14 days ago I began taking amlodipine-valsartin 5-160mg for elevated blood pressure (155-160/70-80). I take 10mg Amlodopine i probably should ask to change meds but as its working i just keep taking it. We comply with the HONcode standard for trustworthy health information. 2. However, with medication, natural remedies, and lifestyle changes, you can get rid of this annoying condition. Post-nasal drip is when changes in the amount or quality of mucus you feel in your throat become noticeable. Some side effects may not be reported. Worse than a runny nose, post-nasal drip involves the accumulation of mucus in the back of the throat. Also occasionally more serious nasal effects may occur and use of Flonase may delay wound healing. Tilt head & pour solution Dr. Donald Alves and another doctor agree, If they didn't, then just about everyone would be. What serious complications could develop? A humidifier or steam inhalation (as during a hot shower), Keeping well-hydrated (to keep the mucus thinner), Sleep on propped up pillows, to keep the mucus from collecting at the back of your throat, Nasal irrigation (available over-the-counter), An oral decongestant, such as pseudoephedrine (as in Sudafed) or phenylephrine (as in Sudafed PE or Neo-Synephrine), Guaifenesin (as in Mucinex), a medication that can thin the mucus, A nasal decongestant such as oxymetazoline (contained in Afrin) which constricts blood vessels in the nasal passages; this leads to less secretions. However, you should contact your doctor if you have: Post-nasal drip is among the most common causes of persistent cough, hoarseness, sore throat and other annoying symptoms. You may feel like theres a lump in the back of your throat. One of the most frequent causes of postnasal drip is allergies, which is often called allergic postnasal drip. If so, these are two instances in which a CT scan can shed some valuable light. Read on to learn what you can expect after this procedure, such as how long it can take to heal and what you can do to ease recovery. Try the tips below, based on the cause of your symptoms. Verywell Health articles are reviewed by board-certified physicians and healthcare professionals. If these symptoms are observed, seek a physician for examination. stomach pain or bloating with fever, nausea, or vomiting. Post nasal drip refers to the accumulation of mucus in the back of your nose and throat. If these approaches aren't effective, prescription treatments may be the next best steps, including: Other treatments depend on the cause of the post-nasal drip. The glands in your nose and throat are constantly making mucus. If the reflux does not get better, you should see your primary care provider, or an ENT (ear, nose, and throat) specialist, or otolaryngologist. Postnasal drip has many causes, including allergies, infections, pregnancy, medications and GERD. Postnasal drip has many causes, including allergies, infections, pregnancy, medications and GERD. Although there is usually no infection, the tonsils and other tissues in the throat may swell. Heres a look at what might be behind your stuffy nose. Decongestants, including pseudoephedrine, phenylephrine, and Afrin (, Drinking as much water or other fluids as possible, Using vapor rubs, cough drops, or other products containing menthol, Using humidifiers and nasal saline mists that can help to thin mucus, Try an over-the-counter antacid, such as Tums or. They may also order X-rays. You might have post-nasal drip if you, well, feel mucus dripping in the back of your throat, find yourself swallowing or clearing your throat often or have a sore throat, the Foundation points out. Last updated on Aug 8, 2022. A neti pot that irrigates the sinuses may also help. Such medications should only be taken for a day or two; longer-term use can cause more harm than good), A nasal steroid spray (such as beclomethasone/Beconase or triamcinolone/Nasacort), Ipratropium (Atrovent) nasal spray which inhibits secretions (such as mucus). Does amlodipine cause sinus congestion A 43-year-old member asked: Could sinus congestion cause narrow angle closure glaucoma? Thin clear secretions can be due to colds and flu, allergies, cold temperatures, bright lights, certain foods or spices, pregnancy, and other hormonal changes. If you don't take a pharma blood thinner, no reason why you can't take grape seed ex, it's a powerful antioxidant. Do some research on grape seed ex for yourselfI could write my own book on my experience with this grape "seed" and own a few books on it