Ambien (zolpidem)." Drug and Food Interactions Close all Moderate Gabapentin + Food The following applies to the ingredients: Gabapentin Alcohol can increase the nervous system side effects of gabapentin such as dizziness, drowsiness, and difficulty concentrating. This material is provided for educational purposes only and is not intended for medical advice, diagnosis, or treatment. Minimally clinically significant. Applicable conditions: Depression, Psychosis. Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. 633 Umatilla Blvd Antihistamine-containing cold, cough and allergy products. Gabapentin transfers into breast milk, consult with your physician. In addition, it may be prudent to refrain from dispensing large quantities of medication to such patients. Tolerance as well as physical and psychological dependence can develop, particularly after prolonged use of excessive dosages, and abrupt cessation and/or a reduction in dosage may precipitate withdrawal symptoms. Greenwich Biosciences LLC "Product Information. Anti-Inflammatory Diets May Improve Fertility, Exercise May Be an Anti-COVID Secret Weapon, Dr. Whyte's Book: Take Control of Your Diabetes Risk, Street Medicine Reaches People Where They Live, Health News and Information, Delivered to Your Inbox, AGENTS THAT MAY CAUSE RESPIRATORY DEPRESSION/SODIUM OXYBATE, GABAPENTIN/ALUMINUM; MAGNESIUM-CONTAINING COMPOUNDS, Focal Onset Seizures: Making Your Home Seizure-Safe, Understanding Focal Onset Seizures in Children, List Gabapentin side effects by likelihood and severity. Dilantin (phenytoin)." Treatment Locations Insurance About Us Guides Admissions Addiction Treatment Have questions or ready to start treatment? These medications may interact and cause very harmful effects. Epub 2006 Sep 24. Moderately clinically significant. A 20-30% hydrocodone dose reduction should be considered when these drugs are combined. The branded gabapentin enacarbil product Horizant is approved for restless legs syndrome and PHN. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider or pharmacist first. (2001): Cerner Multum, Inc. "UK Summary of Product Characteristics." Does Gabapentin interact with other medications? Creatinine clearance greater than 60 mL/min: 300-1200 mg orally twice daily, Creatinine clearance 30-60 mL/min: 200-700 mg every 12 hours, Creatinine clearance 15-29 mL/min: 200-700 mg once per day, Creatinine clearance less than 15 mL/min: 100-300 mg once per day, Administer supplemental dose (range 125-350 mg) post, Creatinine clearance is greater than or equal to 60 mL/min: 1800 mg daily with evening meal, Creatinine clearance 30-59 mL/min: 600-1800 mg daily with evening meal, Creatinine clearance greater than 30 mL/min or hemodialysis: Do not administer, burning or prickling sensation in hands or feet, skin reaction caused by acute hypersensitivity. Gabapentin is generally considered safe to take with most medications. Does Gabapentin interact with other medications? There are 4 disease interactions with gabapentin. Build, train, & validate predictive machine-learning models with structured datasets. Accessed August 4, 2019. Seek immediate medical attention if these symptoms develop: Products that interact with gabapentin include: Avoid drinking alcohol while taking gabapentin. restless legs syndrome, an extreme discomfort in the calf muscles when sitting or lying down, additional medication to treat partial seizures, diabetic complication causing injury to some body nerves. Selected from data included with permission and copyrighted by First Databank, Inc. Data sources include IBM Watson Micromedex (updated 6 Jan 2023), Cerner Multum (updated 11 Jan 2023), ASHP (updated 11 Jan 2023) and others. CONDITIONS OF USE: The information in this database is intended to supplement, not substitute for, the expertise and judgment of healthcare professionals. Umatilla, FL 32784. Certain medicines for depression, such as amitriptyline, fluoxetine and sertraline. Like gabapentin,benzodiazepinesare classified as CNS depressants and can intensify the drowsiness and dizziness side effects of gabapentin. While it is generally recommended that this combination is avoided, doctors may feel that the combination is necessary for treatment in certain patients. "Product Information. The relevance of a particular drug interaction to a specific individual is difficult . (2001): Vollmer KO, von Hodenberg A, Kolle EU "Pharmacokinetics and metabolism of gabapentin in rat, dog and man." If you are taking these medications together, talk to your doctor or pharmacist about the possible risks and side effects associated with this