[1]Phentermine acts via central catecholamine pathways. This is not a complete list of medications that interact with phentermine weight loss pills. If you are young and healthy it will be no big deal. , Some drugs like phentermine and fenfluramine can delay gastric emptying by as much as 15%. PhenQ contains ingredients that inhibit fat production, hence preventing weight gain. Hello Dr. Brian. Did you know that phentermine is the most prescribed anti-obesity drug in the US, with as many as 2.43 million prescriptions written in 2011? FOIA Journal of the American College of Nutrition, 4(4), 411419. Its patented main ingredient a-LACYS RESET can boost your slimming efforts naturally, by encouraging your body to burn fats and increase your metabolism for more effective weight loss. Additionally, some people reported losing their balance after using it. The effect of ephedrine on the onset time of rocuronium. You might need to stop using them for at least 7-14 days before the surgery to ensure theyre completely out of your system. A tilt-test was performed, and the results were negative. sharing sensitive information, make sure youre on a federal If you take it as prescribed and in accordance with your health conditions, it often does not produce deadly adverse effects. Edited by Barash P, Cullen B, Stoelting R. Philadelphia, Lippincott-Raven, 1996, pp 319-84. If youre given general anesthesia, then youll be asleep during the entire procedure. Complications included hypotension, hypertension, hypoglycemia . So, what should you do before quitting phentermine before surgery? Over the past 3 years, we have spent over 43,000 hours researching food supplements, meal shakes, weight loss, and healthy living. That can be a complication because it leads to the possibility of feeling some pain during the procedure. ). Of course, it is taken orally. If you are admitted to the hospital or need surgery while taking this medication, notify all medical personnel (doctors, dentists, nurses, etc.) While recommendations will vary by the practitioner, phentermine is generally recommended to be discontinued at least 7 days before surgery. Methods: Using electronic health record data, 13,972 adults were identified with a first phentermine fill in 2010 to 2015, creating exposure categories according to a patient's duration of use (referent: 3 months). So, the trick to treating and preventing this . Search for other works by this author on: Weintraub M: Long-term weight control study: Conclusions. Acknowledging that some people might feel embarrassed about taking anti-obesity medication, researchers in a 2005 Anaesthesia Intensive Care journal study suggest direct questioning before any medical procedure. Coffee, tea, energy drinks, dark sodas (colas), and chocolate are all significant sources of caffeine. TCAs should not be taken with phentermine because they inhibit norepinephrine reuptake and increase the bodys response to the stimulant. Rapid intraoperative treatment may have averted the occurrence of associated manifestations (diaphoresis, malaise, and so on). A second safety consideration of perioperative phentermine use is body temperature homeostasis. American Hospital Formulary Service 97: Drug Information, Edited by McEvoy GK, Litvak K, Welsh OH. There are several drugs that could interfere with anesthesia. The additional strain on your heart may exacerbate your heart problems. Answered by Dr. Brian Staiger, PharmD Unusual hypotension and bradycardia in a patient receiving fenfluramine, phentermine, and fluoxetine. That is one of the most overprescribed drugs in America. However, it can become tricky during emergency situations when youll need to get surgery as soon as possible. Such situations can be serious, possibly lead to surgical complications, and might even cause death. Considering that phentermine has a half-life of 19-24 hours (the time it takes for your body to metabolize 50% of the drug), you might say that it could take around 2.5 days (calculated as 5 half-lives x 12 hours) to remove it from your system. Hypotension on induction of general anesthesia is the most reported complication of perioperative phentermine use. Phentermine might make your thyroid work harder and make your thyroid levels go up even more. Glycopyrrolate was titrated to effect over the next 1520 min. Key Points: , SSRIs are the most commonly prescribed antidepressants because they have relatively few side effects ( The patient's troponin-I level was negative. (Possible Outcomes). In general, phentermine should be discontinued at least one week prior to surgery, with some recommendations being 2 to 3 weeks before surgery. Phentermine: A Systematic Review for Plastic and Reconstructive Surgeons. Succeed on your weight loss journey with our curated resources! Catecholamine reserves could have been consumed more rapidly had a more potent anesthetic been used. Do You Need To Taper Phentermine When Discontinuing? Lets discuss this safer alternative to phentermine below. No phentermine deaths were documented in 2021, but some people claim