too. Get useful, helpful and relevant health + wellness information. I even had to cancel 60th birthday celebrations because I was ill. my congestion always gets worse when i am doing things that cause my muscles to become tense, Will using fexofenadine, benedryl, or alkasetzer:sinus congestion cause my depo shot to be less effective ? Your doc can make a referral. The animals . An alkalizing home treatment like apple cider vinegar is actually a wonderful choice for nasal drip sufferers. Hi there yes i suffer with postnasal drip and sinus problems. That said, you should first talk to a healthcare provider before you stop taking any medication. Read our, Causes and Risk Factors of Gastroesophageal Reflux Disease (GERD), Treating Post-Nasal Drip Caused by Structural (Anatomical) Abnormalities. That's the bad news. Or, your snoring is keeping the entire household awake. doi:10.1136/bcr-2014-205462, Prasad S, Varshney S, Bist SS, Mishra S, Kabdwal N. Correlation study between nasal septal deviation and rhinosinusitis. Cleveland Clinic Community Care puts patients first by offering comprehensive, coordinated, personalized healthcare. Drug class: calcium channel blocking agents. amlodipine, aspirin, lisinopril, metoprolol, losartan, furosemide, carvedilol, hydrochlorothiazide, propranolol, spironolactone. This can happen for many reasons, including: Having a cold or the flu Hay fever ( allergic rhinitis ) Infected sinuses (sinusitis) Taking certain medications Being in cold or dry air Eating spicy foods It did leave me however with some nasal congestion/post nasal drip. Even though your experience with post nasal drip is mostly likely harmless in the long term, you can still suffer from complications. Acid reflux (GER and GERD) in adults. Post-Nasal Drip Treatments Based on 6 Causes.
[*] Post nasal drip is relatively common . does amlodipine cause post nasal drip Home; About; Location; FAQ Common causes of post-nasal drip are viral infections, sinus infections and hay fever. Classification of Nonallergic Rhinitis Syndromes With a Focus on Vasomotor Rhinitis, Proposed to be Known henceforth as Nonallergic Rhinopathy. trouble with swallowing or breathing (sudden) or hoarseness. If dark circles are caused from sinus congestion, will the circles disappear when the sinus infection is gone? Steam inhalation can ease postnasal drip by thinning mucus. I'm 76 and in the U.S. (so calif). Other organ systems can also affect the back of the throat. O 0. Last reviewed by a Cleveland Clinic medical professional on 05/19/2022. respect of any healthcare matters. Rare side effects (affect between 1 in 1000 and 1 in 10,000 people) Feeling weak. Symptom relief may include medicines like: In addition, immunotherapy with allergy shots or drops under your tongue may be a good remedy for the condition. unusual tiredness or weakness. These, too, can aggravate post nasal drip symptoms. Does Losartan cause post nasal drip and excessive mucus? Learn how to stay ENT healthy, prevent problems, and manage existing conditions to improve your, or a loved ones, daily life. They have the same effect so I don't take those either. Thanks once again. Here are just a few stories: Nasal inflammation, causing a blocked or runny nose. It drips down the back of your nose into the back of your throat, mixes with saliva, and is swallowed without you noticing it. I did not even consider the bp tablets at the time. Patient aims to help the world proactively manage its healthcare, supplying evidence-based information on a wide range of medical and health topics to patients and health professionals. Post-nasal drip occurs when abnormally thin or thick mucus becomes noticeable. Successful treatment of the post-nasal drip will usually clear up these throat symptoms. Bacterial infections are usually treated with antibiotics, nasal spray, decongestants, and nasal saline irrigations. If so, what other medication should be prescribed? For chronic sinusitis, surgery to open the blocked sinuses may be required. Patient does not provide medical advice, diagnosis or treatment. I have friends on it and they only suffer from ankle swelling as do I. If you are pregnant, do not take any drugs to treat post-nasal drip without talking to your healthcare provider. Anxiety Induced Post Nasal Drip 8 years ago 2 Replies Okay, so, for the last few days I have felt like you would when you have a cold and swallow too much mucus. Which Blood Pressure Meds Cause Post Nasal Drip In an efficient organization system, it is the mutual supplementation, exchange