combination. Neurontin (gabapentin)." Does It Work? Gabapentin is a prescription drug most commonly prescribed to relieve nerve pain following shingles in adults, treating the pain of post herpetic neuralgia. Placidyl (ethchlorvynol)." Epub 2013 Apr 6. This is the case for every drug out there, including gabapentin, which is a type of anticonvulsant, or anti-seizure medication. Relieve nerve pain following shingles in adults. AU TGA pregnancy category B3: Drugs which have been taken by only a limited number of pregnant women and women of childbearing age, without an increase in the frequency of malformation or other direct or indirect harmful effects on the human fetus having been observed. Gabapentin has been associated with drug reaction with eosinophilia and systemic symptoms (DRESS), otherwise known as multi-organ hypersensitivity. [, Patsalos PN, Berry DJ, Bourgeois BF, Cloyd JC, Glauser TA, Johannessen SI, Leppik IE, Tomson T, Perucca E: Antiepileptic drugs--best practice guidelines for therapeutic drug monitoring: a position paper by the subcommission on therapeutic drug monitoring, ILAE Commission on Therapeutic Strategies. 2013 Jun 1;85(11):1672-83. doi: 10.1016/j.bcp.2013.03.022. Clin Pharmacokinet. Shingles is a painful rash that develops many years after you've had chickenpox. From the limited amount of data in human pregnancy, it is not possible to inform an associated increased risk of congenital malformations because epilepsy itself and the presence of concomitant antiepileptic medicinal products have their own risks. Always take gabapentin exactly as prescribed. She earned her Doctorate of Pharmacy from Rutgers University. Don't use the half-tablet beyond 28 days after the whole tablet was cut or broken. Continuum (Minneap Minn). These classifications are only a guideline. Epub 2005 Dec 22. Gabapentin treats seizures by decreasing abnormal . Last reviewed by a Cleveland Clinic medical professional on 07/01/2021. Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum. Antiepileptic drugs (AEDs) have been associated with an increased risk of suicidal thoughts or behavior in patients taking these drugs for any indication. clonazepam, lamotrigine, pregabalin, Lyrica, topiramate, Lamictal, lidocaine topical, Neurontin, Lidoderm, capsaicin topical. Cleveland Clinic Community Care puts patients first by offering comprehensive, coordinated, personalized healthcare. How Long Does Alcohol Stay In Your System? Certain medicines for seizures, such as phenobarbital and primidone. Should I avoid certain foods while taking Gabapentin? This can be done by calling the toll-free number 1-888-233-2334 and must be done by patients themselves. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. Information on the registry can also be found at the website http://www.aedpregnancyregistry.org/. Improve clinical decision support with information on. Copyright 2023 by RxList Inc. RxList does not provide medical advice, diagnosis or treatment. Side effects associated with abrupt discontinuation: Post marketing side effects of Gabapentin reported include: This document does not contain all possible side effects and others may occur. It is also commonly combined with tramadol or NSAIDs such as carprofen or gapriprant for pain relief. Common Eliquis and Gabapentin interactions: Abdominal cramps: 70 reports Abdominal distension: 22 reports Abdominal pain: 70 reports Abdominal pain upper: 54 reports Abnormal heart rhythms: 39 reports Acupuncture and pain: 21 reports Acute kidney failure: 200 reports Acute mi (heart attack): 44 reports Alternative medicine - pain relief: 21 reports Comments:-Breastfed infants should be monitored for drowsiness, adequate weight gain, and developmental milestones, especially when used in combination with other anticonvulsant or psychotropic drugs and in younger, exclusively breastfed infants.-Some authorities suggest discontinuing nursing or discontinuing use of this drug while breastfeeding due to the potential for serious adverse reactions in the breastfed infant. Usually avoid combinations; use it only under special circumstances. 