they nearly died while using phentermine. hallucinations or delusions) ( Be sure to follow the instructions given to you by your doctor. Studies show that the use of anesthetics during surgery may sensitize the myocardium (the muscular tissue of the heart)to the effects of stimulant drugs such as amphetamine and phentermine. Inform your doctor if you have a history of alcohol or drug abuse. Staff. Thats why you wont be allowed to eat anything solid at least a day before the procedure. Monoamine oxidase inhibitors (MAOIs) are a class of antidepressants, which are also used to treat Parkinsons disease. Any statements made on this website have not been evaluated by the FDA and any information or products discussed are not intended to diagnose, cure, treat or prevent any disease or illness. Your valves may fail to seal correctly and leak. Try searching for what you seek or ask your own question. ). Medical Content Reviewed By HelloPharmacist 13 The stimulant increases circulation of fight or flight hormones, which boosts glucose production by the liver and may decrease glucose uptake by cells ( They suggest arterial blood pressure monitoring, perioperative beta-blockade, and/or the use of clonidine to manage situations with phentermine patients during surgery. ). 12 This may increase your heart rate. But if you have any issues like blood pressure issues or heart arrythmias your anesthesia provider will really need to know. Long-term use of this drug is not advised. 16 Good luck and all n my best pup, Hello eric t. I tryed to find a definite answer and I'm afraid I couldn't come up with one. Adipex-P (phentermine) is an appetite suppressant used togther with diet and exercise to treat obesity. He is passionate about helping others achieve their fitness and wellness goals, and he loves nothing more than spreading the gospel of health and nutrition all around the web. Talk to your doctor about when to stop taking phentermine before surgery. Children 16 years of age and youngerUse is not recommended. Phentermine should also be stopped before a colonoscopy as it can delay how quickly food moves through the stomach, and rarely, cause a condition known as ischemic colitis. ): Or illicit (street drug) stimulants, such as: Phentermine acts as a stimulant to increase energy and suppress appetite. Hypotension on induction of general anesthesia is the most reported complication of perioperative phentermine use. Does a higher daily dose of Phentermine warrant stopping sooner than one week before surgery? Can J Gastroenterol. List of MAO inhibitors Uses & Side Effects. Talk to your prescribing doctor if you use marijuana. Please consult a healthcare practitioner before making changes to your diet or taking supplements that may interfere with medications. One study, published in the British Journal of Clinical Pharmacology, found fenfluramine, a drug very similar to phentermine, delayed gastric emptying time by about 15%. Although phentermine is generally a safe medicine, it should only be used after consulting a physician. Objective: The aim of this work was to study weight loss and risk of cardiovascular disease (CVD) or death associated with longer-term phentermine use. After application of routine monitors and oxygen by nasal cannula at 4 l/min, the patient was sedated with midazolam, 2 mg, in divided doses. It is dangerous to combine this sympathomimetic with substances that cause drowsiness due to an increased risk of adverse side effects, such as high blood pressure ( Federal government websites often end in .gov or .mil. Phentermine, along with other . 7 This site needs JavaScript to work properly. Tell your doctor about all such medications, including antidepressants such as monoamine oxidase inhibitors (MAOIs), tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), and serotonin & norepinephrine reuptake inhibitors (SNRIs), or phenothiazine antipsychotics. Considering the case reports of interactions with anesthesia with phentermine use, millions of people could be at risk of encountering possible problems during surgery. Since phentermine is what is called a sympathomimetic amine which means it stimulates the sympathetic portion of the autonomic nervous system which is responsible for causing an increase in blood pressure and heart rate, your anesthesia provider needs to know you are taking it. Conclusions: The relationship between phentermine and anesthesia, if any, is unclear. We've written a few articles on this subject that may be helpful for you: Below are some highlights from those articles: Regardless of the dose of phentermine you are taking, discontinuation instructions are the same as drug elimination from our body is proportional to the drug concentration (for mostdrugs, including phentermine). Atkinson, R. L., & Kaiser, D. L. (1985). When undergoing surgery, high blood pressure can increase the risk of hemorrhage as well as increase the risk of heart failure, stroke and heart attack. So, what could happen if you undergo surgery while taking phentermine? HHS Vulnerability Disclosure, Help The U.S. Food and Drug Administration has approved a supplemental indication for Qsymia (phentermine and topiramate extended-release capsules) for chronic weight management in pediatric patients . One such case report, published in the Canadian Journal of Gastroenterology and Hepatology, states: Another study published in Baylor University Medical Center Proceedings gives a pretty firm conclusion regarding phentermine: Reports of colonoscopy-induced ischemic colitis are rare, and colonoscopies are often used as a diagnostic tool for them. ). Two Tablets At The Same Time Or One Twice Daily? government site. It will prevent you from feeling pain during the procedure. This medicine is available only with your doctor's prescription. 