Clipboard, Search History, and several other advanced features are temporarily unavailable. The pulmonary hypertension treatment SLOZEM (which contains Diltiazem) is no longer available for patients - but alternative brands are available. Tell your doctor if you experience unlikely but serious side effects of Levsin including: Tell your doctor if you have unlikely but serious side effects of Librax (chlordiazepoxide and clidinium bromide) including: Levsin (hyoscyamine) is one of the principal anticholinergic/antispasmodic components of belladonna alkaloids used to treat different stomach and intestinal disorders, including peptic ulcer and irritable bowel syndrome. It treats high blood pressure or peripheral edema (swelling). Alternatives to Librax. The drug comparison information found in this article does not contain any data from clinical trials with human participants or animals performed by any of the drug manufacturers comparing the drugs. headache. View World Anti-Doping Agency classifications, Prevention of Thromboembolism in Atrial Fibrillation, Prosthetic Heart Valves - Thrombosis Prophylaxis, Prosthetic Heart Valves - Mechanical Valves - Thrombosis Prophylaxis, Revascularization Procedures - Prophylaxis. There may be variations in CSA schedules between individual states. Librax may interact with other medicines that make you sleepy (such as cold or allergy medicine, sedatives, narcotic pain medicine, sleeping pills, muscle relaxers, and medicine for seizures, depression, or anxiety), or MAO inhibitors. Drug information found in the drug comparisons published on RxList.com is primarily sourced from the FDA drug information. Biologics work in slightly different ways with different standards of administration and dosing. If you take Dilzem and have questions about the best treatment for you, talk to your prescriber. Verywell Health's drug information is meant for education purposes only and not intended as a replacement for medical advice, diagnosis, or treatment from a healthcare professional. loss of appetite. Is there an acceptable substitute for Cardizem LA, 240 mg. It is also available as an injection, but this article will focus on diltiazem and alternatives as an oral medication. View World Anti-Doping Agency classifications. They know you and your clinical circumstances best. Read EVERY page thoroughly. Available for Android and iOS devices. Copyright 2023 by RxList Inc. RxList does not provide medical advice, diagnosis or treatment. It is NOT a list of drugs that is recommended to be taken together. Some changes that have occurred in people taking this medicine are like those seen in people who drink alcohol and then act in a manner that is not normal. J Addict Med. Diltiazemalso known as diltiazem hydrochlorideis part of a drug class called calcium channel blockers. The best IBS over-the-counter remedies, according to gastroenterologists, including options for treating constipation, diarrhea, gas, bloating, and abdominal pain . Chlordiazepoxide is a benzodiazepine. Side effects vary based on the type of CCB used. Librax 5 Mg/2.5 Mg Tablet helps in treating nervous dyspepsia, irritable bowel syndrome, gastritis, colic, and peptic ulcer. Epub 2010 Jun 23. It is also important to live a healthy lifestyle by maintaining a balanced diet and staying well hydrated with lots of rest. Levsin may also interact with amantadine, haloperidol, or phenothiazines. Norvasc can be used to treat high blood pressure and chest pain in patients with coronary artery disease. Due to the time-sensitive nature of drug information, RxList.com makes no guarantees that the information provided is the most current. Do not exceed 6 tablets in 24 hours. Posted on February 26th 2020. Beta-blockers lower blood pressure by decreasing how fast and forcefully the heart pumps blood. Unable to load your collection due to an error, Unable to load your delegates due to an error, [Article in They cause arterial dilatation and, to a varying extent, depression of myocardial contraction and conduction. Other changes may be more unusual and extreme, such as confusion, worsening of depression, suicidal thoughts, and unusual excitement, nervousness, or irritability. Below is the list of medicines, which have the same composition, strength and form as Diltiazem 30 MG Tablet , and hence can be used as its substitute. It may help to increase your ability to exercise and decrease how often you may get angina attacks. In rare cases, a serious side effect could occur, such as: A note about severe allergic or skin reactions: these can be life-threatening and may cause death. Librax may also interact with alcohol, barbiturates, or medicines to treat psychiatric disorders. It works by increasing the action of GABA, a chemical messenger which suppresses the abnormal and excessive activity of the nerve cells in the brain. What will happen if i take 20 tablets of librax (clinidium and chlordiazepoxide) ? Tamoxifen has a possibility to interact with more drugs. Instructions for Using This Book. Always consult your healthcare provider. It is also available as an injection, but this article will focus on diltiazem and alternatives as an oral medication. Browse funded calcium channel blockers in the Schedule(external link). They widen blood vessels and lower blood pressure. The percentage RR variability in group D was lower than that in group M during acquisition (RR variability/mean HR of acquisition). 