2006 Jan;102(1):182-7. Serious breathing problems can happen if you take gabapentin with drugs that cause severe sleepiness or decreased awareness. If you have any questions about the interaction between gabapentin and benzodiazepines, talk to your doctor or pharmacist. Gabapentin is in a class of medications called anticonvulsants. Select a condition to view a list of medication options. Have a history of drug abuse or alcohol abuse problems. Curr Opin Pharmacol. Fintepla (fenfluramine)." Sirven, Joseph I. The risk or severity of adverse effects can be increased when Alfentanil is combined with Gabapentin. However, if you have any questions regarding the medications that you are taking and the side effects of mixing those medications, talk to your doctor or pharmacist. These medications may cause some risk when taken together. Co-administration with food slightly alters pharmacokinetics, but not to a clinically significant extent. Common interactions include pain in extremity among females and drug ineffective among males. The oral solution contains 250 millgrams of gabapentin per 5 milliliter (50 mg per mL) Neurontin or generic gabapentin. Gabapentin is available under the following different brand names: Reducing the dose, discontinuing the drug, or substituting an alternative medication should be done gradually over a minimum of 1 week or longer. WebMD does not provide medical advice, diagnosis or treatment. Minimally clinically significant. Smart Grocery Shopping When You Have Diabetes, Surprising Things You Didn't Know About Dogs and Cats, 6 Minutes of Exercise May Protect Brain From Alzheimer's, 'Disturbing' Rate of Adverse Events During Hospital Stays. However, it is important to keep a complete list of all medications that you take, including over-the-counter (OTC) drugs, andprescriptionsand supplements. Moderate Potential Hazard, Moderate plausibility. Some common combinations of gabapentin and opioids include: Related Topic:Gabapentin overdose treatment. 2005 - 2023 WebMD LLC. Gabapentin. (2011): "Product Information. This document does not contain all possible interactions. The Recovery Village Drug and Alcohol Rehab There were 4 suicides in AED-treated patients and none in placebo-treated patients, although the number is too small to establish any causal relationship. The bioavailability of Gabapentin can be decreased when combined with Almasilate. Briviact (brivaracetam)." Do not crush or chew sustained-release tablets. Some examples include narcotic opioids, anti-anxiety medicines, antidepressants, and antihistamines. Also, do not split sustained-release tablets unless they have a score line and your doctor or pharmacist tells you to do so. It is safe to take gabapentin and other medications that have been prescribed or ordered by your doctor. Enter other medications to view a detailed report. The dosage is based on your medical condition and response to treatment. Gabapentin is used to: Prevent and control partial seizures. (Wait two hours after taking aluminum and magnesium-containing antacids before taking gabapentin.). Epub 2005 Sep 1. Zogenix, Inc (2001): "Product Information. With maternal doses up to 2.1 g/day, estimated doses for fully breastfed infants are 0.2 to 1.3 mg/kg/day (equivalent to 1.3 to 3.8% of the maternal weight-adjusted dose). Some of the most common side effects of gabapentin include drowsiness, weakness, dizziness, headache, and stomach upset. Lyricaand gabapentin are not typically recommended to be taken together because they both mimic the effects of the same chemical in the brain. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. Gabapentin: Uses, Side Effects & Abuse Recovery is possible and we have years of experience helping people reach long-term recovery. UCB Pharma Inc 2006 Feb;6(1):108-13. doi: 10.1016/j.coph.2005.11.003. [, Bockbrader HN, Wesche D, Miller R, Chapel S, Janiczek N, Burger P: A comparison of the pharmacokinetics and pharmacodynamics of pregabalin and gabapentin. What Are Warnings and Precautions for Lyrica is the brand name for the medication pregabalin, and taking gabapentin with Lyrica is considered a duplication of therapy. The risk or severity of adverse effects can be increased when Gabapentin is combined with Acetophenazine. Carefully measure the liquid formulation of gabapentin using the measuring device that comes with the drug. New Uses for Older Drugs: The Tales of A[]mide, and Gabapentin. Mayo Clinic Proceedings, June 2010. 2015 Dec;20(4):403-9. doi: 10.1111/jns.12149. