I also have fat rolls on my back now. My progesterone levels were really low so she has me taking progesterone during my cycle. My thighs got huge. 2023 Apr 18;9(2):e083. PubMed, Cochrane Library, Embase, and Web of Science were searched from inception through June 11, 2021. However, the certainty of the evidence was low and future studies are needed, including among diverse populations such as younger individuals and those with acne or hirsutism. My dermatologist unfortunately prescribed this medication to me. Treatment of Secondary Vestibulodynia withConjugated Estrogen Cream: A Pilot, Double-Blind, Randomized Placebo-Controlled Trial. Aldactone lowers aldosterone levels in your body, so it can make Addisons disease worse. I have been on Spironolactone and birth control since March 2019. It isnt known how often this side effect may have occurred in clinical trials. For hypertension (high blood pressure), the typical Aldactone dosage is 25 to 100 mg, once per day. Do not have low-sodium salt or salt substitutes, like Lo-Salt, because they contain a lot of potassium. Safety profile of mineralocorticoid receptor antagonists: Spironolactone and eplerenone. I stopped taking spiro about 3weeks ago and I actually gained another 5lbs in the first couple days.I'm going to chug through and pay attention to my diet and exercisemood etc so that I can post an update about when I finally regulate.So far my mood seems better and libido is back. After stopping spironolactone and applying a topical estrogen/testosterone gel to the vestibule, all women had significant improvement in their vulvar atrophy, resolution of their dyspareunia, and improved sexual arousal. Spironolactone comes as an oral tablet and an oral suspension. They can give you tips on how to manage any side effects that may be concerning or bothersome. Spironolactone is not prescribed to treat acne in men due to side effects. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Doc put me on in October for testosterone dominance and acne. These medicines are sometimes called "water tablets" because they make you pee more. Disclaimer. These include: These side effects are more likely to be caused by high doses over a long period of time. Its available in three strengths: 25 milligrams (mg), 50 mg, and 100 mg. For treating heart failure with reduced ejection fraction, your doctor will likely have you start with an Aldactone dosage of 25 mg, once a day. and transmitted securely. Please try again. I wish I never tried this drug although my skin looked absolutely AMAZING while on it the weight gain isn't worth it. Before taking spironolactone, its important to know that this medication is a diuretic, so youll find yourself urinating more often. Spironolactone. Zeng J, Xie TF, Huang T, Li F, Wang ZP, Feng LL. Spironolactone may worsen kidney function in patients with low to no salt in their body or in those who take other blood pressure medicines (eg, ARB, ACE inhibitor). As with all medications, the cost of Aldactone can vary. Its obviously a matter of patience and letting your body figure itself out. Curr Hypertens Rep. 2004 Oct;6(5):342-5. doi: 10.1007/s11906-004-0051-3. The site is secure. Is the ketogenic diet right for autoimmune conditions? So to do this and not see anything change, I knew something was wrong! Spironolactone May be a Cause of Hormonally Associated Vestibulodynia and Female Sexual Arousal Disorder. Tell them about all prescription, over-the-counter, and other drugs you take. I even had a few days where I was sick and didn't consume more than 500 calories in a day. For this purpose, your doctor will likely have you start with an Aldactone dosage of 100 mg per day. Are you struggling to clear acne on your chest or back as well? Take this medication by mouth. 2022 Feb 25;23(3):79. doi: 10.1208/s12249-021-02201-9. The information on this site is for informational and educational purposes only. See a HORMONE SPECIALIST. This warning was included after researchers gave animals very high doses of spironolactone. National Library of Medicine And generics tend to cost less than brand-name drugs. I cant lose it. Although spironolactone is an effective treatment for androgen-mediated cutaneous disorders, the potential sexual side-effects are poorly documented in current literature. I recently went to a new gyno who put me on testosterone cream because mine was non existent because of the spironolactone. I continue to gain weight. Sharing this information can help you avoid potential interactions. Women who have acne along their jawline and lower face tend to have good results from hormonal therapy for acne. As of 2 days ago August 23rd, I quit it cold turkey and I feel so much better. Generic version: Aldactone is available in a generic form called spironolactone. Although treatment of androgen-mediated cutaneous disorders is warranted, medical providers should be aware of the potential sexual side effects of this anti-androgenic medication. Does Spironolactone cause weight gain and cellulite? Do not take more Aldactone than your doctor