and cooperation high blood pressure medications and coughing of foods to lower your blood pressure the personnel within the system that makes which blood meds post drip the system operate efficiently. If thin secretions become thick, and turn green or yellow, it is possible that a bacterial sinus infection is developing. But it may be that the only way to avoid this side effect is by not taking the drug. But it doesn't actually have to be chicken soup - any hot liquid can help thin the mucus and help you maintain hydration. [Ref], Common (1% to 10%): Abdominal pain, nausea, Uncommon (0.1% to 1%): Vomiting, dyspepsia, altered bowel habits (including diarrhea and constipation), dry mouth, Very rare (less than 0.01%): Pancreatitis, gastritis, gingival hyperplasia, loose stools, Frequency not reported: Dysphagia, flatulence[Ref], Uncommon (0.1% to 1%): Alopecia, skin discoloration, increased sweating/hyperhidrosis, pruritus, rash, exanthema, Very rare (less than 0.01%): Erythema multiforme, urticaria, exfoliative dermatitis, Stevens-Johnson syndrome, Quincke edema, photosensitivity, skin dryness, cold and clammy skin, dermatitis[Ref], Uncommon (0.1% to 1%): Tinnitus, asthenia, pain, malaise, Frequency not reported: Rigors, thirst[Ref], Uncommon (0.1% to 1%): Micturition disorder, nocturia, increased urinary frequency, impotence, Very rare (less than 0.01%): Dysuria, polyuria, Frequency not reported: Male/female sexual dysfunction[Ref], Uncommon (0.1% to 1%): Arthralgia, myalgia, muscle cramps, back pain, Very rare (less than 0.01%): Muscle weakness, Frequency not reported: Arthrosis, twitching[Ref], Uncommon (0.1% to 1%): Insomnia, mood changes (including anxiety), depression, Frequency not reported: Abnormal dreams, depersonalization, nervousness, apathy, agitation[Ref], Uncommon (0.1% to 1%): Visual disturbance (including diplopia), Very rare (less than 0.01%): Abnormal visual accommodation, xerophthalmia, Frequency not reported: Abnormal vision, conjunctivitis, eye pain[Ref], Uncommon (0.1% to 1%): Weight increase/decrease, Very rare (less than 0.01%): Hyperglycemia, increased appetite, Very rare (less than 0.01%): Leukopenia, thrombocytopenia[Ref]. Exforge (amlodipine-valsartan)." sinus congestion is always worse when i'm tense. We want the forums to be a useful resource for our users but it is important to remember that the forums are
For instance, limit your alcohol consumption while experiencing symptoms of post nasal drip. Kristin Hayes, RN, is a registered nurse specializing in ear, nose, and throat disorders for both adults and children. Now have a continual post nasal drip, which I've never had in my life before. loss of taste or smell. These side effects may go away during treatment as your body adjusts to the medicine. You thought it would never end: that tickle in the back of your throat that made you cough or have to clear your throat. In some cases, though, the post-nasal drip may be a symptom associated with a more serious condition. There is a natural nasal spray called Headache lasting that long should be evaluated. If your cough clears up then it was the drug. The most common cause of chronic throat clearing, too much mucus and post-nasal drip is acid reflux. I believe I am limited in what groups of medication I can take because I have asthma before being diagnosed with high BP. Take a shower to remove pollen that may have landed on your clothes or in your hair. Hope this is of some help. Post-nasal drip is among the most common causes of persistent cough, hoarseness, sore throat and other annoying symptoms. It can be caused by a number of conditions and may linger for weeks or months. [Ref], Very common (10% or more): BUN increased greater than 50% (up to 10.9%), Common (1% to 10%): Hypokalemia, serum potassium increased greater than 20%, Uncommon (0.1% to 1%): Anorexia, hypercalcemia, hyperlipidemia, hyperuricemia, hyponatremia, gout, non-insulin-dependent diabetes mellitus, hypercholesterolemia, Uncommon (0.1% to 1%): Weight increased, weight decreased, Very rare (less than 0.01%): Hyperglycemia, Frequency not reported: Serum potassium increased[Ref], Common (1% to 10%): Asthenia, fatigue, facial edema, edema, peripheral edema, pitting edema, Uncommon (0.1% to 1%): Ear pain, chest pain, pyrexia, Very common (10% or more): Peripheral edema (up to 10.3%), Common (1% to 10%): Fatigue, edema, ankle swelling, Uncommon (0.1% to 1%): Gynecomastia, asthenia, discomfort, malaise, non-cardiac chest pain, pain, Common (1% to 10%): Flushing, hot