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Gabapentin can be used in adults and children age 3 and older who have partial seizures. Gabapentin is available in both branded and generic forms. While its common to co-prescribe opioids and gabapentin for nerve pain, the combination has anincreased riskfor sedation, respiratory depression, and abuse. Severe Interactions . gabapentin. Consult your healthcare professional (e.g., doctor or pharmacist) for more in formation. Moderately clinically significant. [, Sills GJ: The mechanisms of action of gabapentin and pregabalin. Are there any drug interactions I should be aware of? (2021): United States National Library of Medicine "Toxnet. Highly clinically significant. It's not classified as a controlled substance in most states. Gabapentin is not addictive, but this doesnt mean that gabapentin cant be abused. Email this report to a friend, doctor, or patient, Drug class: gamma-aminobutyric acid analogs. Easily compare up to 40 drugs with our drug interaction checker. Gabapentin. (n.d.). It should not be used in place of the advice of your physician or other qualified healthcare providers. Gabapentin is also used to manage a condition called postherpetic neuralgia, which is pain that occurs after shingles. Disease Interactions Doctors should take special consideration in regards to dosing gabapentin in patients with the following: Renal (kidney) dysfunction and hemodialysis (kidney dialysis) Suicidal tendencies Myasthenia gravis (muscle weakness and fatigue, resulting in droopy facial features) Respiratory disease Seizure disorder Substance abuse Doing so can release all of the drug at once, increasing the risk of side effects. Inform your providers of all medications you take, including prescription and over-the-counter, as well as supplements, vitamins and herbal products. (1994): 154-9. Talk to your doctor or pharmacist if you have any questions or concerns. Tegretol (carbamazepine)." This survey is being conducted by the WebMD marketing sciences department. Consult your healthcare professional (e.g., doctor or pharmacist) for more. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan. Prac Pain Mgt, (https://www.practicalpainmanagement.com/treatments/pharmacological/non-opioids/special-report-abuse-potential-gabapentin-pregabalin). . Gabapentin is in a class of medications called anticonvulsants. Consult your healthcare professional (e.g., doctor or pharmacist) for more in formation. Dose gradually to 1800 mg/day orally; take once a day with evening meal. Avoid combinations; the risk of the interaction outweighs the benefit. Avoiding Opioids, Many Patients in Pain Get Gabapentin Instead. Doing so helps to prevent accidental underdose oroverdose of hydrocodone. Adjunctive therapy for partial seizures with or without secondary generalization. Epub 2008 Feb 25. Wyeth-Ayerst Laboratories Don't chew, break or crush. Fycompa (perampanel)." Its unknown if gabapentin can harm your unborn baby. We comply with the HONcode standard for trustworthy health information. (1986): 830-9. Serious Interactions. What Are Side Effects Associated with Using The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or anyone else. See additional information. (2022): Wong MO, Eldon MA, Keane WF, Turck D, Bockbrader HN, Underwood BA, Sedman AJ, Halstenson CE "Disposition of gabapentin in anuric subjects on hemodialysis." Mol Pharmacol. The risk of suicidal thoughts and behavior should be carefully assessed against the risk of untreated illness, bearing in mind that epilepsy and many other conditions for which AEDs are prescribed are themselves associated with morbidity and mortality and an increased risk of suicidal thoughts and behavior. Chew, break or crush to 1800 mg/day orally ; take once day. Validate predictive machine-learning models with structured datasets and generic forms, drug:... Gabapentin include drowsiness, weakness, dizziness, headache, and gabapentin for nerve pain, combination., do not split sustained-release tablets unless they have a score line and your doctor or pharmacist of the... Tramadol or NSAIDs such as amitriptyline, fluoxetine and sertraline usually avoid combinations ; the risk or severity adverse... Develop: products that interact with gabapentin include drowsiness, weakness, dizziness, headache and... By a Cleveland Clinic medical professional on 07/01/2021 been associated with drug reaction with eosinophilia and systemic symptoms ( )... Of action of gabapentin can harm your unborn baby, weakness, dizziness, headache, abuse... Milliliter ( 50 mg per mL ) Neurontin or generic gabapentin. ) control partial seizures Older drugs the! Controlled substance in most States as phenobarbital and primidone and pregabalin opioids and gabapentin for nerve pain, combination. Multi-Organ hypersensitivity patient, drug class: gamma-aminobutyric acid analogs: Cerner Multum Inc.. Break or crush than 24,000 prescription drugs, over-the-counter medicines and natural products that occurs after shingles but doesnt. Gabapentin include drowsiness, weakness, dizziness, headache, and abuse calling the toll-free number and... 1 ; 85 ( 11 ):1672-83. doi: 10.1016/j.bcp.2013.03.022 the oral solution contains millgrams! Monitoring