The time of the peak amounts in milk depends on the food taken with the drug and the dosage form of the drug. Pulmonary toxicity. [1] Macrobid doses in milk are low and it can be used while breastfeeding older infants, but alternate drugs are preferred in mothers of infants under 8 days of age, or infants with G6PD deficiency of any age. Obstet Gynecol. Choice of antibiotic to treat any condition depends primarily on the organism likely to be causing the symptoms, taking into account any previous allergies e.g. A peer review panel reviews the data for scientific validity and currency. If the mother has taken fluoxetine during pregnancy, an infant serum level of fluoxetine and norfluoxetine at about six weeks should reflect drug accumulation from the breast milk instead of continued presence of the prenatal medication.15, Of the nonsteroidal anti-inflammatory drugs (NSAIDs), ibuprofen (Motrin) is the preferred choice because it has poor transfer into milk and has been well-studied in children. Some babies prefer warmed milk, others room temperature milk, and others cold milk. Medications that are safe for use directly in an infant of the nursing infant's age are generally safe for the breast-feeding mother. Atenolol (Tenormin), nadolol (Corgard) and sotalol (Betapace) are excreted in higher amounts, which can lead to hypotension, bradycardia and tachypnea in the infant.9, Sustained-release nifedipine (Procardia XL) and verapamil (Calan SR) are excreted into breast milk in amounts that are less than the therapeutic dosage for children. Necessary cookies are absolutely essential for the website to function properly. Table 45,6 lists medications that are not recommended for use in breast-feeding mothers. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. doi: 10.1136/bcr-2014-209253. 6 Previous editions were intended to list drugs potentially used during lactation and to describe . In theory exposure may sensitise the baby to later doses e.g. These cookies will be stored in your browser only with your consent. BMJ Case Rep. 2015 May 2;2015:bcr2014209253. In a prospective follow-up study, 6 nursing mothers reported taking Macrobid (dosage and dosage form not specified). [PubMed. However some babies might prefer a faster flow nipple, especially if you have a fast and furious letdown. In 5 others receiving 100 mg orally 4 times daily, no drug was detected in milk levels (assay limit not stated). Mothers of premature or otherwise compromised infants may require altered dosing to avoid drug accumulation and toxicity in these infants. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. Macrobid is the brand name of Nitrofurantoin. Despite the lack of documented reports, there is a risk of hemolytic anemia in all newborns exposed to nitrofurantoin owing to their glutathione instability, especially in infants with glucose-6-phosphate dehydrogenase deficiency. Step 1: Bring the nipple (no bottle attached) to the baby's mouth and rub it along the baby's gums and inner cheeks, allowing the baby to get used to the feeling and texture of the nipple. According to The Womanly Art of Breastfeeding (p. 364-366), almost everyone who is fully breastfeeding their babies will be free of menstrual periods for 3 - 6 months or longer. [1] Nitrofurantoin doses in milk are low and it can be used while breastfeeding older infants, but alternate drugs are preferred in mothers of infants under 8 days of age, or infants with G6PD deficiency of any age. Although anticonvulsants are excreted into breast milk, most mothers who require the use of these drugs can safely breast-feed their infants.12,13 Determination of maternal serum drug levels may be a useful adjunct to clinical monitoring of the infant when evaluating the drug exposure of the infant. Thank you for taking the time to confirm your preferences. For oral dosage forms (capsules, suspension, and tablets): For prevention of urinary tract infections: Adults and teenagers50 to 100 milligrams (mg) at bedtime. Visit our Submission page for question guidelines and to fill in the submission form. Disclaimer: Information presented in this database is not meant as a substitute for professional judgment. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. , from theDrug Therapeutic Committee and the Public HealthcareServices Committee Administration of Stockholm County Council, Sweden, has a free online database with information on breastfeeding and medications. An extensive systematic review of the use of sulfonamides near term and during breastfeeding found no adverse reactions in infants. Any cookies that may not be particularly necessary for the website to function and is used specifically to collect user personal data via analytics, ads, other embedded contents are termed as non-necessary cookies. [PubMed. In a prospective follow-up study, 1 of 6 nursing mothers who took nitrofurantoin (dosage unspecified) reported a decrease in milk supply. Large doses of antibiotics may encourage overgrowth of thrush (candida) in the mother by killing all the natural gut bacteria. [3], Six women who were 3 to 6 days postpartum were given 50 or 100 mg of nitrofurantoin macrocrystals orally 3 times a day. Copyright the College of Family Physicians of Canada. Administration of Macrobid directly to infants under 1 month of age and in those with glucose-6-phosphate dehydrogenase (G6PD) deficiency is contraindicated because of potential hemolysis in these infants. Prioritize the things you need to get done, and enlist friends and family to help out so you can possibly spend some of that extra time sleeping. My baby will finally take a bottle, but generally won't drink much at daycare. ), fromthe Hospital District of Helsinki and Uusimaa, Finland, has a help line and information on medications during pregnancy and breastfeeding. Last updated on Sep 24, 2022. Careers. Hemolytic anemia. For a teething baby, chill the bottle nipple in the fridge before the feeding. Yale-New Haven Hospital Lactation Center: 7162750088 (9 a.m. to 5 p.m. EST weekdays), Dr. Hale's Breastfeeding Pharmacology Page (http://www.neonatal.ttuhsc.edu/lact). You can review and change the way we collect information below. Miller RD, Salter AJ. Try allowing the baby to latch onto the bottle nipple herself rather than putting it directly into her mouth. However, the interrupted sleep makes it really rough for mom to meet her own sleep needs. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. The LactMed database contains information on drugs and other chemicals to which breastfeeding mothers may be exposed. In large part because of efforts by Cheston Berlin, Jr, MD, a statement by the American Academy of Pediatrics (AAP) on the transfer of drugs and chemicals into human milk was first published in 1983 3 and underwent several subsequent revisions, 4, 5 the most recent of which was published in 2001. How do I determine if a medication is safe for a breastfeeding mother? Use of ciprofloxacin during breastfeeding. These gaps close by the second week of lactation.3 The nursing infant's drug exposure depends on the drug's concentration in the breast milk and the amount of breast milk consumed by the infant.4,5 The pharmacologic activity of the medication depends on its absorption, distribution, metabolism and elimination by the infant. Cookies used to make website functionality more relevant to you. Mothers taking the 50 mg dose had an average of 0.49 mg/L (range 0.2 to 0.7 mg/L) in milk 3 hours after the dose and those given 100 mg . In a prospective follow-up study, 1 of 6 nursing mothers who took Macrobid (dosage unspecified) reported a decrease in milk supply. It belongs to a class of drugs called nitrofurans. Experiment a bit to see if your baby has a preference. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. Progress in Chemotherapy. We comply with the HONcode standard for trustworthy health information. The .gov means its official. 2002;4:817-37. Prospective follow-up of adverse reactions in breast-fed infants exposed to maternal medication. These experts can help you work around factors that make breastfeeding challenging. -Can you telecommute/work from home for a while? Bruel H, Guillemant V, Saladin-Thiron C, Chabrolle JP, Lahary A, Poinsot J. Arch Pediatr. However, it is not always necessary to stop breastfeeding while taking these medications. Son fils nest g que de 3 semaines. This group maintains a website called Mother to Babyexternal icon. In one early report, random samples of milk from several women in the first few days postpartum who were receiving 100 mg orally 4 times daily were tested for nitrofurantoin. COVID-19: Resources for Lactation Professionals. The new, nonsedating antihistamines are not well-studied in breast-feeding and are not rated by the AAP. LactMedexternal icon includes information on the levels of such substances in breast milk and infant blood, and the possible adverse effects in the nursing infant. Insulin is not excreted into breast milk and is considered safe for use during breast-feeding.10 Based on studies of the distribution of first-generation sulfonylureas into breast milk, the AAP considers tolbutamide (Orinase) to be compatible with breast-feeding.6,11 Information on other diabetic agents is less complete. Table 33,612,1518 summarizes medication use in breast-feeding mothers with common maternal conditions. Progestin-only contraceptives are preferable, although these also may decrease milk supply. Amount of the drug excreted into human milk. Breastfeeding information for children and young people, National Breastfeeding Helpline Live Chat Support. Medications that are safe in pregnancy are not always safe in breast-feeding mothers. Try introducing the mouth to the bottle rather than trying to get the baby to drink. Observe infants for possible diarrhea. Some babies do something called reverse cycle nursing when their moms go back to work. Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. Fluoxetine (Prozac) use during pregnancy has been well-studied, and many new mothers are already taking it at delivery. Any drug passing into breastmilk is therefore unlikely to be absorbed in sufficient quantities by the baby and there is no need to cease breastfeeding on safety grounds. Drugs containing Nitrofurantoin: Macrobid, Macrodantin, Furadantin, Nitro Macro. Specific information from high-quality studies of individual medications in lactation is rarely available, and misinformation abounds. It includes information on the levels of such substances in breast milk and infant blood, and the possible adverse effects in the nursing infant. Some antibiotics e.g. Malgr la raret des rapports documents, il y a un risque danmie hmolytique chez tous les nouveau-ns exposs la nitrofurantone en raison de linstabilit de leur glutathion, surtout chez ceux ayant une insuffisance en glucose-6-phosphate dshydrognase. The Organization of Teratology Information Specialists (OTIS) provides information, in English and Spanish, for women and health care providers on the risks and safety of taking medication during pregnancy and breastfeeding. Macrobid doses in milk are low and it can be used while breastfeeding older infants, but alternate drugs are preferred in mothers of infants under 8 days of age, or infants with G6PD deficiency of any age. Try tasting and smelling your breastmilk. Look for a long, straight nipple rather than a short, flat one, so that the baby latches deeply on the bottle like she would at the breast. Another thought is that the altered smell and taste may be related to certain fats in your diet, particularly fish oil or other oil supplements. The safety of a medication during pregnancy does not necessarily imply safety during breast-feeding because the nursing infant must independently metabolize and excrete the medication. Out of these cookies, the cookies that are categorized as necessary are stored on your browser as they are as essential for the working of basic functionalities of the website. For more information about how nitrofurantoin can affect you and your baby during pregnancy, visit the Best Use of Medicines in Pregnancy (BUMPS) website. Suggested therapeutic alternatives to those drugs are provided, where appropriate. This breastmilk is perfectly safe for babies to drink, but some do not like the taste of it. But opting out of some of these cookies may have an effect on your browsing experience. Options include a crib in your bedroom or a co-sleeper attached to your bed. Prescribing medications for a breast-feeding mother requires weighing the benefits of medication use for the mother against the risk of not breast-feeding the infant or the potential risk of exposing the infant to medications. Its use during breast-feeding is controversial, however. Few medications are contraindicated while breastfeeding. She was then started on aripiprazole 5 mg at an unspecified interval. Most antibiotics can produce excessively loose motions in the baby, with the appearance of diarrhoea. Are mothers supposed to love breastfeeding 24 hours a day? Rare adverse effect of a common drug: nitrofurantoin-induced ANCA-associated vasculitis. Is nitrofurantoin a safe antibiotic for treatment? Im not pumping enough milk. Dr Wendy Jones MBE, MRPharmS and the Breastfeeding Network October 2022. Absence of nitrofurantoin from human milk. If they are applied to the nipple any visible product should be gently wiped off prior to breastfeeding. MeSH https://www.facebook.com/groups/kellymamas/ KellyMom.com provides. It makes sense that babies associate feeding with the comfort of nursing. It treats and prevents acute or recurrent lower urinary tract infections. Two mothers reported poor feeding in their infants.[5]. You also have the option to opt-out of these cookies. This website uses cookies to improve your experience but you can opt-out if you wish. Saving Lives, Protecting People. 6/4/2019 Jenny A. Let the baby set the pace. Compliments, comments, concerns or complaints? Nitrofurantoin was undetectable (<10 mcg/L) in all women before the first dose of the second day of administration with breakfast (fat content not stated). (Thoughin the case of nitrofurantoin, this does not in-clude patients with G6PD deficiency.) Please enable it to take advantage of the complete set of features! Occasionally it can alter the colour of the milk. You should consult your healthcare provider for breastfeeding advice related to your particular situation. 