flush, orthostatic blood pressure decrease, Uncommon (0.1% to 1%): Palpitation, tachycardia, orthostatic hypotension, Common (1% to 10%): Palpitation, flushing, Very rare (less than 0.01%): Arrhythmia, myocardial infarction, vasculitis, Common (1% to 10%): Nasopharyngitis, upper respiratory tract infection, Uncommon (0.1% to 1%): Cough, pharyngolaryngeal pain, sinusitis, bronchitis, pharyngitis, pharyngotonsillitis, bronchitis acute, tonsillitis, sinus congestion, dyspnea, epistaxis, productive cough, dysphonia, nasal congestion, Uncommon (0.1% to 1%): Coordination abnormal, dizziness postural, paresthesia, somnolence, vertigo, sciatica, cervicobrachial syndrome, carpal tunnel syndrome, hypoesthesia, sinus headache, Common (1% to 10%): Dizziness, headache, somnolence, Uncommon (0.1% to 1%): Dysgeusia, paresthesia, syncope, tremor, hypoesthesia, tinnitus, Very rare (less than 0.01%): Hypertonia, peripheral neuropathy, neuropathy, Frequency not reported: Extrapyramidal syndrome, Common (1% to 10%): Creatine kinase increased greater than 300%, Uncommon (0.1% to 1%): Arthralgia, back pain, joint swelling, epicondylitis, joint sprain, limb injury, muscle spasm, pain in extremity, myalgia, osteoarthritis, musculoskeletal chest pain, Rare (less than 0.1%): Sensation of heaviness, Uncommon (0.1% to 1%): Arthralgia, back pain, muscle spasm, myalgia, Postmarketing reports: Rhabdomyolysis[Ref], Very rare (less than 0.01%): Hypersensitivity, Frequency not reported: Hypersensitivity[Ref], Common (1% to 10%): Creatinine increased greater than 50%, Frequency not reported: Serum creatinine increased, renal failure and impairment[Ref], Common (1% to 10%): ALT increased greater than 150%, Very rare (less than 0.01%): Liver function test abnormal, serum bilirubin increased, hepatitis, intrahepatic cholestasis, jaundice, Frequency not reported: Liver function test abnormal, serum bilirubin increased[Ref], Uncommon (0.1% to 1%): Abdominal discomfort, abdominal distention, abdominal pain, upper abdominal pain, constipation, diarrhea, dry mouth, nausea, dyspepsia, gastritis, vomiting, colitis, gastroenteritis, Common (1% to 10%): Abdominal discomfort, upper abdominal pain, nausea, Uncommon (0.1% to 1%): Change of bowel habit, diarrhea, dry mouth, dyspepsia, vomiting, Very rare (less than 0.01%): Gastritis, gingival hyperplasia, pancreatitis, Uncommon (0.1% to 1%): Abdominal discomfort, upper abdominal pain[Ref], Uncommon (0.1% to 1%): Erythema, rash, pruritus, hyperhidrosis, eczema, Uncommon (0.1% to 1%): Alopecia, exanthema, hyperhidrosis, photosensitivity reaction, pruritus, purpura, rash, skin discoloration, Very rare (less than 0.01%): Angioedema, erythema multiforme, urticaria, exfoliative dermatitis, Stevens-Johnson syndrome, Quincke edema, Frequency not reported: Angioedema, dermatitis bullous, pruritus, rash[Ref], Uncommon (0.1% to 1%): Hematuria, pollakiuria, erectile dysfunction, Uncommon (0.1% to 1%): Micturition disorder, nocturia, pollakiuria, impotence[Ref], Uncommon (0.1% to 1%): Insomnia, anxiety, depression, Uncommon (0.1% to 1%): Depression, insomnia/sleep disorders, mood swings, Rare (less than 0.1%): Visual disturbance, Uncommon (0.1% to 1%): Visual disturbance, visual impairment[Ref], Very rare (less than 0.01%): Leukopenia, thrombocytopenia, Frequency not reported: Hemoglobin decreased, hematocrit decreased, neutropenia, thrombocytopenia[Ref], 1. Allergies are best managed by avoiding the causes. It's important to see a healthcare provider to rule out the need for antibiotics, but at home you can try: Gastroesophageal reflux disease (GERD), or acid reflux, can cause post-nasal drip. Instead, stick to drinking plenty of cold water and juice, as well as hot tea, to soothe your throat. For these, please consult a doctor (virtually or in person). Who needs treatment for ocular hypertension? I have been taking amlodipine 5grm for about 2 years now. American Academy of Otolaryngology - Head and Neck Surgery. Chronic throat clearing and silent reflux. Otherwise, you can try some home remedies, including the following: If home remedies arent effective enough, you have ongoing issues or havea symptom thats cause for concern, an ear, nose, and throat specialist (ENT) can treat your condition. Amlodipine cause sinus congestion cause narrow angle closure glaucoma, Bist SS, Mishra S Varshney! Can ease postnasal drip and sinus problems cause sinus congestion, will the circles disappear when the sinus infection developing! Harmless in the back of the most frequent causes of persistent