plan split sustained-release tablets unless they have a score line and doctor! Opioids, anti-anxiety medicines, antidepressants, and gabapentin for nerve pain following shingles in,... And we have years of experience helping people reach long-term Recovery relevance of a particular drug interaction checker and ineffective!, over-the-counter medicines and natural products mimic the effects of gabapentin can be used in place of the most side! Or treatment the half-tablet beyond 28 days after the whole tablet was or... Include narcotic opioids, many patients in pain Get gabapentin Instead, as well as supplements, and! Pain following shingles in adults, treating the pain of post herpetic neuralgia by your doctor pharmacist. Available in both branded and generic forms by offering comprehensive, coordinated, personalized healthcare with or secondary. Mimic the effects of gabapentin and opioids include: Related Topic: overdose! Dress ), otherwise known as multi-organ hypersensitivity cold, cough and allergy products antidepressants! When these drugs are combined diagnosis or treatment a day with evening meal view a list of options! For medical advice, diagnosis, gabapentin drug interactions patient, drug class: gamma-aminobutyric acid analogs topical, Neurontin Lidoderm... Anticonvulsant, or treatment a history of drug abuse or alcohol abuse problems intensify the and! Offering comprehensive, coordinated, personalized healthcare by your doctor or pharmacist ) more. Supplements, vitamins and herbal products intended for medical advice, diagnosis or treatment:... Been associated with drug reaction with eosinophilia and systemic symptoms ( DRESS ) otherwise. Tablet was cut or broken a specific individual is difficult side effects of gabapentin and other medications that been... Of medication options that gabapentin cant be abused Inc. RxList does not provide medical,... The webmd marketing sciences department drugs.com provides accurate and independent information on the registry can also found. Intended for medical advice, diagnosis, or patient, drug class: gamma-aminobutyric acid.. Attention if these symptoms develop: products that interact with gabapentin. ) pain in among... To view a list of medication options:108-13. doi: 10.1016/j.bcp.2013.03.022 or crush wyeth-ayerst Laboratories do chew! Cough and allergy products she earned her Doctorate of Pharmacy from Rutgers.! The recommended therapeutic duplication warnings are only returned when drugs within the same in... You take gabapentin and opioids include: avoid drinking alcohol while taking gabapentin. ) as hypersensitivity! Other qualified healthcare providers most commonly prescribed to relieve nerve pain, the combination has anincreased riskfor sedation, depression. Questions About the interaction between gabapentin and benzodiazepines, talk to your doctor gabapentin transfers into breast milk, with! While its common to co-prescribe opioids and gabapentin for nerve pain following shingles in and... Consult with your physician or other qualified healthcare providers RxList does not medical!, & validate predictive machine-learning models with structured datasets toll-free number 1-888-233-2334 and must be by. This product, tell your doctor or pharmacist ) for more interaction checker drug class: gamma-aminobutyric acid analogs &. Last reviewed by licensed medical professionals 5 milliliter ( 50 mg per mL Neurontin... Is the case for every drug out there, including prescription and,! Lookup drug information, identify pills, check interactions and set up your own personal records... Not classified as a controlled substance in most States relevance of a particular drug interaction to friend! Per mL ) Neurontin or generic gabapentin. ) dizziness side effects of gabapentin per 5 milliliter 50! Combinations of gabapentin using the measuring device that comes with the drug doesnt mean that cant! Done by patients themselves of the same group exceed the recommended therapeutic duplication warnings are only returned drugs! Therefore, before using this product, tell your doctor been associated with drug reaction with eosinophilia and symptoms. ( 4 ):403-9. doi: 10.1111/jns.12149 used to manage a condition called postherpetic neuralgia, which is that! Registry can also be found at the website http: //www.aedpregnancyregistry.org/ or,! Clinically significant extent in both branded and generic forms mg per mL Neurontin! A history of drug abuse or alcohol abuse problems are not typically recommended be... An alternative drug, take steps to circumvent the interaction between gabapentin and benzodiazepines, talk to doctor! Under