recommends. And my skin looked amazing- I started the meds for acne.The last few months my libido has dropped and it wasn't until I completely missed my last 2 periods that I realized it was the meds. I stopped taking it and my face is the same as it was while i was on it. Clarification of Conflict of Interest Disclosures. Men have developed breasts while taking this medication to treat acne. Among them, 1 person (0.0%) has Cellulite. This is because the side effects seem to be worse than any benefit males get from taking the drug. Another spironolactone "victim" here.When I started Spiro, I was 133 lbs. 2023 Feb 1;159(2):227. doi: 10.1001/jamadermatol.2022.5551. Protecting your face from the sun can help prevent these patches. I can't fit into any of my clothes and it's extremely depressing as I'm sure y'all know. Now that I stoped I feel kinda down, sad , not motivated , I want to be by myself kinda feeling . However, the most significant limitation of this case series is that it was not a prospective, controlled study. 2012 May (Acne suppl). Serious side effects from Aldactone arent common, but they can occur. Importance: Spironolactone (the active drug in Aldactone) has been used to treat a specific type of hair loss called androgenic alopecia. Heres a look at how Aldactone and Lasix are alike and different. 2023 eHealthMe.com. The swelling doesn't seem to dependent on sth. Dizziness, lightheadedness, or fainting may also occur, especially when you get up suddenly from a lying or sitting position. I am not going to be taking this drug anymore. Clinical implications: Im so sorry this has happened to each of you but also thankful to know that Im not the only one Z this has happen too since starting this prescription. Hi there, I wish I have seen this post before I took this medicine. I took it and after a month I found I gained 10 lbs:((((((This is a nightmare. The weight didn't fluctuate. Erectile dysfunction (ED) is often a symptom . I recently switched to drospirenone (progesterone which is related to spironolactone) as I suspect the weight gain was due to low testosterone and high estrogen. How might bacteria-eating viruses and gut bacteria contribute to longevity? It is also used for the diagnosis and management of primary hyperaldosteronism (a condition where the adrenal glands produce too much of the hormone aldosterone leading to low potassium levels and a more alkaline blood pH). Common interactions include bronchitis among females and renal failure among males. So Ive been keeping up with this thread as well as many others for the last 4-5 months. When taken alone, spironolactone can be quite effective. My gyno was skeptical of the weight gain too, I finally went to a doctor who practices functional medicine. During that time, 9 cases of breast cancer were reported. For long-term use in people with a type of noncancerous tumor called an, arent able to have surgery to remove the tumor for primary hyperaldosteronism according to their doctor, or, have bilateral micro- or macronodular adrenal hyperplasia (These are lumps on the adrenal gland that may cause the glands to grow and produce too much of a hormone called, the type and severity of the condition youre using Aldactone to treat, how well Aldactone works for your condition, any side effects you have while taking Aldactone. Below are examples of off-label uses for Aldactone. Well I was recently hospitalized and didn't take spironolactone for 5 days. You should always consult your doctor or another healthcare professional before taking any medication. Spironolactone is used to treat heart failure, high blood pressure (hypertension), or hypokalemia ( low potassium levels in the blood). Still looking for answers? Cochrane Database Syst Rev. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. Im 36 411, and slowly gained 10-12lbs. This condition can refer to male* or female* pattern baldness. These lists dont include all possible side effects. You will and it just takes time to adjust back to a healthy balance. Spironolactone is only available on prescription. An official website of the United States government. Stretching is also quite important, especially after a good and steamy workout session. What is Cellulite? National Library of Medicine The search was restricted to studies in the English language. Each is a pill that you would take daily. Off-label drug use is when a drug thats approved for one or more use(s) is prescribed for a different one thats not approved. I think it's getting better, but it's too early to say for sure.. Ankylosing Spondylitis Pain: Fact or Fiction, angiotensin converting enzyme (ACE) inhibitors. Im experiencing the same thing as you and it seems like we are similar in height/weight. This site needs JavaScript to work properly. I have been taking aldactone 50 mg a day for almost 3 months for acne. Hormonal therapy is an option for many women with stubborn acne, but its not always the only option. Page last reviewed: 6 July 2022 Aldactone is FDA-approved to treat heart failure classified as New York Heart Association (NYHA) Class III or IV heart failure. At some point they clashed and squeezed together when I was walking. Use of the term male in this article refers to sex assigned at birth. Crypto See this image and copyright information in PMC. Your doctor will give you more specific information on how much Aldactone to take. For more information and to find out if youre eligible for support, call 866-706-2400 or visit the program website. Water can help remove toxins from your body and can actively increase your energy levels. Aldactone can cause mild or serious side effects. Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Your doctor will determine the best dosage to fit your needs. Does Xcopri cause weight gain or weight loss. While originally approved for the management of heart failure, hypertension, and edema, spironolactone is commonly used off label in the management of acne, hidradenitis, androgenetic alopecia, and hirsutism. Accessibility The pill is generally considered safe for women. The scale wouldnt budge. Spironolactone is used to treat build-up of fluid in your body ( oedema) caused by: heart failure liver disease - it treats build-up of fluid in your abdomen, called ascites kidney disease - it treats a condition that causes your kidneys to leak large amounts of protein into your pee, called nephrotic syndrome Before Yes, lucky me, but I also have had acne since I was 10 years old, so I started Spiro 5 months ago. When you continue to eat healthy, your body slowly starts to melt the excess stored fat to convert it into energy. Obviously the only way to lose fat is to be in a caloric deficit so Ive gone about this through diet and calorie restriction. The actual price youll pay depends on your insurance plan, your location, and the pharmacy you use. Find out how a board-certified dermatologist helped Natalie see clear skin before her wedding. Aldactone is a brand-name oral tablet that's prescribed for heart failure, high blood pressure, and other conditions. The Aldactone dosage your doctor prescribes will depend on several factors. There was an association between spironolactone use and decreased risk of prostate cancer (RR, 0.79; 95% CI, 0.68-0.90; certainty of evidence very low). It is created by eHealthMe based on reports of 98,724 people who have side effects while taking Spironolactone from the FDA, and is updated regularly. Importance: While originally approved for the management of heart failure, hypertension, and edema, spironolactone is commonly used off label in the management of acne, hidradenitis, androgenetic alopecia, and hirsutism. Spironolactone can cause both weight gain and cellulite. The generic is considered to be as safe and effective as the original drug. To learn more about these drugs, including their potential side effects, you can refer to the prescribing information for Aldactone and Lasix. I don't want to look like a model, I just want to fit back into my clothes and not hide from everyone because of my weight. Federal government websites often end in .gov or .mil. Mitchell L, Govind V, Barela K, et al. Aldactone is a brand-name oral tablet thats prescribed for heart failure, high blood pressure, and other conditions. Using these with spironolactone can cause your potassium levels to become too high. Since then, i have gained 10 pounds! "Hormonal treatment for acne. Presented during the forum: Acne guidelines: Translating evidence into practice. As a result, spironolactone promotes a sodium diuresis, but maintains body potassium levels. According to research studies, Spironolactone is not associated with weight gain as a side effect and no medical explanation has been given by experts to understand how it happens. The drug may cause problems with the blood levels of fluids and electrolytes in people with cirrhosis. Protective role of mineralocorticoid receptor signaling in urothelial tumorigenesis. * Optum Perks is a sister site of Medical News Today. You can also add honey to this mixture to help with the taste and drink it on an empty stomach. If you have cirrhosis, youll start taking Aldactone in a hospital. Or they may recommend a medication other than Aldactone. I went on spiro January 2021 (for acne), got off of it January 2022. This combination has another advantage. Take spironolactone with food, to help stop you feeling or being sick. Thyroid I was recently diagnosed as hypothyroid. Its so incredibly aggravating and believe me I understand the frustration and emotional rollercoaster the weight gain and weight loss resistance from this medication causes. When I noticed the weight, I assumed it was the pill so I stopped taking it. Started with 10mg and have been at 50mg for the past year. Epub 2015 May 21. Aldactone should not be taken during pregnancy. If youre planning a pregnancy or can become pregnant, talk with your doctor before taking this medication. doi: 10.1002/14651858.CD005195.pub4. Some people need to take it twice a day. Before your dermatologist prescribes spironolactone, you will need some blood tests. Aldactone isnt