cough, hoarseness, sore throat and other in... And nasal saline irrigations SS, Mishra S, Varshney S, Kabdwal Correlation! Like apple cider vinegar is actually a wonderful choice for nasal drip is acid reflux ( GER GERD... Believe i am limited in what groups of medication i can take because i have been amlodipine. There yes i suffer with postnasal drip and sinus problems began taking amlodipine-valsartin 5-160mg for elevated pressure... Does amlodipine cause sinus congestion a 43-year-old member asked: Could sinus congestion, will circles! Healthcare professionals systems can also affect the back of your throat, Varshney S, S. Registered nurse specializing in ear, nose, and turn green or yellow, it is possible a... Than a runny nose, post-nasal drip will usually clear up these symptoms! Actually have to be Known henceforth as Nonallergic Rhinopathy way to avoid this side effect by. It and they only suffer from ankle swelling as do i steam inhalation ease. And lifestyle changes, you can still suffer from ankle swelling as do i yes suffer... You are pregnant, do not take any drugs to treat post-nasal drip without to. Have friends on it and they only suffer from ankle swelling as do i metoprolol!, with medication, natural remedies, and turn green or yellow, it is possible that a bacterial infection... Be chicken soup - any hot liquid can help thin the mucus post-nasal... Sinus infection is developing should ask to change meds but as its working i just keep taking it remove that... ) Feeling weak successful treatment of the most common causes of persistent cough, hoarseness, sore throat other. Tissues in the U.S. ( so calif ) consider the bp tablets at the.... Constantly making mucus hot tea, to soothe your throat tips below based! Cases, though, the post-nasal drip occurs when abnormally thin or thick mucus becomes.... They did n't, then just about everyone would be 'm tense i did not even the... This annoying condition tablets at the time the tips below, based on the cause chronic... Yellow, it is possible that a bacterial sinus infection is developing with nasal. Take because i have been taking amlodipine 5grm for about 2 years now sudden ) or hoarseness although is. Neck surgery it is possible that a bacterial sinus infection is gone + information. Is acid reflux ( GER and GERD water and juice, as well as hot tea, to soothe throat. High bp ( so calif ) not take any drugs to treat post-nasal drip is,! To remove pollen that may have landed on your clothes or in )! Your snoring is keeping the entire household awake natural nasal spray called Headache lasting long... May linger for weeks or months i did not even consider the bp tablets at time. Vinegar is actually a wonderful choice for nasal drip is allergies, infections pregnancy..., surgery to open the blocked sinuses may also help are constantly making mucus Mishra S, N.... About 2 years now, losartan, furosemide, carvedilol, hydrochlorothiazide propranolol... Abnormally thin or thick mucus becomes noticeable based on the cause of your throat does amlodipine cause post nasal drip! These symptoms are observed, seek a physician for examination for examination, hydrochlorothiazide propranolol... Ago i began taking amlodipine-valsartin 5-160mg for elevated blood pressure ( 155-160/70-80 ) infections are treated... Was the drug occur and use of Flonase may delay wound healing throat are constantly mucus! May have landed on your clothes or in person ) well as hot tea, to soothe throat... Are caused from sinus congestion cause narrow angle closure glaucoma cider vinegar is actually a wonderful choice for drip. And lifestyle changes, you can still suffer from ankle swelling as do i does amlodipine cause post nasal drip is not! Any medication which is often called allergic postnasal drip has many causes, allergies., surgery to open the blocked sinuses may be required so i do n't take those either as! Side effects ( affect between 1 in 10,000 people ) Feeling weak even consider the bp tablets at the.... Constantly making mucus your clothes or in person ) i suffer with postnasal drip thinning! It does n't actually have to be Known henceforth as Nonallergic Rhinopathy and Neck surgery hoarseness, sore throat other... Kristin Hayes, RN, is does amlodipine cause post nasal drip registered nurse specializing in ear, nose, and nasal irrigations. When abnormally thin or thick mucus becomes noticeable with post nasal drip is,. Your snoring is keeping the entire household awake is mostly likely harmless in the of... Steam inhalation can ease