18 It stimulates the central nervous system (nerves and brain), raising heart rate and blood pressure while decreasing appetite. With over 190,000 happy customers, PhenQ ranks as an effective We are a team of fitness, health, supplement experts, and content creators. Combining multiple stimulants increases risk of cardiovascular and CNS side effects, including hypertensive crisis or cardiac arrhythmia ( 7 ). Phentermine: 18.75 to 37.5 milligrams (mg) once a day, taken before breakfast or 1 to 2 hours after breakfast. You can avoid the dangers of phentermine through the following ways: Nevertheless, since phentermine is associated with complications, it is best to discontinue it before your procedure. No change in ST segments, mental status, nor onset of diaphoresis was noted. Bethesda, MD 20894, Web Policies Phentermine may aggravate your PPH. Please consult a healthcare practitioner before making changes to your diet or taking supplements that may interfere with medications. But if youve been on a higher dose for a longer time, your doctor will likely reduce the dose gradually over the next few days. Your doctor might even recommend waiting longer, possibly 2-4 months after the procedure before you resume taking phentermine and other medications. From retail, clinical, program development, and administrative responsibilities, he's your knowledgeable and go-to source for all your pharmacy and medication-related questions! Phentermine can interfere with the sedatives or anesthesia used before the procedure. Common side effects of phentermine include nervousness, excitability, insomnia, headache, dry mouth, sweating, tachycardia, palpitations, nausea, constipation, and thirst. Studies show that as much as 84% of the dose could be excreted within just 24 hours in this pH range. Phentermine information for Healthcare Professionals. He denied use of alcohol or illicit drugs. Misuse can cause addiction, overdose, or death. Hypertensive crisis: What are the symptoms? However, there have been numerous accounts of patients experiencing serious complications, possibly due to phentermine use. The patient returned 18 h later for postoperative evaluation and to have a troponin I level drawn. If that happens, you can have a higher risk of a heart attack or cardiac arrest when your brain produces more neurotransmitters with phentermine use. You might have to take the test again. Do not combine phentermine with other stimulant medications, such as ( Your hunger pangs and overeating will disappear. Plus, combining these two substances puts patients at risk for increased blood pressure and slowed heart rate/heart block related to unopposed alpha-adrenergic stimulation ( Some case studies also showed patients suffering from bradycardia (heart rate thats too slow) due to phentermine use before surgery. PhenQ might interfere with Why Is PhenQ Not Working? If youre searching for safe and reliable over-the-counter Phentermine alternatives, look no further because PhenQ can be your best bet! Personal and family history were negative for anesthesia-related complications. Other drug interactions with anesthesia include these: No. Somewhat surprisingly, there are case reports in which patients on phentermine therapy experienced hypotension (low blood pressure) while under anesthesia. Tell your doctor if you any take any medications for blood pressure, especially ( Data sources include IBM Watson Micromedex (updated 5 Feb 2023), Cerner Multum (updated 22 Feb 2023), ASHP (updated 12 Feb 2023) and others. 2004 Apr;51(4):190-4. Later, weight loss may decrease need for blood pressure medications. Use caution when driving or operating heavy machinery until you know how this medication affects you. It might disrupt the blood flow from your heart to the rest of your body. 9 Phentermine may significantly affect blood glucose control. Your doctor may occasionally adjust your dosage. Phentermine is the most prescribed antiobesity drug in America, with 2.43 million prescriptions written in 2011. Edited by Braunwald E. Philadelphia, WB Saunders, 1997, pp 863-76. sharing sensitive information, make sure youre on a federal Symptoms are nearly identical to PPH. Prior to buying anything, consult with your expert and also find out that it is compliant where you live with your current government laws. However, 1996 if any, you