FDA-approved to treat hair loss, but the drug may be prescribed off-label for this purpose. Can diet help improve depression symptoms? Accessibility Folic acid supplementation and malaria susceptibility and severity among people taking antifolate antimalarial drugs in endemic areas. Aldactone is approved to treat certain forms of the following in adults: Lasix is approved to treat the following in certain situations: Entresto is approved to treat certain forms of heart failure in adults and children. If youre wondering whether hormonal therapy could help clear your acne, you may want to make an appointment to see a dermatologist. I also experienced decrease libido. * Aldactone may also be used off-label for other conditions. For risk of breast cancer, certainty of evidence was very low and downgraded because of indirectness owing to the conversion of the effect estimates and differences in population; it was upgraded owing to addressing residual confounding. I finally found a dermatologist who told me we need to fix the problem from the inside out and I was put up 75mg of spironolactone. Heres what you need to know. I'm so extremely unhappy with my body that I'm actually having gastric bypass this week. I want clear skin, but not at the cost of a nice figure I've worked hard on! It helps with the tightening of skin to reduce the appearance of cellulite. There are a few things that you can try to get rid of Spironolactone-induced weight gain and cellulite. The odd thing is that the more I read here the more i see the similarities. Just apply the mixture to the affected area and cover it up. No other disclosures were reported. These include: The following information describes dosages that are commonly used or recommended. If you have questions about drug interactions that may affect you, ask your doctor or pharmacist. To learn about other mild side effects, talk with your doctor or pharmacist, or view Aldactones prescribing information. READ FOR PEACE OF MIND!!! Cochrane Database Syst Rev. Find out why dark spots appear and what can fade them. Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. Aldactone comes as an oral tablet. My gynecologist seemed skeptical of Spiro as the cause of weight gain and suggested a thyroid test. Spironolactone, a synthetic 17-lactone steroid, is a potassium-sparing diuretic that also displays antagonistic effects on the androgen and progesterone receptors. I have cellulite very visible all over my thighs now when before it was more only sides or when I pinched my skin. The generic is considered to be as safe and effective as the original drug. If you have acne and are interested in using Aldactone or finding a different treatment, talk with your doctor. I noticed I wasn't as depressed and I actually had energy. Expect to get back to your old body and KNOW it will happen because that helps speed up the process too. You can take it with or without food. If youre interested in using Aldactone for PCOS, talk with your doctor. You'll usually take spironolactone once a day in the morning. Buontempo MG, Alhanshali L, Shapiro J, Lo Sicco K. Int J Womens Dermatol. Junk food and high sugary foods have no nutritional benefit. In this systematic review and meta-analysis, spironolactone use was not associated with a substantial increased risk of cancer and was associated with a decreased risk of prostate cancer. Only 7% saw no improvement. Taking hormonal therapy long term appears to be safe. Use of the term female in this article refers to sex assigned at birth. Before you see a dermatologist, it helps to prepare for your appointment. As with most drugs, some people can have an allergic reaction after taking Aldactone. Zaenglein AL, Pathy ALet al. sharing sensitive information, make sure youre on a federal It is used to raise potassium in the body. Check whether Cellulite is associated with a drug or a condition, Cellulite and drugs with ingredients of spironolactone, Hypotension (abnormally low blood pressure), Cellulite in Pfizer BioNTech Covid Vaccine, Cellulite in Johnson and Johnson Covid Vaccine, Ampicillin And Sulbactam and Osteoporosis, Prempro and Amino Acid Metabolism Disorder, Famvir and Sulfamethoxazole drug interaction, Provera and Perphenazine drug interaction, Lipoatrophy (localized loss of fat tissue): 1 person, 100.00%, Peau D'orange (orange peel skin): 1 person, 100.00%. Heres what I did: after constant research, it became apparent that spiro can cause estrogen dominance/low progesterone. Published by Elsevier Inc. All rights reserved. Examination of women taking spironolactone who presented with the complaints of introital dyspareunia revealed vulvar vestibular atrophy and tenderness, especially at the glandular ostia. Note: Optum Perks coupons cannot be used with insurance copays or benefits. My question to all of you that stop taking it how did you feel emotionally once you stoped it?? These include cirrhosis and nephrotic syndrome. Next review due: 6 July 2025, Taking spironolactone with other medicines and herbal supplements, kidney disease it treats a condition that causes your kidneys to leak large amounts of protein into your pee, called nephrotic syndrome, high levels of aldosterone (a hormone made by the adrenal glands). Youll find key information about Aldactone below. Guidelines of care for the management of acne vulgaris.J Am Acad Dermatol. If youre interested in using Aldactone for female pattern hair loss, talk with your doctor. Done with this med permanently!!! To learn more about these drugs, including their potential side effects, you can refer to the prescribing information for Aldactone and Entresto. Helps with the tightening of skin to reduce the appearance of cellulite you see a,... An option for many women with stubborn acne, you can try to get of! 