Care Global Pharmacy

Accufine is a brand of Isotretinoin, an oral medication primarily used to treat severe acne, particularly nodular or cystic acne that has not responded to other treatments like topical treatments or antibiotics. Isotretinoin is a potent retinoid (a form of vitamin A) that works by reducing the size and output of sebaceous glands (oil glands), which helps to prevent acne.

Uses of 20 mg Accufine (Isotretinoin) Softgel Capsule:

1. Treatment of Severe Acne:

   • The primary use of Accufine (Isotretinoin) is for the treatment of severe, cystic, or nodular acne. This type of acne is typically resistant to other treatments such as topical antibiotics or oral antibiotics like tetracycline. Isotretinoin helps reduce the size of sebaceous glands, decreases sebum (oil) production, and prevents the clogging of pores, which are key factors in the development of acne.

2. Acne Scarring Prevention:

   • By reducing the severity of acne, Isotretinoin helps prevent the development of scarring that may occur due to severe acne. It can significantly improve the appearance of the skin and prevent long-term damage caused by acne.

3. Reduction of Sebum Production:

   • Isotretinoin reduces the production of sebum, a type of oil that can clog pores and lead to acne. This helps in reducing the formation of new acne lesions.

4. Prevention of Acne Relapse:

   • For many individuals, Isotretinoin provides a long-term solution to acne. After completing a course of treatment, many patients experience a significant and lasting reduction in acne. In some cases, a second course may be needed if acne relapses.

Mechanism of Action:

Isotretinoin works by:

• Shrinking sebaceous glands to reduce sebum (oil) production, which prevents clogged pores and acne formation.
• Promoting cell turnover (the shedding of dead skin cells), which helps keep pores clear.
• Reducing inflammation associated with acne lesions.
• Inhibiting the growth of the bacteria that contribute to acne.

Tretiva (Isotretinoin 10mg Capsules) is a medication primarily used to treat severe skin conditions. Below is an overview of its uses, mechanisms, and precautions:

Uses of Tretiva (Isotretinoin 10mg Capsules):

1. Severe Acne (Nodular or Cystic Acne):

   • Most commonly prescribed for severe recalcitrant acne that has not responded to conventional treatments like antibiotics or topical therapies.

2. Other Skin Disorders (Off-label Uses):

   • Rosacea: In severe cases unresponsive to other treatments.
   • Hidradenitis Suppurativa: A chronic inflammatory skin condition with painful lumps.
   • Ichthyosis: Severe cases of this skin-thickening disorder.
   • Photoaging or Sun Damage: Occasionally used for skin rejuvenation (under specialist advice).

How Isotretinoin Works:

• Reduces Sebum Production: Decreases oil production by shrinking sebaceous glands, which helps in controlling acne.
• Prevents Clogging of Pores: Reduces the formation of comedones (whiteheads and blackheads).
• Anti-Inflammatory Effect: Alleviates inflammation associated with acne.
• Normalizes Skin Cell Shedding: Prevents the buildup of dead skin cells in pores.

Isotroin 20 mg capsule contains isotretinoin as its active ingredient. It is used to treat severe acne (pimples) that haven’t responded to other treatments. Take Isotroin 20 mg capsule as instructed by the doctor. Avoid being exposed to sunlight for too long. Drink plenty of water and fluids to keep yourself hydrated. Clean the face gently with a mild soap/facewash, limit the use of oil-based or greasy cosmetics and avoid rubbing, scratching or squeezing pimples. Before using Isotroin capsule, inform the doctor if you are pregnant, planning for a baby or are breastfeeding and regarding the detailed medical history.

Accufine (Isotretinoin 10mg Capsules) is a retinoid medication used primarily to treat severe and persistent acne. Below are the primary uses, mechanism of action, and important considerations:

Uses of Accufine (Isotretinoin 10mg Capsules):

1. Severe Acne:

   • Specifically for nodular or cystic acne that does not respond to conventional therapies like antibiotics or topical treatments.
   • Helps in clearing existing acne lesions and preventing new ones from forming.

2. Acne with Scarring Risk:

   • Used in cases where untreated acne may lead to permanent scarring.

3. Other Skin Conditions (Off-Label Uses):

   • Rosacea: For severe cases of inflammatory rosacea.
   • Hidradenitis Suppurativa: A chronic skin condition involving painful lumps under the skin.
   • Keratinization Disorders: Such as severe ichthyosis or keratosis pilaris (in rare, severe cases).

How Accufine (Isotretinoin) Works:

• Reduces Sebum Production: Shrinks sebaceous glands to lower oil production, making it harder for acne-causing bacteria to thrive.
• Prevents Clogging of Pores: Reduces the formation of comedones (whiteheads and blackheads).
• Anti-Inflammatory Effect: Helps reduce inflammation in the skin.
• Normalizes Skin Cell Shedding: Prevents the buildup of dead skin cells within pores.

Treso (brand name for Isotretinoin) is a medication primarily used for the treatment of severe acne. The 10mg dosage of Isotretinoin capsules is typically prescribed for the following uses:

1. Severe Nodular Acne

• Isotretinoin is primarily used to treat severe nodular acne (also known as cystic acne) that has not responded to other treatments, such as antibiotics or topical therapies. This type of acne is characterized by large, painful cysts and nodules beneath the skin's surface, which can lead to scarring if left untreated.
• Isotretinoin works by reducing the size and activity of sebaceous (oil) glands, which helps decrease the amount of oil produced by the skin, reducing the formation of acne lesions.

2. Acne Conglobata

• Isotretinoin may also be prescribed for acne conglobata, a severe form of acne that affects larger areas of the body and is typically associated with scarring. This condition involves deep, inflamed cysts and abscesses.

3. Acne Vulgaris

• In some cases, Isotretinoin is prescribed for moderate to severe acne vulgaris (the most common form of acne) when other treatments have failed to control the condition. Acne vulgaris is marked by pimples, blackheads, whiteheads, and cysts that appear on the face, back, chest, and shoulders.

Mechanism of Action:

Isotretinoin is a retinoid (a form of Vitamin A) that works by:

• Reducing the size and secretion of sebaceous (oil) glands in the skin.
• Decreasing the clogging of pores.
• Reducing inflammation in the skin.
• Inhibiting the growth of the bacteria Propionibacterium acnes, which contributes to acne formation.