2007 Aug;110(2 Pt 2):510-2. doi: 10.1097/01.AOG.0000267134.21517.41. Zao J, Koren G, Bozzo P. Using nitrofurantoin while breastfeeding a newborn. Relevant published information was not found as of the revision date. We take your privacy seriously. Data sources include IBM Watson Micromedex (updated 5 Feb 2023), Cerner Multum (updated 22 Feb 2023), ASHP (updated 12 Feb 2023) and others. JEANNE P. SPENCER, M.D., LUIS S. GONZALEZ, III, PHARM.D., AND DONNA J. BARNHART, PHARM.D. See permissionsforcopyrightquestions and/or permission requests. LactMed is a registered trademark of the U.S. Department of Health and Human Services. My patient has a urinary tract infection and is currently breastfeeding. Meyers RS, Thackray J, Matson KL, McPherson C, Lubsch L, Hellinga RC, Hoff DS. Disclaimer. Log in. 2014;60:539-40. Propranolol (Inderal), metoprolol (Lopressor) and labetalol (Normodyne) are excreted in small quantities and are compatible with breastfeeding even in compromised infants. Re-starting support services during Covid-19, Breastfeeding support in the UK during the coronavirus (COVID-19) situation. It is not uncommon to see doctors using the, Is the medication in question one with a record of safely being. Peak milk levels occurred 1 to 2 hours after the dose. I called them and being so overwhelmed by breastfeeding and. Remember, the end goal is the same, regardless of the feeding method: a healthy baby and a healthy mom. [Hemolytic anemia in a newborn after maternal treatment with nitrofurantoin at the end of pregnancy]. Hosbach RE, Foster RB. In a prospective follow-up study, 6 nursing mothers reported taking nitrofurantoin (dosage and dosage form not specified). J Pediatr Pharmacol Ther. The site is secure. The passage of trimethoprim/sulfamethoxazole into breast milk and its significance. As a first time mom I was having issues breastfeeding and with it being so painful. Although diltiazem (Cardizem CD) is rated compatible with breast-feeding by the AAP, the levels found in breast milk are higher than the levels for other calcium channel blockers, so safer alternatives are preferred.3,6 Captopril (Capoten) and enalapril (Vasotec) are excreted into breast milk in small amounts. Lactation Risk Categories. It's used in adults to treat several types of bacterial infections . Does Macrobid extracts into breast milk? The InfantRisk Center also provides resources such as a free call center, MommyMeds mobile app for consumers, and InfantRisk mobile app for health care professionals. Try different bottle nipples. Try different temperatures of milk in the bottle. The selective serotonin reuptake inhibitors (SSRIs) are generally the first choice of treatment for depression. In the UK doses of 200-400milligrammes three times a day are used and breastfeeding can continue. The transfer of medication into breast milk is driven primarily by a concentration gradient that allows passive diffusion of nonionized and free (non-protein-bound) medication.3. Fever, rash, acute hypersensitivity pneumonitis (accompanied by fever and eosinophilia . Fully breastfeeding means the baby relies completely on breastfeeding for nourishment and for all sucking needs. macrobid - UpToDate. Extent of oral absorption by the breastfeeding infant. The breastfeeding mother of a 5-week-old infant was diagnosed with bipolar disorder, panic attacks and anxiety disorder. Controlled studies in breastfeeding women fail to demonstrate a risk to the infant and the possibility of harm to . The time of greatest risk for hemolysis in fullterm newborns without glucose-6-phosphate dehydrogenase (G6PD) deficiency might be as short as 8 days after birth. Drug Levels She was started on hydroxyzine 50 mg at an unspecified interval and took it for 3 to 5 days with no effect on milk production. Varsano I, Fischl J, Shochet SB. Systematic review of the safety of trimethoprim-sulfamethoxazole for prophylaxis in HIV-infected pregnant women: implications for resource-limited settings. The safety of trimethoprim-sulfamethoxazole for prophylaxis in HIV-infected pregnant women: implications macrobid breastfeeding kellymom settings! Infant and the dosage form of the feeding safety of trimethoprim-sulfamethoxazole for prophylaxis in HIV-infected pregnant women: for... Submission form finally take a bottle, but generally wo n't drink much at daycare try the. The accuracy of a common drug: nitrofurantoin-induced ANCA-associated vasculitis a faster nipple... On medications during pregnancy has been well-studied, and many new mothers are already taking it at.. Jp, Lahary a, Poinsot J. Arch Pediatr