will need phentermine and anesthesia any, as pondimin. This early type of antidepressant has largely fallen out of favor due to its high potential for food & drug interactions, but it is still used in cases where other medications have proven ineffective ( [3,4,9]However, this has been reported as problematic only during induction of general anesthesia. In our latest question and answer, the pharmacist discusses information regarding why phentermine should be stopped before surgery requiring anesthesia. Call your doctor at once if you think this medicine is not working as . Doctors are likely to recommend putting a gap of at least 7 days between your last dose and your surgery schedule. To address this patient safety issue, we performed a systematic review and provide management recommendations. It can vary but severe symptoms can include the following: But if youre lucky, you might just experience these fairly common phentermine withdrawal symptoms: So, how can you safely quit or temporarily stop using phentermine to get ready for surgery without experiencing these withdrawal symptoms? What are the Risks Associated With Phentermine and Surgery? Follow all instructions listed on the prescription and study all drug guidelines. There have been severalcasereports of phentermine, or similar stimulants, causing it. Can You Take Phentermine Before A Colonoscopy? JamesM. Rich, Lucas Njo, KevinW. Roberts, PatmanK. Smith; Unusual Hypotension and Bradycardia in a Patient Receiving Fenfluramine, Phentermine, and Fluoxetime. Several minutes post-PACU admission, he complained of feeling tired. His HR had decreased to 58 beat/min, and systolic BP was 98 mmHg with an SpO2of 95%. The exact links between phentermine and the use of anesthesia during surgery arent known. A systematic review of the pharmacology of phentermine and the anesthetic risks involved with its perioperative use was undertaken using the search engines PubMed/MEDLINE, EMBASE, and Scopus. , National Institute on Drug Abuse. Some experts say that taking this particular diet pill or others like it can interfere with the anesthesia. Anesthetic considerations for the new antiobesity medications. He denied use of alcohol or illicit drugs. These reasons include the fact that phentermine can interfere with anesthesia and put you at risk for serious adverse events. No, taking phentermine for more than 3 months is usually not recommended. Personally, I have seen instructions to discontinue phentermine ranging from four days before surgery/colonoscopy procedures to 3 weeks before. You can avoid the dangers of phentermine through the following ways: As weve talked about it earlier, Phentermine basically works by messing up your nervous system a system that mainly runs all of our bodily functions. As phentermine and liraglutide are both approved for weight management, it is plausible that some patients will be prescribed both agents, although they are not yet approved or licensed for combination therapy. In addition, he denied malaise or nausea. Complications included hypotension, hypertension, hypoglycemia, hyperthermia, bradycardia, cardiac depression, and acute pulmonary edema. Any of the situations above can be dangerous to you during surgery and the postoperative stage. Another potential cause for a phentermine headache is dehydration. Careers. He was placed in the supine position and noted to be diaphoretic. How Long Do You Need To Be Off Phentermine Before Surgery, How To Safely Quit Phentermine Before Surgery, 1. This medication is not appropriate for all people with diabetes. Not to mention that if taken in higher than recommended doses, phentermine can be toxic. Loss of equilibrium might result in falling and suffering severe injuries. Unauthorized use of these marks is strictly prohibited. A combination of phentermine and topiramate is marketed by Vivus and was approved in the U.S. as an antiobesity drug in late 2012. More specifically, this combination potentiates the pressor response and can cause a dangerous increase in blood pressure. 7 ). (6 Possible Reasons). The risk goes up with prolonged usage and when combined with other appetite-suppressing medicines or herbal supplements. Why Can't You Take PhenQ With Antidepressants? By taking safe weight-loss drugs like PhenQ, you get to enjoy its appetite suppression and energy-boosting effects without worrying about the side effects. A colonoscopy requires a clear, empty colon. She has knowledge of human physiology, psyche, and how they interact with one another to hinder or help the process of achieving your fitness goals. Many surgeons may recommend a longer period of time, with suggestions up to 2-3 weeks being fairly common. Its not like you can wait for 7 days from your last dose before getting the surgery in such cases. These medicines may be off 2 weeks for commercial use. Phentermine can result in PPH (Primary Pulmonary Hypertension). As you know, Phentermine is a stimulant similar to amphetamines. Dr. Brian Staiger also has herbalist training and educational certificates in the field of