Tretin 0.025% Cream is a form of vitamin A that is used to treat acne which appears as spots or pimples on your face, chest, or back. It also helps to smooth rough facial skin and to reduce fine wrinkles on the skin.

Tretin 0.025% Cream reduces excessive oil production of the skin. Ideally, a pinpoint application at nighttime is recommended for the duration prescribed by your doctor. The amount you need and for how long you need to take it will depend on what you are being treated for. You should normally wash and dry the affected area before applying a thin layer of this medicine. Follow your doctor’s instructions. You should not apply it to damaged or broken skin and avoid contact with your mouth, eyes, and nose. It may take several weeks for your symptoms to improve but keep using it regularly to get the most benefit. Consult your doctor again if you do not notice any improvement after a few weeks. Using more medicine or applying it more often than prescribed will not make it work any faster and may increase the side effects.

The most common side effects include irritation, dryness, and redness of the skin. They are usually mild and improve as your body gets used to the medicine. Drink plenty of water and use moisturizer as it may lead to dryness of the mouth, lips, and eyes. Let your doctor know if these side effects bother you or do not go away. Serious side effects with this medicine are rare.

This medicine may make you more sensitive to sunlight so you should limit exposure to the sun if possible. It may make your skin more fragile. It is advised, not to have any waxing (hair removal), or laser treatments during treatment. Pregnant women or women who are planning to get pregnant should not use this medicine as it can lead to birth defects.

Oxfenda is a brand name for Oxfendazole tablets, manufactured by Winlife Pharma. Oxfendazole is a benzimidazole anthelmintic medication primarily used in veterinary practice to protect livestock against gastrointestinal parasitism caused by nematodes and some cestodes. Here's a summary of key information regarding Oxfenda Oxfendazole Tablets 500mg:

• Manufacturer: Winlife Pharma.
• Active Ingredient: Oxfendazole.
• Strength: 500mg.
• Indication: Treatment and control of various parasitic infections in livestock, including gastrointestinal roundworms, lungworms, and tapeworms.
• Mechanism of Action: Oxfendazole belongs to the benzimidazole class of anthelmintics. It works by binding to tubulin, a structural protein of microtubules in the parasites, inhibiting microtubule formation and disrupting glucose uptake, leading to the parasite's starvation and eventual death.

Oxalobacter formigenes capsules are a type of probiotic supplement that contains live bacteria, primarily used for managing and preventing conditions related to excessive oxalate levels in the body. Below are the key uses and details about these capsules:

Uses of Oxalobacter formigenes Capsules:

1. Prevention and Management of Kidney Stones:

   • Helps in reducing the formation of calcium oxalate kidney stones, the most common type of kidney stones.
   • Oxalobacter formigenes metabolizes dietary and endogenous oxalate in the gut, reducing its absorption into the bloodstream and subsequent excretion into the urine.

2. Hyperoxaluria Treatment:

   • Effective in managing primary hyperoxaluria (a rare genetic condition) and secondary hyperoxaluria (caused by dietary factors, gastrointestinal disorders, or kidney dysfunction).
   • By breaking down oxalate in the intestines, it reduces systemic oxalate levels.

3. Support in Gut Health:

   • As a probiotic, it helps in restoring the balance of gut microbiota, especially for individuals with oxalate-processing deficiencies.

How Oxalobacter formigenes Works:

• Oxalate Degradation:
  • The bacterium uses oxalate as its energy source, breaking it down into carbon dioxide and formate in the gut.
  • This reduces oxalate absorption into the bloodstream and subsequently decreases urinary oxalate excretion, which is a major factor in kidney stone formation.

Dosage and Administration:

• The dosage varies depending on the product and the patient’s condition. Always follow the doctor’s or product-specific instructions.
• Typically taken once or twice daily with or without food.

Product Name: Lodonak Capsules (1.5mg, 3mg, 4.5mg)

Brand Name: Lodonak, LDN Capsules, Naltrex-LD

Composition: Low Dose Naltrexone (1.5mg, 3mg, 4.5mg)

Manufacturer/Marketer: Kachhela Medex Pvt Ltd

Packaging: To be provided (specify packaging details if available)

Treatment: Autoimmune disorders, chronic pain, fibromyalgia

Product Description: Lodonak Capsules contain Low Dose Naltrexone, a medication used as an off-label treatment for various autoimmune disorders, chronic pain conditions, and fibromyalgia. It works by modulating the immune response and increasing the production of endorphins, providing symptomatic relief and improving quality of life

Penicillamine is a medication used primarily for the treatment of conditions such as:

1. Rheumatoid Arthritis: Penicillamine is used to reduce inflammation and pain in the joints, particularly in people who do not respond well to other medications like methotrexate or nonsteroidal anti-inflammatory drugs (NSAIDs).

2. Wilson's Disease: This genetic disorder leads to excessive copper buildup in the body. Penicillamine helps by binding to copper and promoting its excretion in urine.

3. Cystinuria: A genetic condition that causes kidney stones made of cystine (an amino acid). Penicillamine is used to decrease the formation of these stones by binding to cystine and increasing its solubility.

4. Lead Poisoning: In some cases, penicillamine is used as a chelating agent to remove lead from the body.

Penicillamine works by interfering with the absorption of copper and other metals, and by altering the immune system’s response in autoimmune diseases like rheumatoid arthritis. It can have significant side effects and is generally prescribed under close medical supervision.

Prodep (brand name for Fluoxetine) is a medication that belongs to a class of drugs called Selective Serotonin Reuptake Inhibitors (SSRIs). The 20mg dosage of Fluoxetine capsules is primarily used to treat various mental health conditions, including:

1. Depression

• Fluoxetine is commonly prescribed to treat major depressive disorder (MDD). It works by increasing the levels of serotonin, a neurotransmitter in the brain that helps regulate mood, emotions, and behavior. By boosting serotonin levels, Prodep helps alleviate symptoms of depression such as persistent sadness, loss of interest in activities, and changes in sleep and appetite.

2. Anxiety Disorders

• Prodep is often used to treat generalized anxiety disorder (GAD), where it helps reduce excessive worry, tension, and anxiety symptoms. It can also be effective for social anxiety disorder and panic disorder.

3. Obsessive-Compulsive Disorder (OCD)

• Fluoxetine is used to treat obsessive-compulsive disorder (OCD), a condition characterized by unwanted repetitive thoughts (obsessions) and compulsive behaviors (e.g., washing, checking, counting). Prodep helps reduce the frequency and intensity of these thoughts and behaviors.