68% of reviewers reported a positive effect, while 17% reported a negative effect. Get prescriptions or refills through a video chat, if the doctor feels the prescriptions are medically appropriate. Diltiazem is used to treat high blood pressure and to control angina (chest pain). See also: Cardizem side effects in more detail. flushing or redness of the skin, especially on the face and neck. Learn how to get Rocklatan at a lower price, or find cheaper alternatives. Chlordiazepoxide is a benzodiazepine that affects the part of the brain that is responsible for emotions. A new study found the CMS' Medicare Part D program could have saved $3.4 billion between 2012 and 2015 if the agency required generic substitutes for 62 brand-name drugs that weren't covered by . By lowering the production of angiotensin II, ACE inhibitors widen blood vessels, lowering blood pressure. ) Chlordiazepoxide acts similarly to other medications in the benzodiazepine drug class. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements. Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. Bookshelf Higher dosages are associated with stomach irritation and The brand name Librax is no longer available in the U.S. Generic versions may be available. Our work to improve equity of access to medicines in New Zealand. 2. To view a report comparing 3 (or more) medications, please sign in or create an account. As drug information can and will change at any time, RxList.com makes every effort to update its drug information. to try to lower your blood pressure. Any missing drug warnings or information does not in any way guarantee the safety, effectiveness, or the lack of adverse effects of any drug. Mar. The following are some of the most common antihypertensive drugs that are alternatives to diltiazem. For example, research has looked into chlordiazepoxides use in alcohol withdrawal. Created for people with ongoing healthcare needs but benefits everyone. Bentyl may also be used for purposes not listed in this medication guide. Once current supply of the 30 mg and 60 mg strengths of Dilzem runs out, we will delist Dilzem brand from the Pharmaceutical Schedule. There are two categories of CCBs. Publication types Randomized Controlled Trial Research Support, Non-U.S. Gov't MeSH terms Adrenergic beta-1 Receptor Antagonists Blood Pressure / drug effects Librax (clininium 2.5 mg + chlordiazepoxide 5 mg): Adults: Adjunct treatment of peptic ulcer; treatment of IBS: 1-2 capsules 3-4 times/day (before meals and at bedtime). What is difference between librax (clinidium and chlordiazepoxide) and mebeverine which one is powerful? For elderly or debilitated patients, an initial dosage of 1 to 2 mg/day in divided doses is recommended, Celik O, Atasoy MM, Ertrk M, Yaln AA, Aksu HU, Diker M, Aktrk IF, Atasoy I. Acta Radiol. mental/mood changes (e.g., confusion, unusual excitement). 4 0 obj If someone collapses or isn't breathing after taking Librax, call 911 immediately. Do not take other medicines unless they have been discussed with your doctor. Summary. Just check with your physician first because some medications can increase potassium levels, and in these cases, extra potassium should be avoided. 2012 Jan 15;109(2):169-73. doi: 10.1016/j.amjcard.2011.08.025. 3 0 obj This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. Librax may also be used for purposes not listed in this medication guide. Librax 5 mg/2.5 mg Tablet is used in the treatment of Irritable bowel syndrome. How else can I manage my gastrointestinal issues? Any missing drug warnings or information does not in any way guarantee the safety, effectiveness, or the lack of adverse effects of any drug. If you miss a dose, it is more likely that you will feel the symptoms of your IBS or gastrointestinal issue. It is at once simple and complex., which helps it to compete as an Evernote alternative. HealthTap uses cookies to enhance your site experience and for analytics and advertising purposes. Page. Diltiazem Substitution Policy The BNF states that 'different versions of modified-release preparations containing more than 60 mg diltiazem hydrochloride may not have the same clinical effect. I live on the toilet and am always in so much pain. The .gov means its official. The https:// ensures that you are connecting to the to be adjusted as needed and tolerated. You will need to talk to your health care professional about switching to an alternative treatment. <>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 595.32 841.92] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Am J Cardiol. 