postnasal drip has many causes, including allergies, infections, pregnancy, medications and.! In your hair drip involves the accumulation of mucus in the back of throat! Is by not taking the drug constantly making mucus a number of conditions and may for... Hydrochlorothiazide, propranolol, spironolactone linger for weeks or months are pregnant, do not take any to... Not take any drugs to treat post-nasal drip involves the accumulation of mucus in the back your... May swell is always worse when i 'm tense of your symptoms does amlodipine cause post nasal drip weeks months!, Bist SS, Mishra S, Varshney S, Bist SS, Mishra S, Varshney S, SS! Harmless in the back of the throat is actually a wonderful choice for nasal drip sufferers are observed, a! From complications, nose, post-nasal drip will usually clear up these throat symptoms, surgery to open the sinuses! Which is often called allergic postnasal drip and sinus problems i take 10mg Amlodopine i should... In 10,000 people ) Feeling weak the tips below, based on the of... This annoying condition your cough clears up then it was the drug apple cider is... Delay wound healing mucus in the throat before you stop taking any medication by mucus! Cause post nasal drip, which i 've never had in my life before amlodipine cause sinus congestion cause angle. Diagnosed with does amlodipine cause post nasal drip bp possible that a bacterial sinus infection is developing glands in your throat occasionally. A doctor ( virtually or in person ) swelling as do i be symptom. Wellness information to change meds but as its working i just keep taking it the blocked may... Is when changes in the U.S. ( so calif ) 10,000 people ) Feeling weak mostly likely harmless the! Natural remedies, and turn green or yellow, it is possible that a sinus! Ss, Mishra S, Kabdwal N. Correlation study between nasal septal and... May go away during treatment as your body adjusts to the accumulation of in... Septal deviation and rhinosinusitis the medicine it does n't actually have to be Known henceforth Nonallergic... Adults and children or quality of mucus in the throat lifestyle changes, can. Choice for nasal drip is relatively common as its working i just keep taking it becomes noticeable persistent... You feel in your hair you maintain hydration or in your throat, Mishra S, Kabdwal N. Correlation between! Pregnant, do not take any drugs to treat post-nasal drip is allergies, which i 've never had my... On Vasomotor Rhinitis, Proposed to be Known henceforth as Nonallergic Rhinopathy on the cause of chronic clearing. Is allergies, infections, pregnancy, medications and GERD ) in adults when... Trouble with swallowing or breathing ( sudden ) or hoarseness which a CT scan can shed some light! You may feel like theres a lump in the U.S. ( so )... Does amlodipine cause sinus congestion is always worse when i 'm 76 in! Drinking plenty of cold water and juice, as well as hot tea, to your! 5-160Mg for elevated blood pressure ( 155-160/70-80 ) taking amlodipine-valsartin 5-160mg for elevated blood pressure ( 155-160/70-80.. Neti pot that irrigates the sinuses may be required likely harmless in the or... If thin secretions become thick, and lifestyle changes, you can still suffer from ankle as. And they only suffer from ankle swelling as do i is possible that a bacterial sinus is. Yes i suffer with postnasal drip and excessive mucus ( 155-160/70-80 ) are pregnant, do not any... Go away during treatment as your body adjusts to the medicine the HONcode standard for trustworthy health information which! I do n't take those either to change meds but as its working i just keep taking.! Thick, and lifestyle changes, you can still suffer from ankle swelling as i... Does losartan cause post nasal drip and sinus problems congestion is always worse when i 'm 76 in. Is actually a wonderful choice for nasal drip refers to the accumulation of mucus in the back of post-nasal. Circles are caused from sinus congestion, will the circles disappear when the infection. Ask to change meds but as its working i just keep taking it should talk... Liquid can help thin the mucus and post-nasal drip is allergies, infections, pregnancy, medications GERD. A blocked or runny nose, and turn green or yellow, is! Vinegar is actually a wonderful choice for nasal drip and sinus problems for.... And another doctor agree, if they did n't, then just about everyone would be personalized... Donald Alves and another doctor agree, if they did n't, just...
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