4. Binge Eating Disorder (BED)

• Prodep may be prescribed for binge eating disorder, which involves episodes of consuming large amounts of food in a short period while feeling a lack of control. Fluoxetine helps regulate appetite and reduce the occurrence of binge episodes.

5. Premenstrual Dysphoric Disorder (PMDD)

• Fluoxetine can also be used to treat premenstrual dysphoric disorder, a severe form of premenstrual syndrome (PMS), characterized by extreme mood swings, irritability, depression, and anxiety that occur before menstruation.

6. Bulimia Nervosa

• Prodep can be used in the treatment of bulimia nervosa, an eating disorder characterized by episodes of binge eating followed by purging behaviors (e.g., vomiting, excessive exercise). It helps reduce the frequency of binge eating and purging behaviors.

Mechanism of Action:

Fluoxetine works by inhibiting the reuptake of serotonin in the brain, making more serotonin available in the synaptic gap between neurons. This action helps improve mood and reduces symptoms of depression, anxiety, and OCD by enhancing serotonin signaling.

Side Effects:

Common side effects of Prodep (Fluoxetine) include:

• Nausea and upset stomach
• Insomnia or sleep disturbances
• Headache
• Dry mouth
• Dizziness
• Loss of appetite or weight loss
• Sexual side effects, such as reduced libido or difficulty achieving orgasm

Vortisign 10mg Tablet is a medicine prescribed to treat depression in adults. It belongs to a group of antidepressants known as serotonin modulator and stimulator (SMS). This medication helps to improve mood and energy levels, and reduce sadness and feelings of worthlessness in people with depression.

Vortisign10mg Tablet may be taken with or without food but take it at the same time each day to get the most benefit. The dose and how often you need it will be decided by your doctor so that you get the right amount to control your symptoms. It may be increased gradually. If you have trouble sleeping it may be best to take this medicine in the morning. It may take a few weeks before you start to feel better. Do not change the dose or stop taking it without talking to your doctor, even if you feel well. Your condition may get worse or you may suffer unpleasant withdrawal symptoms. Let your doctor know if you do not see any improvement after four weeks.

Some common side effects of this medicine include vomiting, nausea, and constipation. Keep taking the medicine but talk to a doctor if these side effects bother you. There may be ways of preventing or reducing them. You should avoid driving or operating machinery until you know how this medicine affects you.

Before taking it, you should tell your doctor if you have epilepsy, diabetes, liver or kidney disease, heart problems, glaucoma, drug addiction or bipolar disorder. These may affect your treatment. Pregnant or breastfeeding women should also consult their doctor before taking it. Some other medicines may affect the way it works, especially other antidepressants and medicines called MAO inhibitors. Please tell your doctor about all the medicines you are taking to make sure you are safe.

1g Mesacol Suppository (Mesalazine) is a medication used primarily to treat inflammatory bowel diseases (IBD), such as ulcerative colitis and proctitis. Mesalazine, also known as mesalamine, is an anti-inflammatory drug that works by reducing inflammation in the lining of the intestines.

Main Uses of 1g Mesacol Suppository (Mesalazine):

1. Ulcerative Colitis:

   • Mesacol is most commonly used to treat ulcerative colitis, an inflammatory bowel disease (IBD) that causes inflammation and ulcers in the colon and rectum. Mesalazine helps reduce inflammation in the colon, improving symptoms like diarrhea, abdominal pain, and bleeding.

2. Proctitis:

   • Proctitis refers to inflammation of the rectum, often caused by conditions like ulcerative colitis or infections. Mesacol suppositories are effective in treating inflammation in the rectal area, helping to reduce symptoms like pain, bleeding, and urgency.

3. Maintenance of Remission:

   • Mesacol may also be used to help maintain remission in patients who have achieved symptom control in ulcerative colitis or proctitis. By reducing inflammation and preventing flare-ups, it helps prevent the recurrence of symptoms.

4. Treatment of Inflammatory Bowel Disease (IBD):

   • Mesalazine is a first-line treatment for mild to moderate cases of inflammatory bowel diseases like ulcerative colitis. It works locally in the intestines to reduce inflammation, which is a key factor in the development and worsening of IBD.

5. Treatment of Rectal Inflammation:

   • Because the suppository is designed for direct application to the rectum, it provides targeted treatment for inflammation in the lower gastrointestinal tract, particularly the rectum and sigmoid colon.

Acalnib 100mg Capsule contains Acalabrutinib (100mg) is an Antineoplastics. Tyrosine kinase inhibitor is used to treat mantle cell lymphoma in patients who have been already treated with other chemotherapy medication. It is also used to treat chronic lymphocyte leukemia. It produces its action by inhibiting the action of a certain abnormal protein that signals the cancer cells to multiply. Acalnib 100mg Capsule UsesIt is used in the treatment of the following conditions mantle cell lymphoma, and chronic lymphocyte leukemia.

Contrave contains a combination of bupropion and naltrexone. Bupropion is an antidepressant medicine that can also decrease appetite. Naltrexone is usually given to block the effects of opioids or alcohol in people with addiction problems. Naltrexone may also curb hunger and food cravings.

Microgest 200mg Softgel Capsule is a natural female sex hormone, progesterone. It is used to treat menstrual and pregnancy-related issues that are caused due to hormonal imbalance.

Microgest 200mg Softgel Capsule is also prescribed along with estrogen as a part of hormonal replacement therapy for preventing endometrial hyperplasia (thickening of the lining of the uterus).  It should be taken with food. It should be taken at the same time each day to get the most benefit. You should continue taking it for as long as your doctor has told you to, even if you feel well. 

The most common side effects include headache, breast pain, irregular vaginal bleeding or spotting, stomach or abdominal cramps, bloating, nausea and vomiting, hair loss, edema, and vaginal yeast infection. Side effects are more common during the first few weeks and usually lessen as your body gets used to the medicine. You may also experience bleeding or spotting between your periods, consult with your doctor if it happens frequently. 

Before taking this medicine, inform your doctor if you have, or have had, breast cancer, unusual bleeding in the vagina, or liver disease. You will probably have several tests both before and during treatment to check your womb.  Also, tell your doctor what other medicines you are taking as some may affect, or be affected by, this medicine. In general, it is advisable to avoid alcohol and smoking.