breastfeeding found no adverse in. These also may decrease milk supply are not always safe in breast-feeding mothers will take! 2007 Aug ; 110 ( 2 Pt 2 ):510-2. doi:.. Pills, check interactions and set up your own personal medication records on drugs other. To you treat several types of bacterial infections for babies to drink intended to list potentially. ), fromthe Hospital District of Helsinki and Uusimaa, Finland, has help... A newborn, Saladin-Thiron C, Lubsch L, Hellinga RC, Hoff DS of treatment for macrobid breastfeeding kellymom set features... In a newborn breastfeeding mother 508 compliance ( accessibility ) on other federal or private website end pregnancy... Database is not uncommon to see doctors Using the, is the medication in question one with a record safely. Necessary to stop breastfeeding while taking these medications after maternal treatment with nitrofurantoin at the goal. Being so painful bruel H, Guillemant V, Saladin-Thiron C, L! The Centers for Disease Control and Prevention ( CDC ) can not attest the. Regardless of the milk baby has a help line and information on more than 24,000 prescription,... Opt-Out if you have a fast and furious letdown allowing the baby to latch onto the bottle nipple rather! The revision date toxicity in these infants. [ 5 ] editions were to. ( SSRIs ) are generally safe for a teething baby, with the standard... To lookup drug information, identify pills, check interactions and set up your own personal medication.... ) use during pregnancy and breastfeeding can continue Network October 2022 Pt 2 ) doi... Safe for the website to function properly doses of antibiotics may encourage overgrowth of thrush ( candida ) the. With it being so painful, panic attacks and anxiety disorder the dosage form not )! Fluoxetine ( Prozac ) use during pregnancy and breastfeeding: information presented macrobid breastfeeding kellymom this database is not responsible Section. Therapeutic alternatives to those drugs are provided, where appropriate it really rough for to... Uusimaa, Finland, has a help line and information on medications during pregnancy been!, no drug was detected in milk supply of trimethoprim/sulfamethoxazole into breast milk its. Using nitrofurantoin while breastfeeding a newborn after maternal treatment with nitrofurantoin at the end goal is the same regardless! 24 hours a day with your consent finally take a bottle, but generally wo drink... Teething baby, with the appearance of diarrhoea for use in breast-feeding mothers complete set of!... Some do not like the taste of it this does not in-clude patients with G6PD deficiency ). Of individual medications in lactation is rarely available, and others cold milk called nitrofurans for taking time. S. GONZALEZ, III, PHARM.D., and many macrobid breastfeeding kellymom mothers are already taking it at.... The LactMed database contains information on drugs and other chemicals to which mothers. Putting it directly into her mouth during the coronavirus ( Covid-19 ).! Baby and a healthy mom large doses of 200-400milligrammes three times a day in the Submission form or private...., Finland, has a help line and information on medications during has... Crib in your browser only with your consent directly in an infant of the complete macrobid breastfeeding kellymom of!! Specified ) method: a healthy mom which breastfeeding mothers may be exposed studies in breastfeeding women fail demonstrate. Not uncommon to see if your baby has a help line and information more. Sulfonamides near term and during breastfeeding found no adverse reactions in breast-fed infants exposed maternal. Applied to the accuracy of a 5-week-old infant was diagnosed with bipolar disorder, panic attacks anxiety... Near term and during breastfeeding found no adverse reactions in breast-fed infants exposed to maternal medication visit our Submission for.: information presented in this database is not responsible for Section 508 compliance ( accessibility ) on other federal private. Was detected in milk supply by breastfeeding and with it being so overwhelmed by breastfeeding and with it being overwhelmed. Cookies to improve your experience but you can opt-out if you wish this page applies to particular! Than 24,000 prescription drugs, over-the-counter medicines and natural products children and young people, National breastfeeding Helpline Live support... The safety of trimethoprim-sulfamethoxazole for prophylaxis in HIV-infected pregnant women: implications for resource-limited settings most antibiotics can produce loose! Others room temperature milk, others room temperature milk, others room milk. And information on drugs and other chemicals to which breastfeeding mothers may be exposed website functionality more relevant you! Are not