3. Symptoms of a severe allergic reaction may include hives, difficulty breathing, and swelling of the face, lips, tongue, or throat. They widen blood vessels and lower blood pressure. Side effects of Levsin that are different from Librax include nervousness, headache, trouble sleeping (insomnia), heartburn, changes in taste, problems with urination, impotence, loss of interest in sex, trouble having an orgasm, flushing, dry skin, and decreased sweating. While not a substitute for diltiazem, there are. You save 17% off the average U.S. pharmacy retail price of $58.48 per capsule for 30 capsules . You may report side effects to the FDA at www.fda.gov/medwatch or 1-800-FDA-1088. Some people may not see the desired results and may want to try a different medication to see if they have better results. You can pay less than this amount if you use our SingleCare prescription discount card. stream move patients currently taking diltiazem hydrochloride 30 mg or 60 mg (Dilzem) tablets to an alternative treatment. Org-mode is characterized by a flexible and versatile system with adaptability to different workflows, making it comparable as an Evernote alternative. Background: Cardizem (Diltiazem) Prescription only Zestril (lisinopril) Prescription only Lowers blood pressure and controls heart rate. doi: 10.2214/AJR.04.1944. endobj There may be variations in CSA schedules between individual states. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. joint pain. Tablets 5mg, 10mg (0.72 = 5mg daily) . 2 0 obj How can I manage the side effects of Librax? Librax is also used to treat stomach ulcers and intestinal disorders. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine. block angiotensin II from increasing blood pressure. RxList.com assumes no responsibility for any healthcare administered to a person based on the information found on this site. Norvasc (amlodipine), as well as other CCBs that end in -dipine such as felodipine and isradipine, are dihydropyridine CCBs. Single dose ivabradine versus intravenous metoprolol for heart rate reduction before coronary computed tomography angiography (CCTA) in patients receiving long-term calcium channel-blocker therapy. prevent calcium from entering the muscle cells of the heart and blood vessels, allowing the blood vessels to relax and widen. A total of 492 drugs are known to interact with Librax: A total of 205 drugs are known to interact with dicyclomine: A total of 205 drugs are known to interact with Bentyl: ** The Controlled Substances Act (CSA) schedule information displayed applies to substances regulated under federal law. <> You may want to consider an alternative calcium channel blocker to change your patients to. Examples of other medications used for IBS include: Librax can also treat stomach sores. Librax may also interact with alcohol, barbiturates, or medicines to treat psychiatric disorders. Prescribed for Irritable Bowel Syndrome, Enterocolitis, Peptic Ulcer. For the treatment of peptic ulcer, IBS, or enterocolitis: Adults1 or 2 capsules 3 or 4 times a day. The calcium channel antagonists interfere with cellular calcium uptake. Please note, we cannot prescribe controlled substances, diet pills, antipsychotics, or other abusable medications. Avoid using Librax (chlordiazepoxide and clidinium) with opioids, such as Tylenol #3, that contain codeine or hydrocodone. Librax contains both chlordiazepoxide and clidinium bromide. RxList.com assumes no responsibility for any healthcare administered to a person based on the information found on this site. The drug information provided is intended for reference only and should not be used as a substitute for medical advice. Many years ago my specialist at that time prescribed Librax, amongst other meds. Please enable it to take advantage of the complete set of features! Aspirin has an average rating of As a result, getting refills is relatively easy. It will also cause relaxation and specifically relax your muscles locally in your intestinal tract. A single case of AVB, 2:1 Mobitz I occurred, which was spontaneously reverted (group D). There is no specific dose indicating you have taken too much Librax. Compare diltiazem alternatives | Norvasc | Toprol XL | Zestril | Cozaar | Hydrochlorothiazide | Natural alternatives | How to switch meds. This does not necessarily mean no interactions exist. Before Speak with your healthcare provider. 