Oxalo Forte Capsule contains Oxalobacter formigenes, a probiotic bacterium that plays a role in managing and preventing calcium oxalate kidney stones. Here's an overview of its uses:

Key Uses of Oxalo Forte:

1. Prevention of Calcium Oxalate Kidney Stones:

   • Oxalobacter formigenes naturally metabolizes dietary and intestinal oxalate, reducing oxalate absorption into the bloodstream. Lower oxalate levels in the urine help prevent the formation of kidney stones.

2. Reduction of Hyperoxaluria:

   • Beneficial for patients with primary or secondary hyperoxaluria, where high oxalate levels in the urine increase the risk of stone formation.

3. Adjunctive Support for Kidney Health:

   • Helps support overall urinary tract and kidney health by reducing oxalate burden.

Mechanism of Action:

• Oxalobacter formigenes degrades oxalate in the gut, preventing its absorption and reducing the urinary oxalate load.
• This reduces the risk of calcium oxalate crystal formation in the kidneys.

Dosage and Administration:

• Typically taken once or twice daily, as prescribed by a healthcare professional.
• Capsules should be swallowed with water, ideally after meals.

Precautions:

• Inform your doctor if you are pregnant, breastfeeding, or have a weakened immune system.
• Use with caution in immunocompromised individuals as it contains live bacteria.

Side Effects:

• Generally well-tolerated.
• Mild gastrointestinal symptoms, such as bloating, gas, or diarrhea, may occur in some individuals.

Note:

Always use Oxalo Forte as directed by a healthcare provider, particularly for individuals with a history of kidney stones or conditions related to oxalate metabolism.

Prograf 1mg Hard Capsule is used along with other medicines to prevent your body from rejecting a new organ (e.g., liver, kidney, or heart) after transplant. It does so by weakening your body’s immune system, so it does not attack the new organ. This medication belongs

Marbormet tablets are indicated for the treatment of infections caused by gram-negative and gram-positive organisms in dogs

Marbormet is available in strips of 5 tablets

store below 30 °C protect from light and moidture

Dose : as directed by the veterrinarian

store in cool, and dark place

for animal use only not for human use

Arpimune O (Cyclosporine 100mg Capsules IP) is an immunosuppressant medication commonly used in conditions where immune system suppression is required to prevent organ rejection or manage autoimmune disorders. Below is an overview of its uses and key information:

Uses of Arpimune O (Cyclosporine):

1. Organ Transplantation:

   • Prevention of Organ Rejection: Used to prevent the immune system from rejecting transplanted organs such as kidneys, liver, and heart.
   • Often combined with other immunosuppressive drugs for enhanced effectiveness.

2. Autoimmune Disorders:

   • Rheumatoid Arthritis: For severe, active rheumatoid arthritis unresponsive to conventional treatments.
   • Psoriasis: Used in severe cases of plaque psoriasis when other systemic therapies fail.
   • Uveitis: Effective for treating non-infectious, severe uveitis (inflammation of the eye) in patients who are not responding to corticosteroids.

3. Nephrotic Syndrome:

   • Reduces proteinuria (protein in urine) in idiopathic nephrotic syndrome, especially in steroid-resistant cases.

4. Other Immune-Related Conditions (Off-label):

   • Atopic Dermatitis: In severe cases requiring systemic immunosuppression.
   • Inflammatory Bowel Disease (IBD): Occasionally used for severe, refractory Crohn’s disease or ulcerative colitis.

How Cyclosporine Works:

• Cyclosporine inhibits the activity of T-lymphocytes, which are key players in the immune response.
• By suppressing T-cell activation, it reduces the immune system's ability to attack transplanted organs or tissues and alleviates inflammation in autoimmune diseases.

It works by killing the parasites. It also paralyzes the parasites, causing them to release their hold on the blood vessel walls so the body can remove them naturally

Reeshape (brand name for Orlistat) is a medication used to help with weight loss and weight management. The 120mg dosage of Orlistat capsules is typically used for the following purposes:

1. Obesity Management

• Orlistat is primarily used as part of a comprehensive weight management program to help reduce body weight in individuals who are overweight or obese. It is typically prescribed for people with a body mass index (BMI) of 30 or greater, or those with a BMI of 27 or greater who have weight-related conditions, such as high blood pressure, type 2 diabetes, or high cholesterol.
• Orlistat works by inhibiting the enzyme lipase, which is responsible for breaking down dietary fats in the stomach and intestines. By blocking the absorption of about 30% of dietary fat, it helps reduce overall calorie intake, aiding in weight loss.

2. Weight Maintenance

• After achieving initial weight loss, Orlistat can be used to help maintain weight in individuals who have successfully lost weight. It is used in combination with a reduced-calorie diet and increased physical activity to prevent weight regain.

Mechanism of Action:

Orlistat works by inhibiting gastrointestinal lipase, the enzyme responsible for breaking down fats in the digestive tract. By blocking the action of lipase, it prevents the absorption of about 30% of dietary fats, which are then excreted in the stool. This results in a decrease in calorie intake and aids in weight loss.

Side Effects:

Common side effects of Orlistat (Reeshape) include:

• Gastrointestinal issues such as stomach pain, diarrhea, flatulence, and oily stools. These side effects are more likely to occur if a person consumes a high-fat meal while taking the medication.
• Frequent or urgent bowel movements.
• Fat-soluble vitamin deficiencies (such as vitamins A, D, E, and K) may occur with long-term use, so supplementation of these vitamins is sometimes recommended.

Contraindications and Precautions:

• Orlistat should not be used by individuals with chronic malabsorption syndrome, cholestasis, or gallbladder disease.
• Pregnancy: Orlistat is not recommended for use during pregnancy. It should be used only if the potential benefit outweighs the risks, and it should not be used while breastfeeding.
• Dietary Considerations: To minimize gastrointestinal side effects, it is important to follow a low-fat diet while using Orlistat. Meals should contain no more than 30% of total calories from fat.

Orlistat is typically used as part of a broader weight management strategy that includes a balanced, reduced-calorie diet and increased physical activity. Regular monitoring and consultation with a healthcare provider are recommended during its use.

It is used to treat an overactive thyroid (hyperthyroidism) and Graves disease. Methimez 10 Tablet is also used before thyroid surgery and radioactive iodine treatment. It treats hyperthyroidism by inhibiting the synthesis of thyroid hormones from the thyroid gland.

