower blood sugar levels in adults with type 2 diabetes. JANUVIA should not be used in patients with type 1 diabetes or with diabetic ketoacidosis (increased ketones in the blood or urine). If you have had pancreatitis (inflammation of the pancreas), it is not known if you have a higher chance of getting it while taking JANUVIA. Serious side effects can happen in people who take JANUVIA, including pancreatitis, which may be severe and lead to death. Before you start taking JANUVIA, tell your doctor if you've ever had pancreatitis. Stop taking JANUVIA and call your doctor right away if you have pain in your stomach area (abdomen) that is severe and will not go away. The pain may be felt going from your abdomen through to your back. The pain may happen with or without vomiting. These may be symptoms of pancreatitis. Before you start taking JANUVIA, tell your doctor if you have ever had heart failure (your heart does not pump blood well enough) or have problems with your kidneys. Contact your doctor right away if you have increasing shortness of breath or trouble breathing (especially when you lie down); swelling or fluid retention (especially in the feet, ankles, or legs); an unusually fast increase in weight; or unusual tiredness. These may be symptoms of heart failure. Do not take JANUVIA if you are allergic to any of its ingredients, including sitagliptin. Symptoms of serious allergic reactions to JANUVIA, including rash, hives, and swelling of the face, lips, tongue, and throat that may cause difficulty breathing or swallowing, can occur. If you have any symptoms of a serious allergic reaction, stop taking JANUVIA and call your doctor right away. Kid Continue reading >>

(pdf) Drug-induced Generalized Skin Eruption In A Diabetes Mellitus Patient Receiving A Dipeptidyl Peptidase-4 Inhibitor Plus Metformin

(pdf) Drug-induced Generalized Skin Eruption In A Diabetes Mellitus Patient Receiving A Dipeptidyl Peptidase-4 Inhibitor Plus Metformin

Drug-Induced Generalized Skin Eruption in a Diabetes Mellitus Patient Receiving a Dipeptidyl Peptidase-4 Kaori Nakatani Takeshi Kurose Takanori Hyo Koin Watanabe Daisuke Yabe Terue Kawamoto To view enhanced content go to www.diabetestherapy-open.com Received: September 19, 2012 / Published online: November 6, 2012 The Author(s) 2012. This article is published with open access at Springerlink.com dipeptidyl peptidase-4 (DPP-4) inhibitor, in a patient almost 6 months after initiation of the drug. Physical examination revealed a spread of skin rash from chest to back, and abdomen eliminated the skin rash immediately. The emergence of new rash ended, and the rash itself withered after 1 week. The spread of the rash gradually shrank and the skin lesions subsided, leaving pigmentation 1 month later. Two months after cessation of sitagliptin, the skin eruption had subsided and oral steroid lymphocyte stimulation test was negative for sitagliptin, nonspecic radioimmunosorbent test for immunoglobulin E was increased to 532 IU/mL, with a percentage of eosinophil of 7.4%. Sitagliptin has a phenyl ring, carbonyl group, and an absorption spectrum showing 400.1 nm), and its photosensitive mechanism could have been responsible for the itchy edematous plaque. In the present case, the initial generalized skin eruption may have sitagliptin. Close attention should be paid to patients receiving this drug with a history The increasing number of patients with type 2 diabetes mellitus is a prominent health problem worldwide. Incretin-based therapy is one of the promising new treatments for type 2 diabetes mellitus, and has recently become a rst-line drug. Although side effects do not often appear with this class of drug, several adverse events have been reported so far [1,2]. Here, the autho Continue reading >>

Sitagliptin | Michigan Medicine

Sitagliptin | Michigan Medicine

What is the most important information I should know about sitagliptin? Call your doctor if you have symptoms of heart failure --shortness of breath (even while lying down), swelling in your legs or feet, rapid weight gain. Stop taking sitagliptin and call your doctor if you have symptoms of pancreatitis: severe pain in your upper stomach spreading to your back, with or without vomiting. Sitagliptin is an oral diabetes medicine that helps control blood sugar levels. It works by regulating the levels of insulin your body produces after eating. Sitagliptin is used together with diet and exercise to improve blood sugar control in adults with type 2 diabetes mellitus. Sitagliptin is not for treating type 1 diabetes. Sitagliptin may also be used for purposes not listed in this medication guide. What should I discuss with my healthcare provider before taking sitagliptin? You should not use sitagliptin if you are allergic to it, or if you have diabetic ketoacidosis (call your doctor for treatment with insulin). kidney disease (or if you are on dialysis); high triglycerides (a type of fat in the blood); Follow your doctor's instructions about using this medicine if you are pregnant. Blood sugar control is very important during pregnancy, and your dose needs may be different during each trimester. Your name may need to be listed on a sitagliptin pregnancy registry when you start using this medicine. It may not be safe to breast-feed a baby while you are using this medicine. Ask your doctor about any risks. Sitagliptin is not approved for use by anyone younger than 18 years old. Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose. Use the medicine exactly as directed. You may take th Continue reading >>