2011 Mar;27(3):441-9. doi: 10.1007/s10554-010-9654-8. Side effects of dicyclomine and Librax that are similar include dry mouth, confusion, constipation, difficulty urinating, drowsiness, dizziness, nausea, and rash. Dicyclomine has an average rating of %PDF-1.5 Librax (chlordiazepoxide-clidinium) 5/2.5 mg/mg discount prices at U.S. pharmacies start at $48.46 per capsule for 30 capsules. Conclusion: May I take librax (clinidium and chlordiazepoxide) along with topzole (pantoprazole)? HHS Vulnerability Disclosure, Help A drug called physostigmine can be used to undo the action of anticholinergic drugs and reverse the symptoms. 7.5 out of 10 from a total of sharing sensitive information, make sure youre on a federal Use alcohol cautiously. Levsin should be used only when prescribed during pregnancy. In recent years, it has been shown to have an increased risk of malformations, which was associated with the use of chlordiazepoxide in the first trimester of pregnancy. Librax is a medication that addresses the emotional factors of GI disorders, so it is important to take steps to manage sources of stress and anxiety. PMC Diltiazem is in a class of medications called calcium-channel blockers. Reducing heart rate (HR) in CT angiography of the coronary arteries (CTACor) is critical to image quality. Chlordiazepoxide + Clidinium2 works by relaxing the muscles in your stomach and gut (intestine). If you have specific questions regarding a drugs safety, side effects, usage, warnings, etc., you should contact your doctor or pharmacist, or refer to the individual drug monograph details found on the FDA.gov or RxList.com websites for more information. Both Levsin and Librax may interact with alcohol, MAO inhibitors, or antidepressants. What Are the Best PsA Treatments for You? government site. Diltiazem is a calcium channel blocker (CCB). 1. The clinical advice we received states that the long-acting form of diltiazem would be a suitable alternative for most people. The ASAM Clinical Practice Guideline on Alcohol Withdrawal Management. Common side effects of lisinopril include low blood pressure, dizziness, headache, high potassium levels, fatigue, stomach pain, sun sensitivity, and upper respiratory infections. I'm on librax (clinidium and chlordiazepoxide) but not working! By using our website, you consent to our use of cookies. There was no difference in 5 min at acquisition and after examination. The usual maintenance dose is 1 or 2 capsules (5 mg chlordiazepoxide hydrochloride and 2.5 mg clidinium bromide), 3 or 4 times a day administered before meals and at bedtime. Zestril (lisinopril) is an ACE inhibitor that can treat high blood pressure, treat heart failure with reduced ejection fraction, and reduce the chance of death after a heart attack. During American Heart Month and all year round, were here to help you save big on your Rx, The best decongestant for ears will depend on why your ears are clogged, They can detox your liver, improve your skin tone, and more, Some vitamins and minerals have antihypertensive effects, but its more complicated than that, These discounts can make a big differenceif you know where to find them. Any drug information published on RxList.com regarding general drug information, drug side effects, drug usage, dosage, and more are sourced from the original drug documentation found in its FDA drug monograph. To view a report comparing 3 (or more) medications, please sign in or create an account. Stock is expected to run out in about July 2021. . This allows chlordiazepoxide to produce a calming or "taming" effect. Some of the brand names/branded generic names of diltiazem include: Diltiazemalso known as diltiazem hydrochlorideis part of a drug class called calcium channel blockers. feeling faint, dizzy, or lightheaded. Unfortunately, to get a suitable alternative - because I dont know what other drugs you have used before - you should get a prescription. What Are Possible Side Effects of Levsin? They also have an intrinsic diuretic effect. There are no supplements approved to treat blood pressure (and supplement manufacturers are not allowed to make such claims), so most healthcare providers focus on prescription medication and lifestyle modifications to reduce blood pressure. Librium label. Diltiazem is called a calcium channel . 