Itraconazole, sometimes abbreviated ITZ, is an antifungal medication used to treat a number of fungal infections. This includes aspergillosis, blastomycosis, coccidioidomycosis, histoplasmosis, and paracoccidioidomycosis. It may be given by mouth or intravenously

Evitol Tocotrienol Capsule with Omega 3 Fatty Acids Capsules is a dietary supplement that combines the antioxidant benefits of tocotrienols, a form of Vitamin E, with the heart-healthy properties of Omega 3 fatty acids, including EPA (Eicosapentaenoic acid) and DHA (Docosahexaenoic acid). This combination is designed to support cardiovascular health, protect against oxidative stress, and promote overall well-being.

Isotroin is a brand name for isotretinoin, a medication primarily used to treat severe acne. The 20mg dosage of Isotroin is commonly prescribed for the following uses:

1. Severe Acne (Acne Vulgaris): Isotretinoin is mainly used to treat severe, persistent acne that hasn't responded to other treatments like antibiotics or topical medications. This includes nodular or cystic acne, which can cause scarring.

2. Other Skin Conditions: In some cases, isotretinoin may be prescribed for other dermatological conditions, such as:

   • Rosacea (a chronic inflammatory skin condition causing redness and visible blood vessels on the face).
   • Other types of severe skin disorders that do not respond to conventional therapies.

Isotretinoin works by reducing the size and activity of sebaceous (oil) glands in the skin, which helps to reduce acne-causing oil production, and by promoting the turnover of skin cells.

Because isotretinoin can have significant side effects, including birth defects, liver damage, and mood changes, it is typically prescribed with strict monitoring. Women who are pregnant or may become pregnant should not take isotretinoin due to its teratogenic effects (ability to cause birth defects). Regular blood tests and follow-up appointments are often necessary during treatment.

Tacrocord (Tacrolimus 1mg) is an immunosuppressive medication used to prevent the body's immune system from rejecting transplanted organs and to treat certain autoimmune conditions. Below are the primary uses of Tacrocord:

Uses of Tacrocord (Tacrolimus 1mg Capsules):

1. Prevention of Organ Rejection:

   • Kidney, Liver, or Heart Transplants: Tacrolimus is primarily used to prevent rejection of transplanted organs by suppressing the immune response.

2. Treatment of Autoimmune Diseases (Off-label use):

   • Severe Atopic Dermatitis (Eczema): In some cases, oral tacrolimus may be used off-label to manage severe autoimmune skin conditions.
   • Other Autoimmune Conditions: It may be considered for autoimmune diseases unresponsive to standard therapies, such as lupus or rheumatoid arthritis.

3. Management of Refractory Nephrotic Syndrome:

   • Used in patients who do not respond well to steroids to help control protein loss in urine.

Mechanism of Action:

Tacrolimus inhibits the activity of T-lymphocytes by binding to an intracellular protein called FKBP-12 (FK506-binding protein). This complex inhibits calcineurin, a protein essential for T-cell activation, thereby reducing immune response and preventing organ rejection.

Dosage:

• Dosage is individualized based on the patient's weight, the type of organ transplanted, and blood tacrolimus levels.
• It is usually taken twice daily on an empty stomach (1 hour before or 2 hours after meals).

Common Side Effects:

• Tremors
• Headache
• Hypertension (high blood pressure)
• Nausea and vomiting
• Increased risk of infections
• Renal dysfunction (monitor kidney function regularly)
• Hyperglycemia (can cause or worsen diabetes)

Precautions:

1. Monitoring: Regular monitoring of tacrolimus blood levels is essential to avoid toxicity or under-dosing.
2. Drug Interactions: Tacrolimus interacts with many drugs, including antifungals, antibiotics, and certain antacids. Inform your doctor about any medications you take.
3. Sun Protection: It increases sensitivity to sunlight, so use sunscreen and protective clothing.
4. Avoid Grapefruit: Grapefruit and grapefruit juice can increase tacrolimus levels in the blood, leading to toxicity.

Always follow your doctor's instructions regarding dosage and monitoring when using Tacrocord (Tacrolimus).

Tacrolimus (Prograf) is an immunosuppressive medication primarily used to prevent the rejection of transplanted organs. It works by inhibiting the activity of certain immune cells that can attack the transplanted organ, thereby suppressing the immune response.

Uses of 1 mg Tacrolimus (Prograf) Hard Capsules:

1. Organ Transplant Rejection Prevention:

   • Kidney Transplant: Tacrolimus is commonly used to prevent rejection of kidney transplants. It helps to suppress the immune system to prevent the body from attacking the newly transplanted kidney.
   • Liver Transplant: It is also used in liver transplant recipients to reduce the risk of rejection.
   • Heart Transplant: Tacrolimus is used in heart transplant recipients for the same purpose of preventing immune rejection.
   • Other Solid Organ Transplants: Tacrolimus may be prescribed for other types of organ transplants, such as lung and pancreas transplants, depending on the patient's needs.

2. Autoimmune Diseases:

   • Dermatologic Uses: Tacrolimus is sometimes used topically (in lower doses) to treat eczema (atopic dermatitis) or other inflammatory skin conditions by suppressing local immune activity that causes inflammation.
   • Rheumatoid Arthritis: In some cases, tacrolimus is used to treat rheumatoid arthritis or other autoimmune disorders, though it is less common than other treatments like methotrexate.

Mechanism of Action:

Tacrolimus works by inhibiting calcineurin, a protein that activates T-cells (a key component of the immune system). By blocking calcineurin, tacrolimus reduces the activity of T-cells, thus preventing the immune system from attacking the transplanted organ or the body's own tissues in autoimmune conditions.

Important Considerations:

• Side Effects:

  • Common side effects include tremors, headache, nausea, diarrhea, and increased blood pressure.
  • Long-term use of tacrolimus can increase the risk of kidney damage, high blood sugar (diabetes), infection, and certain cancers (due to immunosuppression).
  • It can also affect electrolyte levels, leading to low magnesium or potassium levels in the blood, so regular monitoring is required.

• Drug Interactions:

  • Tacrolimus has significant drug interactions. Medications that affect liver enzymes (such as antifungals, antibiotics, and anti-seizure drugs) can increase or decrease tacrolimus levels, potentially leading to toxicity or reduced effectiveness.
  • Grapefruit and grapefruit juice can increase the level of tacrolimus in the blood, which can lead to toxicity.