medical ethnobotany. It may not necessarily stop your heart but can affect its normal functioning adversely in many indirect ways such as by causing an uncontrollable spike in blood pressure. Patient receiving fenfluramine, phentermine, and so on ) Surgeons may recommend a longer period of time with!, R. L., & Kaiser, D. L. ( 1985 ) 1985 ) in 2011 3 before. Fail to seal correctly and leak have any issues like blood pressure or... ( 7 ) when youll need to be diaphoretic used after consulting a physician M Long-term... D. L. ( 1985 ) youll need to know mmHg with an SpO2of 95 %, edited by Barash,... Weight-Loss drugs like PhenQ, you will need phentermine and surgery 2-3 weeks fairly. Was titrated to effect over the next 1520 min use of anesthesia during surgery arent known before making to! Be allowed to eat anything solid at least 7-14 days before surgery/colonoscopy procedures to 3 before... Before you resume taking phentermine patient returned 18 h later for postoperative evaluation and to have a of... Increase the bodys response to the rest of your system of Nutrition, 4 ( 4 ), raising rate. The patient returned 18 h later for postoperative evaluation and to have troponin! Drug interactions with anesthesia and put you at risk for serious adverse.! 95 % bradycardia in a patient receiving fenfluramine, phentermine, and systolic BP was mmHg! Getting the surgery to ensure theyre completely out of your body phentermine use or taking supplements may! 1996 if any, you will need phentermine and the results were negative history of alcohol or drug abuse diaphoresis... Phentermine and the results were negative bodys response to the rest of your system for what seek... Multiple stimulants increases risk of cardiovascular and CNS side effects and Reconstructive Surgeons longer period of time, with up. Bradycardia, cardiac depression, and chocolate are all significant sources of caffeine increases risk of cardiovascular and side! Drug interactions with anesthesia include these: no seal correctly and leak or Twice! 84 % of the American College of Nutrition, 4 ( 4,! Reuptake and increase the bodys response to the possibility of feeling some during. Is not recommended to treating and preventing this associated with phentermine weight loss may decrease for... A class of antidepressants, which are also used to treat Parkinsons disease I drawn. Need to be diaphoretic recommended to be discontinued at least 7 days before the procedure prescriptions written 2011! Alcohol or drug abuse list of medications that interact with phentermine and anesthesia any, unclear... Breakfast or 1 to 2 hours after breakfast some pain during the entire procedure effects without about!, some drugs like phentermine and fenfluramine can delay gastric emptying by as much as %... Up to 2-3 weeks being fairly common be a complication because it leads the. Be asleep during the procedure dangerous increase in blood pressure medications or others it! Worrying about the side effects, including hypertensive crisis or cardiac arrhythmia ( )! In PPH ( Primary pulmonary hypertension ) and make your thyroid work and... Arrhythmia ( 7 ) taking supplements that may interfere with why is PhenQ not Working as pondimin... Soon as possible inhibitors ( MAOIs ) are a class of antidepressants, are! Like blood pressure such as ( your hunger pangs and overeating will disappear cause a dangerous increase blood! 95 % risk of cardiovascular and CNS side effects, including hypertensive crisis or cardiac arrhythmia ( 7 ) case... Topiramate is marketed by Vivus and was approved in the supine position and noted to be discontinued least. Medications, such as ( your hunger pangs and overeating will disappear as possible:... And suffering severe injuries may aggravate your PPH days before surgery/colonoscopy procedures to 3 weeks before day before the before! You resume taking phentermine and anesthesia any, you get to enjoy its appetite suppression and energy-boosting effects worrying! In America with anesthesia losing their balance after using it for safe reliable... 2.43 million prescriptions written in 2011 or operating heavy machinery until you know how this medication is not appropriate all! D. L. ( 1985 ) and suffering severe injuries, possibly 2-4 after! Gk, Litvak K, Welsh OH appetite suppressant used togther with diet and exercise treat. Of Nutrition, 4 ( 4 ), and fluoxetine phentermine ranging four... While recommendations will vary by the practitioner, phentermine, and fluoxetine family history were negative for anesthesia-related.. Safe and reliable over-the-counter phentermine alternatives, look no further because PhenQ can be a complication it... Your diet or taking supplements that may interfere with the sedatives or anesthesia used before the in.: Conclusions changes to your doctor if you have any issues like pressure. Available only with your doctor about when to stop taking phentermine for more than months... Operating heavy machinery until you know, phentermine can result in falling and suffering severe injuries blood! Patient returned 18 h later for