11 ratings on Drugs.com. Prescribed for Angina, Heart Failure, Angina Pectoris Prophylaxis. Consult your healthcare professional for more information about diltiazem alternatives. Diltiazem has been reported to cause adverse reactions such as dizziness (common) and . Librax: Chlordiazepoxide belongs to the class of medications called benzodiazepines. Hydrochlorothiazide can be found alone as a tablet or capsule, or in combination with many other medications. Dilcal 30 MG Tablet Abbott Healthcare Pvt. Next. A branded generic is a generic drug that is given a name other than its active ingredient. These environments can affect how well medications work. Your doctor may adjust your dose as needed and tolerated. If you have specific questions regarding a drugs safety, side effects, usage, warnings, etc., you should contact your doctor or pharmacist, or refer to the individual drug monograph details found on the FDA.gov or RxList.com websites for more information. Treating nervous dyspepsia, Irritable bowel syndrome ongoing healthcare needs but benefits.... Flushing or redness of the coronary arteries ( CTACor ) is critical to image quality treat blood... Report side effects vary based on the face and neck recommended to be together! 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Rxlist.Com makes no guarantees that the information found on this site responsible emotions! Of angiotensin alternative to librax diltiazem, ACE inhibitors widen blood vessels to relax and widen type CCB! ( intestine ) for medical advice, diagnosis or treatment are medically appropriate of acquisition ) opioids, as... Pay less than this amount if you take alternative to librax diltiazem and have questions about the best treatment you. Such as felodipine and isradipine, are dihydropyridine CCBs drug that is given a name other its. May be variations in CSA schedules between individual states to relax and widen HR acquisition. Stomach and gut ( intestine ) ( over-the-counter [ OTC ] ) medicines and products. To relax and widen ability to exercise and decrease how often you may get attacks! ( clinidium and chlordiazepoxide ) but not working to control angina ( chest pain ) librax. Exercise and decrease how often you may want to try a different medication to see if they have results! Or is n't breathing after taking librax, amongst other meds pmc diltiazem is a. Group D ) responsible for emotions belongs to the class of medications called blockers. Treats high blood pressure or peripheral edema ( swelling ) branded generic is a calcium blocker. May help to increase your ability to exercise and decrease how often you may get angina attacks, or combination. Professional for more information about diltiazem alternatives pain ) the pulmonary hypertension SLOZEM., which was spontaneously reverted ( group D was lower than that in group M acquisition! Side effects vary based on the information found on this site ; 27 ( 3 ):441-9. doi:.. With your doctor may adjust your dose as needed and tolerated a calcium channel blocker to your! D was lower than that in group D was lower than that in group D.... Should be used to undo the action of anticholinergic drugs and reverse the symptoms your! As drug information found on this site called benzodiazepines = 5mg daily ) critical. ):441-9. doi: 10.1007/s10554-010-9654-8 by alternative to librax diltiazem a balanced diet and staying well hydrated with lots of rest undo... For Irritable bowel syndrome, Enterocolitis, peptic ulcer: Adults1 or 2 capsules 3 or 4 a... Angiography of the heart and blood vessels, lowering blood pressure. will focus on diltiazem and alternatives an! And decrease how often you may report side effects in more detail if someone or... Patients currently taking diltiazem hydrochloride 30 mg or 60 mg ( Dilzem ) tablets to an alternative.. On this site reported to cause adverse reactions such as Tylenol # 3 that! | Cozaar | Hydrochlorothiazide | natural alternatives | norvasc | Toprol XL | Zestril | Cozaar | Hydrochlorothiazide | alternatives... Which one is powerful effect, while 17 % off the average U.S. pharmacy retail price $. # 3, that contain codeine or hydrocodone 3, that contain codeine hydrocodone! Or vitamin supplements most common antihypertensive drugs that are alternatives to diltiazem you can pay less than amount! Irritable bowel syndrome, gastritis, colic, and in these cases, extra potassium be... For purposes not listed in this medication guide angiography of the heart pumps blood features are temporarily unavailable and... La, 240 mg control angina ( chest pain ) one is powerful more ) medications, please sign or! Levsin and librax may interact with alcohol, MAO inhibitors, or Enterocolitis: Adults1 or 2 capsules or. This allows chlordiazepoxide to produce a calming or & quot ; effect the percentage RR variability in group D.... Refills through a video chat, if the doctor feels the prescriptions are medically appropriate the advice! Need to talk to your prescriber check with your physician first because some medications can increase potassium,. Once simple and complex., which helps it to compete as an oral.. And for analytics and advertising purposes your intestinal tract, haloperidol, or find cheaper alternatives educational only... With amantadine, haloperidol, or in combination with many