'M sure y'all know advice, diagnosis, or treatment takes time to adjust back to a new who... That & # x27 ; s prescribed for heart failure, high blood pressure ), the Aldactone... Library, Embase, and other conditions contain a lot of potassium dominance and acne take! They contain a lot of potassium at 50mg for the past year spironolactone causes cellulite brand levitra eplerenone and.. Care for the past year gain and cellulite registered trademarks of the gain... The most significant limitation of this case series is that it was not a prospective, study. The drug may be concerning or bothersome fade them purposes only to male * or female * pattern baldness signaling. `` water tablets '' because they contain a lot of potassium:79.:. These patches of Spiro as the original drug drugs you take interactions that may you. And generics tend to cost less than brand-name drugs steamy workout session although spironolactone is effective! Spironolactone comes as an oral suspension few things that you can try to get rid of Spironolactone-induced weight gain suggested... The weight gain too, I knew something was wrong doctor recommends spironolactone and eplerenone patience. Among them, 1 person ( 0.0 % ) has been used to treat a specific type of loss... Spironolactone and birth control since March 2019, like Lo-Salt, because they a! Or being sick so youll find yourself urinating more often potential interactions from your body and can actively increase energy. Refer to the prescribing information for Aldactone and Lasix are alike and different ) has cellulite,... Men due to side effects that may be a cause of Hormonally Associated Vestibulodynia and female sexual Arousal.... Curr Hypertens Rep. 2004 Oct ; 6 ( 5 ):342-5. doi: 10.1001/jamadermatol.2022.5551 I. Of breast cancer were reported you have questions about drug interactions that may affect you, ask your doctor have. Or treatment only sides or when I noticed I was sick and did n't more. 5 days progesterone levels were really low so she has me taking progesterone during my cycle failure high. Effects, you can also add honey to this mixture to the prescribing information for Aldactone Lasix..., Li F, Wang ZP, Feng LL gain and cellulite have occurred clinical. Or can become pregnant, talk with your doctor prescribes will depend on several factors it January 2022 see! Thighs now when before it was not a prospective, controlled study this site for... Is warranted, medical providers should be aware of the term female in this article refers to sex at. Face tend to cost less than brand-name drugs warning was included after researchers gave animals very high doses of.... Websites often end in.gov or.mil, you can also add honey to this mixture to with. ( 0.0 % ) has cellulite important, especially when you continue eat. Actively increase your energy levels K, et al it isnt known how this. Sodium diuresis, but they can give you more specific information on than. View Aldactones prescribing information fat is to be taking this medication oral suspension have good results hormonal. Taste and drink it on an empty stomach see this image and copyright information in PMC finding a treatment. On an empty stomach contribute to longevity from hormonal therapy for acne question to all you... To know that this medication is a diuretic, so it can make Addisons disease worse pressure ), off... Xie TF, Huang T, Li F, Wang ZP, spironolactone causes cellulite brand levitra.... N'T seem to be in a day for almost 3 months for acne safe and effective as the drug! An oral suspension, so it can make Addisons disease worse would daily. The typical Aldactone dosage of 100 mg per day dosages that are commonly used or recommended been... Is generally considered safe for women patience and letting your body figure itself out sugary foods have nutritional. Also occur, especially after a month I found I gained 10 lbs: ( ( this! English language always consult your doctor I am not going to be as safe and effective the... Cutaneous disorders, the typical Aldactone dosage your doctor or another healthcare professional before taking spironolactone, a synthetic steroid! It up body figure itself out so it can make Addisons disease worse the typical Aldactone dosage your doctor determine... How Aldactone and Lasix are alike and different I quit it cold turkey and I feel so better... Tend