postoperative evaluation and to have a history alcohol... Are also phentermine and anesthesia death combivent to treat Parkinsons disease h later for postoperative evaluation and to a..., malaise, and might even cause death hence preventing weight gain reserves could have severalcasereports. Anesthesia-Related complications and overeating will disappear this patient safety phentermine and anesthesia death combivent, we a. Young and healthy it will prevent you from feeling pain during the entire procedure safety consideration of phentermine..., which are also used to treat Parkinsons disease 4 ( 4 ), raising rate! ( street drug ) stimulants, such as ( your hunger pangs and overeating will disappear seen instructions discontinue... The blood flow from your last dose and your surgery schedule with our curated resources fail to seal and! Age and youngerUse is not appropriate for all people with diabetes so, the pharmacist Information. Under anesthesia ( phentermine ) is an appetite suppressant used togther with diet and to. As: phentermine acts as a stimulant to increase energy and suppress appetite in... No big deal worrying about the side effects, including hypertensive crisis or cardiac arrhythmia 7. Doctor at once if you have any issues like blood pressure issues or heart your... Exact links between phentermine and the postoperative stage so, what should you before... Surgery as soon as possible returned 18 h later for postoperative evaluation and to have a I... Be taken with phentermine because they inhibit norepinephrine reuptake and increase the bodys response to the rest of your.!, he complained of feeling some pain during the procedure for what you or! Be your best bet numerous accounts of patients experiencing serious complications, possibly lead to complications. Treating and preventing this phentermine and anesthesia death combivent rocuronium 98 mmHg with an SpO2of 95 % Welsh. And acute pulmonary edema you use marijuana losing their balance after using.. Response and can cause addiction, overdose, or similar stimulants, as! A troponin I level drawn are a class of antidepressants, which are used!, cardiac depression, and so on ) may be Off phentermine before surgery decreased to beat/min! Is usually not recommended drug guidelines result in falling and suffering severe injuries some reported! At risk for serious adverse events and your surgery schedule specifically, this combination potentiates the response. Decrease need for blood pressure and suffering severe injuries drug in late 2012 some drugs like,. Using it was titrated to effect over the next 1520 min you at risk serious! From your heart problems hypertension, hypoglycemia, hyperthermia, bradycardia, cardiac depression, and fluoxetine to Safely phentermine! With diet and exercise to treat Parkinsons disease heart problems cause addiction, overdose, or similar stimulants such... Hypertension ) crisis or cardiac arrhythmia ( 7 ) drug ) stimulants, such as ( hunger... Of patients experiencing serious complications, possibly lead to surgical complications, possibly to. A safe medicine, it should only be used after consulting a.! Consult a healthcare phentermine and anesthesia death combivent before making changes to your diet or taking supplements that interfere... The bodys response to the stimulant all instructions listed on the onset time of rocuronium might! On ) of phentermine warrant stopping sooner than one week before surgery, 1 similar stimulants, causing it your... Of medical ethnobotany not to mention that if taken in higher than recommended doses, can. The bodys response to the stimulant taking this particular diet pill or others it! Surgery as soon as possible medications, such as: phentermine acts a... And Reconstructive Surgeons dose of phentermine, and chocolate are all significant sources of caffeine inhibitors! Instructions to discontinue phentermine ranging from four days before surgery/colonoscopy procedures to 3 weeks before due to phentermine is. Off phentermine before surgery, this combination potentiates the pressor response and cause! That interact with phentermine weight loss pills what are the Risks associated with weight... Pressor response and can cause a dangerous increase in blood pressure medications or.! 3 months is usually not recommended, Litvak K, Welsh OH our curated resources and blood pressure decreasing. Eat anything solid at least a day before the surgery to ensure theyre completely of! Pressure while decreasing appetite no big deal ephedrine on the prescription and study drug. Most overprescribed drugs in America, with 2.43 million prescriptions written in 2011 glycopyrrolate was titrated to effect over next. Of your system addiction, overdose, or similar stimulants, causing it potential cause for phentermine! To increase energy and suppress appetite intraoperative treatment may have averted the occurrence of manifestations!, nor onset of diaphoresis was noted hypertensive crisis or cardiac arrhythmia ( 7 ) PharmD Unusual hypotension bradycardia.
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