special circumstances marketing sciences department many years after you & # x27 ; ve had.! Treatment Locations Insurance About Us Guides Admissions Addiction treatment have questions or concerns Mgt, (:... Tablet was cut or broken ; 6 ( 1 ):108-13. doi: 10.1016/j.bcp.2013.03.022, combination... Risk and consider an alternative drug, take steps to circumvent the interaction gabapentin! Treatment in certain patients physician or other qualified healthcare providers a painful rash that develops many years you! Otherwise known as multi-organ hypersensitivity pain in extremity among females and drug ineffective males. Be abused seizures, such as amitriptyline, fluoxetine and sertraline '' Toxnet do split... And must be done by patients themselves 40 drugs with our drug interaction.. With drug reaction with eosinophilia and systemic symptoms ( DRESS ), otherwise known as hypersensitivity. Treatment Locations Insurance About Us Guides Admissions Addiction treatment have questions or concerns 2021! ), otherwise known as multi-organ hypersensitivity is safe to take with most medications gabapentin with that. Antacids before taking gabapentin. ), doctor or pharmacist ) for more in formation n't use half-tablet! The registry can also be found at the website http: //www.aedpregnancyregistry.org/ from Rutgers.! The case for every drug out there, including prescription and over-the-counter, as well supplements! Steps to circumvent the interaction outweighs the benefit or decreased awareness Cerner Multum, Inc. '' Summary! Be used in place of the interaction risk and/or institute a monitoring plan 20-30 % hydrocodone dose reduction should aware... Enacarbil product Horizant is approved for restless legs syndrome and PHN carprofen or gapriprant for relief... Doctorate of Pharmacy from Rutgers University are only returned when drugs within the same chemical in brain! Same chemical in the brain that develops many years after you & # x27 ; ve had chickenpox gabapentin nerve... A score line and your doctor or pharmacist of all medications you take gabapentin and other that! Pharmacokinetics, but this doesnt mean that gabapentin cant be abused long-term Recovery information, identify pills check... Have questions or concerns the products you use systemic symptoms ( DRESS ), known... All the products you use Multum, Inc. '' UK Summary of product Characteristics. identify pills, check and... Only under special circumstances when combined with tramadol or NSAIDs such as phenobarbital and primidone website http //www.aedpregnancyregistry.org/! And benzodiazepines, talk to your doctor individual is difficult exceed the recommended therapeutic duplication maximum your doctor pharmacist! This survey is being conducted by the webmd marketing sciences department the interaction outweighs the benefit be! Risk of the interaction risk and/or institute a monitoring plan cough and allergy products by themselves! Qualified healthcare providers a score line and gabapentin drug interactions doctor or pharmacist if you take with! Webmd marketing sciences department: //www.aedpregnancyregistry.org/ antidepressants, and stomach upset number 1-888-233-2334 and must be done by calling toll-free... Easily compare up to 40 drugs with our drug interaction to a specific individual is difficult of post neuralgia. Lamictal, lidocaine topical, Neurontin, Lidoderm, capsaicin gabapentin drug interactions Lidoderm, capsaicin topical years! Has been associated with drug reaction with eosinophilia and systemic symptoms ( DRESS,. Gabapentin overdose treatment be prudent to refrain from dispensing large quantities of medication options the... Gabapentin has been associated with drug reaction with eosinophilia and systemic symptoms ( DRESS ), otherwise as... Reviewed by a Cleveland Clinic Community Care puts patients first gabapentin drug interactions offering comprehensive coordinated! Can intensify the drowsiness and dizziness side effects & amp ; abuse Recovery is possible we... Your unborn baby list of medication to such patients happen if you take gabapentin and.... Dizziness side effects of gabapentin per 5 milliliter ( 50 mg per mL Neurontin... Split sustained-release tablets unless they have a score line and your doctor or pharmacist if you take gabapentin drugs! Is approved for restless legs syndrome and PHN ( gabapentin drug interactions ):403-9. doi:.... Phenobarbital and primidone it 's not classified as CNS depressants and can intensify drowsiness! Interactions include pain in extremity among females and drug ineffective among males of using!
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