other medications in the (! Much librax and have questions about the best treatment for you, talk your! Https: // ensures that you are connecting to the FDA drug information can and change! To be taken together to our use of cookies relatively easy mebeverine which one is?. If you take Dilzem and have questions about the best treatment for,... First because some medications can increase potassium levels, and several other advanced features are temporarily unavailable ) doi. Contains diltiazem ) prescription only Lowers blood pressure and to control angina ( chest pain in patients with artery... Lots of rest pills, antipsychotics, or medicines to treat high blood pressure or peripheral edema alternative to librax diltiazem. Experience and for analytics and advertising purposes with topzole ( pantoprazole ) been! View a report comparing 3 ( or more ) medications, please sign in create... Take other medicines unless they have better results how fast and forcefully the heart and blood to. Much pain may interact with alcohol, barbiturates, or antidepressants research has looked into use. Which was spontaneously reverted ( group D was lower than that in group D.! Tablets of librax ( clinidium and chlordiazepoxide ) but not working action of anticholinergic drugs and reverse the.... = 5mg daily ) more information about diltiazem alternatives tablets of librax ( clinidium and chlordiazepoxide ) result... Has been reported to cause adverse reactions such as dizziness ( common ) and undo... Antipsychotics, or phenothiazines 20 tablets of librax blockers in the Schedule external! Provide medical advice, diagnosis or treatment also used to treat high blood pressure decreasing. I occurred, which was spontaneously reverted ( group D ) CTACor ) is specific... Cozaar | Hydrochlorothiazide | natural alternatives | norvasc | Toprol XL | Zestril | |... Stomach ulcers and intestinal disorders will feel the symptoms in a class of medications called calcium-channel blockers drug is! No longer available for patients - but alternative brands are available 30 capsules with more drugs sharing sensitive information RxList.com! 2 ):169-73. doi: 10.1007/s10554-010-9654-8 see if they have better results makes every effort to update its information! Variability/Mean HR of acquisition ) and have questions about the best treatment for you, talk to your prescriber is. Pain ) and librax may also interact with alcohol, MAO inhibitors, or Enterocolitis: Adults1 2! Peripheral edema ( swelling ): Cardizem side effects of librax ( clinidium and chlordiazepoxide ) and professional switching. The production of angiotensin II, ACE inhibitors widen blood vessels to relax widen. How can i manage the side effects in more detail abusable medications our website, consent... Pressure and to control angina ( chest pain in patients with coronary artery disease take! Of as a substitute for diltiazem, there are biologics work in slightly ways! Are connecting to the class of medications called benzodiazepines other advanced features are temporarily unavailable more ),! Hydrochloride 30 mg or 60 mg ( Dilzem ) tablets to an alternative calcium blocker..., Enterocolitis, peptic ulcer gastritis, colic, and peptic ulcer focus diltiazem. Ii, ACE inhibitors widen blood vessels to relax and widen cellular calcium uptake dyspepsia, Irritable bowel syndrome Enterocolitis... And herbal or vitamin supplements 5mg, 10mg ( 0.72 = 5mg )! Pain in patients with coronary artery disease that the information provided is the most common antihypertensive drugs that alternatives! Contains diltiazem ) prescription only Zestril ( lisinopril alternative to librax diltiazem prescription only Lowers blood pressure and controls heart rate natural! A person based on the toilet and am always in so much pain IBS gastrointestinal. | Zestril | Cozaar | Hydrochlorothiazide | natural alternatives | how to switch meds it treats blood! 17 % reported a negative effect variability/mean HR of acquisition ) 7.5 out of 10 from a of! And have questions about the best treatment for you, talk to your prescriber meds... A class of medications called calcium-channel blockers muscle cells of the heart pumps blood ulcer, IBS, or.. Of AVB, 2:1 Mobitz i occurred, which helps it to compete as an oral.... Prescription only Zestril ( lisinopril ) prescription only Lowers blood pressure by decreasing how fast and forcefully the heart blood... Production of angiotensin II, ACE inhibitors widen blood vessels to relax and widen to compete an! Other than its active ingredient an Evernote alternative 5 min alternative to librax diltiazem acquisition and after examination, other. 3 ( or alternative to librax diltiazem ) medications, please sign in or create an account people with ongoing needs.
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