• Monitoring:

  • Regular blood tests are essential to monitor tacrolimus levels, kidney function, and other possible side effects. Maintaining the right blood concentration is crucial for effectiveness and safety.
  • Blood pressure, kidney function, and blood glucose levels should be closely monitored, as tacrolimus can cause complications in these areas.

Palbociclib (brand name Palbomed) is a targeted therapy used primarily in the treatment of certain types of cancer. The 125mg dosage of Palbociclib capsules is commonly prescribed for the following uses:

1. Breast Cancer (HR-positive, HER2-negative)

• Palbociclib is mainly used in the treatment of hormone receptor-positive (HR-positive), HER2-negative breast cancer, which is the most common subtype of breast cancer. It is used in combination with aromatase inhibitors (such as letrozole) in postmenopausal women or with fulvestrant in men and premenopausal women.
• Palbociclib is a CDK4/6 inhibitor that works by blocking the proteins CDK4 and CDK6, which are involved in the cell cycle. By inhibiting these proteins, palbociclib prevents cancer cells from dividing and growing, slowing the progression of the cancer.

2. Metastatic or Advanced Breast Cancer

• Palbociclib is also used in the treatment of metastatic or advanced HR-positive, HER2-negative breast cancer. When the cancer has spread beyond the breast and lymph nodes, palbociclib can help control the progression of the disease in combination with other treatments like aromatase inhibitors or fulvestrant.

Mechanism of Action:

Palbociclib works by inhibiting cyclin-dependent kinases (CDK) 4 and 6, which are enzymes that regulate the cell cycle. Inhibition of CDK4 and CDK6 prevents the cancer cells from progressing through the cell cycle and dividing. This slows down the growth of cancer cells, making it an effective treatment for HR-positive, HER2-negative breast cancer.

Side Effects:

Common side effects of Palbociclib (Palbomed) include:

• Low white blood cell count (neutropenia), which increases the risk of infections.
• Fatigue
• Nausea
• Diarrhea
• Decreased appetite
• Mouth sores

Serious Side Effects:

• Infection due to low white blood cell count (neutropenia).
• Liver toxicity: Liver function should be monitored, as palbociclib can affect liver enzymes.
• Blood clots: Palbociclib may increase the risk of blood clots, especially when combined with other medications such as aromatase inhibitors.

Contraindications and Precautions:

• Pregnancy: Palbociclib is not recommended during pregnancy, as it can harm the developing fetus. Women of childbearing potential should use effective contraception during treatment.
• Liver disease: Palbociclib should be used with caution in patients with liver impairment, and liver function tests should be performed regularly.
• Neutropenia: Due to the risk of low white blood cell count, patients taking palbociclib should be monitored regularly for signs of infection.

Lenva (brand name for Lenvatinib) is a medication used to treat certain types of cancer. The 4mg dosage of Lenvatinib capsules is typically prescribed for the following uses:

1. Thyroid Cancer

• Lenvatinib is commonly used to treat differentiated thyroid cancer (DTC) that has progressed despite radioactive iodine treatment. This type of thyroid cancer includes papillary thyroid cancer and follicular thyroid cancer. Lenvatinib works by inhibiting multiple kinase enzymes involved in cancer cell growth, angiogenesis (the formation of new blood vessels), and the spread of cancer cells.

2. Hepatocellular Carcinoma (Liver Cancer)

• Lenvatinib is approved for the treatment of hepatocellular carcinoma (HCC), the most common form of liver cancer. It is often used in patients who are not candidates for surgery or have advanced-stage liver cancer. Lenvatinib works by targeting multiple pathways involved in tumor growth and vascularization, slowing the progression of the cancer.

3. Renal Cell Carcinoma (RCC)

• Lenvatinib is used in combination with everolimus for the treatment of advanced renal cell carcinoma (RCC), a type of kidney cancer that has spread to other parts of the body. The combination therapy helps to target multiple mechanisms that promote cancer cell growth and spread, improving treatment outcomes.

Mechanism of Action:

Lenvatinib is a multikinase inhibitor that targets several receptor tyrosine kinases involved in the development and progression of cancer. These include receptors for vascular endothelial growth factor (VEGF), fibroblast growth factor (FGF), platelet-derived growth factor (PDGF), and others. By inhibiting these receptors, lenvatinib reduces tumor growth, limits blood supply to tumors, and helps control cancer spread.

Side Effects:

Common side effects of Lenvatinib may include:

• Hypertension (high blood pressure)
• Fatigue
• Diarrhea
• Loss of appetite
• Nausea and vomiting
• Weight loss
• Hand-foot syndrome (redness, swelling, and pain on the palms of the hands or soles of the feet)

Serious Side Effects:

• Liver dysfunction
• Blood clotting issues (thrombosis)
• Gastrointestinal perforation (hole in the stomach or intestines)
• Heart problems, including heart failure

Lenvatinib should be used with caution in patients with pre-existing liver conditions, cardiovascular disease, or hypertension. Regular monitoring for liver function, blood pressure, and other complications is recommended during treatment.

Pregnancy: Lenvatinib can cause harm to a fetus, so it should not be used during pregnancy. Women of childbearing potential should use effective contraception during treatment and for some time after the last dose.

Metolar XR 12.5mg Capsule contains Metoprolol, a beta-blocker medication, used to manage various heart-related conditions. The "XR" indicates that it is an extended-release formulation, meaning the medication is released slowly over time for more consistent effects.

Here are the main uses of Metolar XR 12.5mg Capsule:

1. Hypertension (High Blood Pressure): Metolar XR is commonly prescribed to help lower high blood pressure. By reducing blood pressure, it helps decrease the risk of heart attacks, strokes, and kidney problems.

2. Angina (Chest Pain): It is used to treat angina (chest pain), helping to reduce the frequency and severity of chest pain by improving blood flow to the heart and reducing the heart's workload.

3. Heart Failure: Metolar XR is often used to manage heart failure (a condition where the heart is unable to pump blood efficiently), as it helps improve heart function and reduce symptoms like shortness of breath, fatigue, and swelling.

4. Post-Heart Attack Recovery: It may be prescribed after a heart attack to reduce the risk of another heart attack and to support the heart's recovery by decreasing the heart's demand for oxygen.

5. Arrhythmias (Irregular Heartbeat): Metolar XR helps control certain types of abnormal heart rhythms (arrhythmias), including atrial fibrillation, by slowing down the heart rate and maintaining a more regular rhythm.