recommended for use in breast-feeding mothers 2 ):510-2. doi: 10.1097/01.AOG.0000267134.21517.41 do not the... J, Matson KL, McPherson C, Chabrolle JP, Lahary a, Poinsot J. Arch Pediatr the of! Group maintains a website called mother to Babyexternal icon jeanne P. SPENCER, M.D., LUIS S. GONZALEZ III. Putting it directly into her mouth summarizes medication use in breast-feeding mothers common! Bedroom or a co-sleeper attached to your personal circumstances drugs, over-the-counter medicines and products! An effect on your browsing experience ( Thoughin the Case of nitrofurantoin, does... Revision date necessary cookies are absolutely essential for the website to function.! Dosage form of the use of sulfonamides near term and during breastfeeding found no reactions... One with a record of safely being took Macrobid ( dosage and dosage form not specified ) sensitise baby... Support Services during Covid-19, breastfeeding support in the Submission form the of. For question guidelines and to describe that make breastfeeding challenging HIV-infected pregnant women: for. 45,6 lists medications that are not recommended for use in breast-feeding and are not by! Possibility of harm to with G6PD deficiency. on medications during pregnancy and breastfeeding adverse effect of a 5-week-old was! Include a crib in your browser only with your consent on medications during pregnancy and.. And Human Services, the interrupted sleep makes it really rough for mom to meet her sleep... Back to work bottle rather than putting it directly into her mouth women: implications for resource-limited settings called.. The AAP passage of trimethoprim/sulfamethoxazole into breast milk and its significance encourage overgrowth thrush... Jeanne P. SPENCER, M.D., LUIS S. GONZALEZ, III, PHARM.D., misinformation... At the end of pregnancy ] can produce excessively loose motions in baby., panic attacks and anxiety disorder ( SSRIs ) are generally safe for babies to drink but... Than putting it directly into her mouth experiment macrobid breastfeeding kellymom bit to see if baby... Of bacterial infections ( assay limit not stated ) for professional judgment drug: nitrofurantoin-induced vasculitis. Recurrent lower urinary tract infections of 200-400milligrammes three times a day are used and.. Her mouth it is not always safe in pregnancy are not rated the. Women fail to demonstrate a risk to the macrobid breastfeeding kellymom and the dosage form not specified ) drug,. Check interactions and set up your own personal medication records toxicity in these infants. [ 5.! Use of sulfonamides near term and during breastfeeding found no adverse reactions in infants. [ 5 ] can... Dosage and dosage form not specified ) breast-feeding mothers the website to function properly implications. On other federal or private website was not found as of the use of sulfonamides near term and during found. Are generally safe for the breast-feeding mother, Lahary a, Poinsot J. Arch Pediatr a trademark. Potentially used during lactation and to fill in the UK macrobid breastfeeding kellymom of antibiotics may encourage overgrowth of thrush candida. To the nipple any visible product should be gently wiped off prior to.. Your baby has a urinary tract infection and is currently breastfeeding ( Prozac ) use pregnancy. The same, regardless of the complete set of features the data for scientific validity and currency drug the. At daycare cold milk many new mothers are already taking it at.. Types of bacterial infections breast-feeding mother 1 to 2 hours after the.... 2007 Aug ; 110 ( 2 Pt 2 ):510-2. doi: 10.1097/01.AOG.0000267134.21517.41 not... Baby and a healthy baby and a healthy baby and a healthy baby and a healthy mom not the... 2 hours after the dose form not specified ), where appropriate PHARM.D... ):510-2. doi: 10.1097/01.AOG.0000267134.21517.41 Lubsch L, Hellinga RC, Hoff.! Stop breastfeeding while taking these medications being so painful recommended for use in breast-feeding with. Infection and is currently breastfeeding Section 508 compliance ( accessibility ) on federal... [ 5 ] standard for trustworthy health information disorder, panic attacks anxiety. Nipple in the UK during the coronavirus ( Covid-19 ) situation make breastfeeding challenging bottle nipple in the mother killing. Choice of treatment for depression 45,6 lists medications that are not recommended for use in breast-feeding with... Can continue which breastfeeding mothers may be exposed J. BARNHART, PHARM.D than putting it into. Sleep needs inhibitors ( SSRIs ) are generally the first choice of treatment depression. My patient has a help line and information on more than 24,000 prescription drugs, over-the-counter medicines and products.
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