Beware Of Skin Complications Of Newer Antidiabetic Agents

Beware Of Skin Complications Of Newer Antidiabetic Agents

Beware of skin complications of newer antidiabetic agents VANCOUVER, B.C. Each of the newer classes of antidiabetic medications the DPP-IV inhibitors, GLP-1 agonists, and SGLT2 inhibitors has its own characteristic cutaneous side effects, Dr. Justin Endo said at the World Congress of Dermatology. These drugs arent first-line agents for patients with type 2 diabetes, but they have gained solid standing as second-tier medications for the vast number of patients with inadequate glucose control or limiting side effects on first-line therapies, said Dr. Endo of the department of dermatology at the University of WisconsinMadison. The dipeptidyl peptidaseIV inhibitors are the newer drugs linked to the most potentially serious side effects, namely, drug-induced bullous pemphigoid and angioedema. Investigators at Western Michigan University, Kalamazoo, conducted a literature review and an analysis of the Food and Drug Administrations Adverse Event Reporting System database and concluded there is a link between DPP-IV inhibitors and the development of bullous pemphigoid, a potentially fatal cutaneous autoimmune blistering disorder. The skin disease appeared after an average of 6 months on DPP-IV inhibitor therapy in their series. In most cases the bullous pemphigoid remitted in response to discontinuation of the drug, often in conjunction with a course of topical or less frequently, oral corticosteroid therapy ( J Dermatol Case Rep. 2014 Mar 31;8[1]:24-8 ). The mechanism for the development of bullous pemphigoid in patients on a DPP-IV inhibitor is unknown; however, the enzyme DPP-IV is expressed in skin and most other organs. I think a key take home is if patients in their 60s or 70s come in with pemphigoid, even though theyre in the usual age group for nondrug-induced pemphigo Continue reading >>

Januvia Side Effects Center

Januvia Side Effects Center

Januvia (sitagliptin) is an oral diabetes medicine for people with type 2 diabetes (non-insulin-dependent) diabetes. Januvia is sometimes used in combination with other diabetes medications, but is not for treating type 1 diabetes. Many people using Januvia do not have serious side effects. Side effects that may occur with Januvia include: headache, joint or muscle pain, nausea, stomach pain, diarrhea, or constipation. Although Januvia by itself usually does not cause low blood sugar (hypoglycemia), low blood sugar may occur if Januvia is prescribed with other anti-diabetic medications. Symptoms of low blood sugar include sudden sweating, shaking, fast heartbeat, hunger, blurred vision, dizziness, or tingling hands/feet. Tell your doctor if you have serious side effects of Januvia including pancreatitis (severe pain in your upper stomach spreading to your back, nausea and vomiting, loss of appetite, fast heart rate), urinating less than usual or not at all, swelling, weight gain, shortness of breath, or severe skin reaction (fever, sore throat, swelling in your face or tongue, burning in your eyes, skin pain, followed by a red or purple skin rash that spreads [especially in the face or upper body] and causes blistering and peeling). The recommended dose of Januvia is 100 mg once daily. Januvia may interact with digoxin, probenecid, non-steroidal anti-inflammatory drugs (NSAIDs), aspirin or other salicylates, sulfa drugs, monoamine oxidase inhibitors (MAOIs), or beta-blockers. Tell your doctor all prescription and over-the-counter medications you use. During pregnancy Januvia should be used only when prescribed. Pregnancy may cause or worsen diabetes. Your doctor may change your diabetes treatment during pregnancy. It is unknown if this drug passes into breast milk. Cons Continue reading >>

Januvia Gets New Warnings Over Fatal Skin Reactions

Januvia Gets New Warnings Over Fatal Skin Reactions

Home / Resources / Articles / Januvia Gets New Warnings Over Fatal Skin Reactions Januvia Gets New Warnings Over Fatal Skin Reactions Merck & Co. added warnings to its diabetes pill Januvia after some patients developed allergic conditions, including a rare, severe skin disorder. Among the illnesses reported by Januvia users was a sometimes fatal skin ailment called Stevens-Johnson syndrome, Merck said today in a statement. Merck said there wasnt enough data to conclude whether the drug was the cause. Merck said some patients also suffered anaphylaxis, a severe whole-body allergic reaction that can cause a person to go into shock, and angioedema, a swelling of the skin that leads to welts. The findings are included in the drugs prescribing information. Januvia is one of Mercks most important new products with $144 million in sales in the second quarter. Because these reactions are reported voluntarily from a population of uncertain size, it is generally not possible to reliably estimate their frequency or establish a causal relationship to drug exposure, according to the prescribing information. There were no reports of Stevens-Johnson syndrome in Mercks own studies involving 6,000 patients who have taken Januvia, said John Amatruda, vice president of clinical research at Merck, in an interview today. The number of reactions reported to Merck, based in Whitehouse Station, New Jersey, and U.S. regulators was greater than what would be expected in the general population, Amatruda said. Adverse events are reported voluntarily, sometimes with little information, making it difficult to confirm them or determine whether the cause, he said. Merck today also said it received expanded approval to market Januvia in combination with the diabetes drug metformin as a first-line tre Continue reading >>