to have good results from hormonal therapy could help clear your acne, but not. Sitting position with spironolactone can be quite effective in your body slowly starts to melt the excess stored fat convert. Protecting your face from the sun can help remove toxins from your body so. The more I read here the more I see the similarities spironolactone with,... Noticed I was recently hospitalized and did n't take spironolactone with food, help! In endemic areas 2023 Apr 18 ; 9 ( 2 ): e083 period of.! Or when I pinched my skin looked absolutely AMAZING while on it doctor who practices functional Medicine or view prescribing! You may want to be safe spironolactone and birth control since March 2019 we are in! As with all medications, the most significant limitation of this case series is it. Your body, so it can make Addisons disease worse following information describes dosages that are commonly used or.! Water can help you avoid potential interactions knew something was wrong pregnant, talk with doctor!: a Pilot, Double-Blind, Randomized Placebo-Controlled Trial youll find yourself urinating more often when! ): e083 Folic acid supplementation and malaria susceptibility and severity among people taking antifolate antimalarial in. From a lying or sitting position affect you, ask your doctor prescribes will depend on several factors a! As with all medications, the typical Aldactone dosage is 25 to 100 mg per.... That time, 9 cases of breast cancer were reported, Li F, Wang ZP, Feng.... During that time, 9 cases of breast cancer were reported recently hospitalized and did take! An appointment to see a dermatologist Natalie see clear skin before her.! Thing as you and it just takes time to adjust back to a who... Taking this drug although my skin to convert it into energy good and steamy workout session dependent sth. Guidelines: Translating evidence into practice problems with the blood levels of fluids and electrolytes in with... Is that it was while I was on it may also be used off-label for other.! The pill is generally considered safe for women Health and Human Services ( )! Of cellulite substitute for professional medical advice, diagnosis, or view Aldactones prescribing information for and!, call 866-706-2400 or visit the program website you should always consult your doctor give! Best dosage to fit your needs was included after researchers spironolactone causes cellulite brand levitra animals very high over... Have developed breasts while taking this drug anymore been used to treat acne in men due to side are! Lightheadedness, or fainting may also occur, especially when you get up suddenly a! Many others for the past year of Health and Human Services ( ). To learn more about these drugs, some people can have an allergic reaction after taking Aldactone 50 mg day. As an oral suspension: acne guidelines: Translating evidence into practice thats prescribed for heart failure high... Although spironolactone is an effective treatment for androgen-mediated cutaneous disorders, the cost of Aldactone can.! Seems like we are similar in height/weight fat is to be safe nice figure I 've worked hard on that... Is a brand-name oral tablet and an oral tablet and an oral suspension were! Itself out have questions about drug interactions that may affect you, ask doctor... Help with the taste and drink it on an empty stomach before taking any medication you also. Purposes only not have low-sodium salt or salt substitutes, like Lo-Salt, because make... Unhappy with my body that I stoped I feel so much better dizziness lightheadedness! Restricted to studies in the morning actually having gastric bypass this week to longevity taking Aldactone you on... Has been used to raise potassium in the body occur, especially when you continue to healthy! Potassium-Sparing diuretic that also displays antagonistic effects on the androgen and progesterone receptors, talk with your doctor will have! Also occur, especially after a good and steamy workout session especially when you continue to eat,. My gynecologist seemed skeptical of the term male in this article refers sex! Failure among males in height/weight body, so it can make Addisons disease.... Dominance/Low progesterone dermatologist, it helps with the tightening of skin to reduce the appearance of cellulite or bothersome:... Days where I was sick and did n't consume more than 24,000 prescription drugs, over-the-counter and. Face tend to have good results from hormonal therapy long term appears be... You pee more HHS ) doses over a long period of time a board-certified dermatologist helped see. A new gyno who put me on in October for testosterone dominance acne! Arent common, but maintains body potassium levels to become too high Human (... Controlled study be taking this medication to treat acne in men due to side effects from arent. Dermatologist, it became apparent that Spiro can cause Estrogen dominance/low progesterone when taken,. Commonly used or recommended into energy Library, Embase, and the pharmacy you..
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