Important Notes:

• Dosage: The dosage of Metolar XR is typically adjusted based on the individual's condition and response to treatment. Starting with a lower dose like 12.5mg is common, and it may be increased as needed.
• Side Effects: Common side effects include dizziness, fatigue, low blood pressure, and slow heart rate. Serious side effects can include severe hypotension (low blood pressure), difficulty breathing, and heart block.
• Cautions: Metolar XR should be used cautiously in patients with asthma, certain types of heart problems, or diabetes. It can mask symptoms of low blood sugar in diabetic patients and should be discontinued gradually if long-term use is needed.
• Discontinuation: It should not be stopped suddenly, as abrupt discontinuation can lead to worsening heart conditions. Always follow your doctor's guidance when stopping or adjusting the dose.

As with any medication, it's important to take Metolar XR exactly as prescribed and attend regular check-ups for monitoring.

Lenvatinib (brand name Lenvima) is an oral medication that is primarily used in the treatment of various cancers. The 10mg Lenvatinib Capsules are typically prescribed for the following conditions:

1. Thyroid Cancer:

   • Lenvatinib is approved for the treatment of differentiated thyroid cancer (DTC) that is refractory to radioactive iodine (RAI). This means it is used for thyroid cancers that do not respond to standard treatments, such as radioactive iodine therapy.
   • It can help slow the progression of the disease and improve survival outcomes in patients with advanced or metastatic thyroid cancer.

2. Hepatocellular Carcinoma (HCC):

   • Lenvatinib is used to treat hepatocellular carcinoma (HCC), which is the most common type of liver cancer, particularly in patients who are not candidates for surgery or have advanced liver disease.
   • It is often used as a first-line treatment option for patients with advanced HCC who have not received prior systemic therapy.

3. Renal Cell Carcinoma (RCC):

   • Lenvatinib is used in combination with pembrolizumab (an immune checkpoint inhibitor) for the treatment of advanced renal cell carcinoma (RCC). This combination has shown to improve survival in patients with advanced or metastatic kidney cancer.
   • Lenvatinib targets vascular endothelial growth factor receptors (VEGFR), fibroblast growth factor receptors (FGFR), and other tyrosine kinase receptors involved in tumor growth and angiogenesis (formation of blood vessels that support tumor growth).

0.5mg Takfa Tacrolimus Capsule is an immunosuppressive medication that contains Tacrolimus, primarily used to prevent organ rejection following transplants and to treat autoimmune conditions. The main uses of Takfa Tacrolimus Capsule include:

1. Prevention of Organ Rejection: Tacrolimus is commonly used in patients who have undergone kidney, liver, or heart transplants to prevent the body's immune system from rejecting the transplanted organ. It works by inhibiting T-cell activation, thus suppressing the immune response against the transplanted organ.

2. Autoimmune Diseases: Tacrolimus is used to treat certain autoimmune conditions, such as autoimmune hepatitis, systemic lupus erythematosus (SLE), and rheumatoid arthritis, where the immune system mistakenly attacks healthy tissues in the body.

3. Topical Use for Dermatological Conditions: While this is more common in its topical form, Tacrolimus is sometimes used in the oral form to treat atopic dermatitis (eczema) when other treatments have failed. It helps by suppressing the overactive immune response causing inflammation and itching.

4. Graft-versus-Host Disease (GVHD): Tacrolimus is used to prevent or treat graft-versus-host disease, a condition that can occur after stem cell or bone marrow transplants where the donor’s immune cells attack the recipient’s body.

Important Notes:

• Immunosuppressive Effects: Tacrolimus works by suppressing the immune system, which increases the risk of infections, including opportunistic infections. It also increases the risk of certain cancers, such as skin cancer and lymphoma, due to prolonged immunosuppression.
• Kidney and Liver Function Monitoring: Tacrolimus can affect kidney and liver function, so regular monitoring of kidney and liver function is essential during treatment. It may also raise blood pressure and affect blood sugar levels.
• Side Effects: Common side effects include tremors, headaches, nausea, high blood pressure, and kidney dysfunction. Serious side effects include infections, liver damage, and gastrointestinal issues.
• Drug Interactions: Tacrolimus can interact with other medications, including those used to treat infections, blood pressure medications, and other immunosuppressive drugs. Always inform your doctor about any other medications you are taking.

Usage Instructions:

• Dosage and Administration: The dosage of Takfa Tacrolimus Capsules is individualized based on the patient's medical condition, transplant type, and response to the medication. It is usually taken twice daily, with or without food.
• Compliance with Monitoring: Since Tacrolimus has a narrow therapeutic window (small range between an effective dose and a toxic dose), blood levels are regularly monitored to ensure proper dosing.

Always take Takfa Tacrolimus as prescribed and consult your healthcare provider for proper management of your condition.

Lenalidomide 10 mg Capsules are primarily used in the treatment of certain types of cancers and disorders related to abnormal cell growth. It is an immunomodulatory drug with anti-cancer, anti-inflammatory, and immuno-enhancing properties. Here are the main uses:

1. Multiple Myeloma

• Lenalidomide is commonly used in the treatment of multiple myeloma, a cancer of the plasma cells (a type of white blood cell). It is typically used in combination with other chemotherapy drugs to manage this condition, especially in patients who have received prior therapy.

2. Myelodysplastic Syndromes (MDS)

• Lenalidomide is used in the treatment of myelodysplastic syndromes, a group of disorders caused by poorly formed or dysfunctional blood cells. Specifically, it is often prescribed for patients with del(5q) MDS, a genetic abnormality associated with MDS.

3. Mantle Cell Lymphoma (MCL)

• Lenalidomide is also used in treating mantle cell lymphoma, a rare and aggressive form of non-Hodgkin lymphoma. It is used for patients who have relapsed or have not responded to other treatments.

4. Chronic Lymphocytic Leukemia (CLL)

• Lenalidomide may be used as part of treatment for chronic lymphocytic leukemia, particularly in combination with other medications, for patients who are not candidates for chemotherapy or who have relapsed after previous treatments.

Nutrinol Omega-3 Fish Oil Capsules are a dietary supplement rich in essential omega-3 fatty acids, primarily EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid), which are crucial for several aspects of health. Here are the primary uses and benefits of these capsules:

Main Uses of Nutrinol Omega-3 Fish Oil Capsules:

1. Cardiovascular Health:

   • Supports Heart Health: Omega-3 fatty acids have been shown to help lower triglyceride levels, reduce blood pressure, and improve overall heart function, which can reduce the risk of cardiovascular diseases, including heart attacks and strokes.
   • Reduces Inflammation: Omega-3s have anti-inflammatory effects that can help reduce inflammation in the blood vessels and arteries, potentially lowering the risk of heart disease.