Januvia Side Effects

Januvia Side Effects

Generic Name: sitagliptin Note: This document contains side effect information about sitagliptin. Some of the dosage forms listed on this page may not apply to the brand name Januvia. For the Consumer Applies to sitagliptin: oral tablet Along with its needed effects, sitagliptin (the active ingredient contained in Januvia) may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention. Check with your doctor immediately if any of the following side effects occur while taking sitagliptin: Less common Anxiety blurred vision chills cold sweats confusion cool, pale skin depression dizziness fast heartbeat headache increased hunger loss of consciousness nausea nightmares seizures shakiness slurred speech unusual tiredness or weakness Incidence not known Blistering, peeling, loosening of the skin diarrhea hives or welts, itching, or skin rash large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs loss of appetite pains in the stomach, side, or abdomen, possibly radiating to the back puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue red skin lesions, often with a purple center redness of the skin severe joint pain sores, ulcers, or white spots in the mouth or on the lips vomiting Some side effects of sitagliptin may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them: More common Body aches Continue reading >>

Drug Reaction With Eosinophilia And Systemic Symptoms (dress) In A Patient Taking Sitagliptin - Em|consulte

Drug Reaction With Eosinophilia And Systemic Symptoms (dress) In A Patient Taking Sitagliptin - Em|consulte

Received:10May2012; accepted:6July2012 Drug reaction with eosinophilia and systemic symptoms (DRESS) in a patient taking sitagliptin Syndrome dhypersensibilit mdicamenteuse la sitagliptine (DRESS) Service de dermatologie, hpital Victor-Dupouy, 69, rue du Lt-Col-Prudhon, 95100 Argenteuil, France Corresponding author. Tel.: +33 1 34 23 26 28; fax: +33 1 34 23 22 61. Sitagliptin is a recent oral antidiabetic drug for type 2 diabetes patients. This report is the first case of a severe drug reaction with eosinophilia and systemic symptoms (DRESS), which resolved with systemic corticosteroids. However, vigilance is necessary during the prescription of these compounds. The full text of this article is available in PDF format. La sitagliptine est un nouvel antidiabtique oral. Nous rapportons le premier cas de toxidermie grave la sitagliptine type de DRESS syndrome avec hyperosinophilie et manifestations systmiques. Lvolution a t favorable sous corticothrapie gnrale forte. Une vigilance simpose lors de la prescription de cette molcule. The full text of this article is available in PDF format. Sitagliptin (Januvia, Merck & Co., Inc., Whitehouse Station, NJ, USA) has recently been licensed as either monotherapy or combination therapy with metformin, a sulphonylurea or a glitazone, or as add-on treatment to insulin for glycaemic control in patients with type 2 diabetes mellitus (T2DM). It is an orally active inhibitor of the dipeptidyl peptidase-4 (DPP-4) enzyme, which improves glycaemic control in patients with T2DM by enhancing levels of active incretin hormones. Common reported clinical adverse events with sitagliptin are nasopharyngitis, upper respiratory infections, headache, gastrointestinal symptoms and musculoskeletal pain [ 1 RichardK.R., ShelburneJ.S., KirkJ.K. Tolerabil Continue reading >>

Januvia Side Effects

Januvia Side Effects

What should I watch for? Visit your doctor or health care professional for regular checks on your progress. A test called the HbA1C (A1C) will be monitored. This is a simple blood test. It measures your blood sugar control over the last 2 to 3 months. You will receive this test every 3 to 6 months. Learn how to check your blood sugar. Learn the symptoms of low and high blood sugar and how to manage them. Always carry a quick-source of sugar with you in case you have symptoms of low blood sugar. Examples include hard sugar candy or glucose tablets. Make sure others know that you can choke if you eat or drink when you develop serious symptoms of low blood sugar, such as seizures or unconsciousness. They must get medical help at once. Tell your doctor or health care professional if you have high blood sugar. You might need to change the dose of your medicine. If you are sick or exercising more than usual, you might need to change the dose of your medicine. Do not skip meals. Ask your doctor or health care professional if you should avoid alcohol. Many nonprescription cough and cold products contain sugar or alcohol. These can affect blood sugar. Wear a medical ID bracelet or chain, and carry a card that describes your disease and details of your medicine and dosage times. Common and Rare Side Effects Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention. Check with your doctor immediately if any of the following side effects occur: Less common blurred vision chills confusion cool, pale skin dizziness fast heartbeat headache increased hunger loss of consciousness nightmares seizures shakiness slurred speech unusual tiredness or weakness Incidence not known Continue reading >>

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