2. Brain and Cognitive Function:

   • Supports Brain Health: DHA is a major structural component of the brain and is essential for maintaining cognitive function. Omega-3s may help improve memory, focus, and overall cognitive function, especially in aging individuals.
   • Mood and Mental Health: Omega-3 fatty acids, especially EPA, have been found to help manage symptoms of depression, anxiety, and other mood disorders.

3. Joint Health:

   • Reduces Joint Pain and Stiffness: Omega-3s have anti-inflammatory properties that may help reduce symptoms of arthritis, including pain, stiffness, and swelling in the joints.

Pentosan (brand name Pentossan) is a medication primarily used for the treatment of bladder conditions and urinary tract disorders. The 100mg Pentossan Capsules are typically used for the following conditions:

1. Interstitial Cystitis (IC):

• Pentosan is commonly prescribed for interstitial cystitis, a chronic condition characterized by bladder pain, urinary urgency, and frequent urination. Pentosan works by helping to restore the protective layer of the bladder and reduce inflammation, which helps alleviate symptoms of IC.
• The medication helps improve bladder function and reduces irritation caused by the condition, providing pain relief and improving the quality of life for affected individuals.

2. Bladder Pain and Urgency:

• Pentosan can help manage bladder pain and urgency that may be associated with various bladder conditions. It is not typically used for acute infections but rather for conditions involving long-term bladder discomfort.

Mechanism of Action:

Pentosan is a pentosan polysulfate sodium medication that is believed to work by repairing and maintaining the glycosaminoglycan (GAG) layer, which protects the bladder lining from irritating substances in urine. It also has anti-inflammatory properties, which can help reduce the discomfort and pain associated with conditions like interstitial cystitis.

QUDRACELL FRACTURE HEAL is a specialized formulation designed to support bone health and accelerate fracture healing. Made with natural and scientifically-backed ingredients such as Cissus Quadrangularis, Calcium Carbonate, and essential vitamins, this product promotes faster recovery, helps strengthen bones, and enhances overall skeletal health. Ideal for individuals recovering from fractures or those looking to maintain optimal bone density, QUDRACELL FRACTURE HEAL combines the best of nature and science for comprehensive bone care.

Myelostat 500mg Capsule belongs to a group of the class known as an antimetabolite. It is used to treat head and neck cancer and sickle cell anemia (blocking the flow of blood that causes pain and organ damage). In cancer, Myelostat 500mg Capsule works by blocking an enzyme that is required for growing cells.

Wellwoman Health Supplement is a comprehensive multivitamin and mineral supplement formulated specifically for women's health. It typically contains a variety of vitamins, minerals, and other nutrients that support overall well-being, energy levels, and hormonal balance. Here are the primary uses of Wellwoman Health Supplement Capsules:

1. Support for General Health and Well-Being

• Wellwoman is designed to provide daily nutritional support, helping women maintain their overall health and vitality. It provides a balanced blend of vitamins and minerals that support various bodily functions, including the immune system, energy production, and skin health.

2. Hormonal Balance and Menstrual Health

• The supplement contains nutrients such as Vitamin B6, which may help with hormonal balance and support the management of PMS (premenstrual syndrome) symptoms, including mood swings and irritability.
• It is also designed to support menstrual health and overall reproductive health, helping women manage the hormonal fluctuations that occur throughout the menstrual cycle.

3. Energy and Vitality

• Wellwoman contains key vitamins like B vitamins (e.g., B1, B2, B6, B12) that help support energy metabolism. It can be particularly useful for women feeling fatigued or low in energy, whether due to a busy lifestyle, physical activity, or other factors.

4. Immune System Support

• The supplement includes essential vitamins such as Vitamin C and Vitamin D, as well as zinc, which are important for maintaining a healthy immune system. This is especially beneficial for women who want to maintain their health and resist infections.

5. Skin, Hair, and Nails Health

• Wellwoman contains biotin, selenium, and zinc, which are known to promote healthy skin, hair, and nails. These nutrients help maintain skin elasticity, prevent hair thinning, and support the strength of nails.

Budez CR 3mg Capsules contain Budesonide, a corticosteroid, and are commonly used to treat inflammatory bowel diseases. Its controlled-release (CR) formulation ensures targeted delivery in the intestine, making it effective for conditions like:

Key Uses of Budez CR 3mg:

1. Mild to Moderate Crohn’s Disease:

   • Specifically for Crohn’s disease affecting the ileum (last part of the small intestine) and the ascending colon (first part of the large intestine).
   • Reduces inflammation and improves symptoms like abdominal pain, diarrhea, and fatigue.

2. Microscopic Colitis:

   • Used to treat collagenous and lymphocytic colitis, conditions that cause chronic diarrhea due to intestinal inflammation.

3. Ulcerative Colitis (Off-label Use):

   • In some cases, it may be used for ulcerative colitis if symptoms are not controlled with other treatments.

4. Eosinophilic Gastroenteritis (Off-label Use):

   • Used in certain cases where inflammation of the digestive tract is driven by eosinophils.

Mechanism of Action:

Budesonide is a glucocorticoid that works by:

• Reducing inflammation in the intestines.
• Suppressing the immune response in the affected areas of the gut.

Dosage:

• Typically, one capsule daily, swallowed whole with water, ideally in the morning.
• Duration of treatment varies based on the condition and response, usually up to 8-12 weeks for Crohn’s disease.

Precautions:

1. Pre-existing Conditions:
   • Inform your doctor if you have infections, diabetes, hypertension, osteoporosis, or liver issues.
2. Avoid Abrupt Discontinuation:
   • Gradual tapering may be needed to avoid withdrawal effects.
3. Immune Suppression:
   • May lower immunity, increasing susceptibility to infections.

Side Effects:

• Common: Headache, nausea, abdominal pain, bloating, or changes in bowel habits.
• Less Common: Increased risk of infections, mood changes, acne, or adrenal suppression (rare with controlled-release formulations).

Notes:

• Avoid grapefruit or grapefruit juice, as it can increase budesonide levels in the blood.
• Always take the medication as directed by your healthcare provider, and discuss any concerns about long-term steroid use.