side effects of anastrozole

The maximum plasma concentration is reached about 1 hour after ingestion. Due to the pronounced metabolism in “first pass” through the liver bioavailability is the average value of about 34%. Side effects of anastrozole protein binding is 30%. In the dose range from 4 to 20 mg tizanidine pharmacokinetics is linear.

Between the individual variability of pharmacokinetic parameters is low. Gender does not affect the pharmacokinetics of tizanidine. It is metabolized in the liver, mainly izofermenom 1A2 cytochrome P450. The metabolites are inactive. The half-life is 2-4 hours. Write mainly kidneys as metabolites, a small portion – unchanged. In patients with renal impairment (creatinine clearance less than 25 mL / min), the average value of the maximum plasma concentration is 2 times greater than the rate in healthy volunteers, and elimination half period lengthened to 14 hours.

Simultaneous food intake has no clinically meaningful effect on the pharmacokinetics of tizanidine.

 

Indications for use:

  • painful muscle spasms associated with static and functional disorders of the spine, as well as after surgery;
  • spasticity of the skeletal muscles during nevralogicheskih diseases (multiple sclerosis, chronic myelopathy, degenerative spinal cord disease, cerebrovascular accidents, cerebral palsy (in patients older than 18 years).

 

Contraindications:

  • severely impaired liver function,
  • hypersensitivity to any component side effects of anastrozole of the drug,
  • simultaneous use with fluvoxamine,
  • age of 18 years (due to lack of data)
  • pregnancy and lactation.

Precautions:
renal impairment, advanced age, concurrent use inhibitors (anti-arrhythmic drugs (amiodarone, mexiletine, propafenone), cimetidine, fluoroquinolones, rofecoxib, oral contraceptives, ticlopidine).

 

Dosage and administration:

Inside.

With painful muscle spasms: 2-4 mg three times a day. In severe cases, before bedtime in addition take 2-4 mg.

When spasticity of the skeletal muscles: the initial daily dose should not exceed 6 mg, divided into 3 doses. The dose may be increased gradually to 4.2 mg at intervals of 3-7 days. Optimum therapeutic benefit is achieved at a daily dose of 12-24 mg divided by 3-4 hours at regular intervals.

The maximum daily dose of 36 mg.

In patients with renal failure is recommended to begin treatment with a dose of 2 mg once daily. Increasing the dose should be gradual, focusing on tolerability and efficacy. In case of need to increase the dose, the dosage is increased first to be assigned to one time per day, then increased dosing frequency.

Side effect:

Drowsiness, weakness, dizziness, a slight decrease in blood pressure, dry mouth, nausea, gastrointestinal disorders, passing increase in liver transaminases.

When taking the drug in higher side effects of anastrozole doses, further, there may be: lower blood pressure, bradycardia, muscle weakness, insomnia, sleep disorders, hallucinations, acute hepatitis (very rarely), anxiety.

Overdose:

Symptoms include nausea, vomiting, decreased blood pressure, dizziness, drowsiness, cramps, anxiety, respiratory failure, coma.

Treatment: multiple appointment of activated charcoal is recommended to remove the drug from the body. Forced diuresis also may accelerate the excretion of tizanidine. Subsequently, symptomatic therapy.

Interaction with other drugs:
The simultaneous use of fluvoxamine leads to 33-fold increase in area under the curve “concentration-time” tizanidine. As a result, developing long-lowering blood pressure, drowsiness, weakness and lethargy.

With simultaneous use of tizanidine with antihypertensive drugs (including a diuretic) may develop arterial gipogenzii and bradycardia.

Sedatives and ethanol, may increase the sedative action of tizanidine.

Simultaneous use of oral contraceptives leads to a significant decrease in clearance of tizanidine.

Special instructions:

It reported liver problems associated with taking tizanidine, but the application of a daily dose to 12 mg of these cases were rare. In this connection, it is recommended to control hepatic function tests 1 time per month during the first 4 months of treatment, and if the levels of side effects of anastrozole in serum staunchly upper limit of normal 3 times or more, the use of tizanidine should be discontinued.

Patients who marked drowsiness should refrain from the types of jobs that require high concentration and speed of psychomotor reactions (eg driving vehicles or using machines and mechanisms).

anastrozole price

In the case of overdose tienama recommended removal of the drug, the appointment of symptomatic and supportive therapy. Specific information on the treatment of overdose is not tienama.
Anastrozole price – cilastatin sodium is displayed during hemodialysis, but the effectiveness of this procedure in case of overdose is unknown.

Interaction with other drugs:
Co-administration  is accompanied by a minimal increase in plasma concentrations and elimination tienama, and therefore the introduction of probenicid during antibiotic therapy is not recommended.
Introduction tienama accompanied by a decrease in serum valproic acid concentrations with the associated risk of increasing seizure activity (registered clinical cases), so during treatment tienama recommend monitoring serum levels of valproic acid.
Tien should not be mixed anastrozole price in the same syringe with other antibiotics, while at the same time allowed – isolated – administration with other antibiotics (aminoglycosides).

Special instructions:


Tien 500 mg intramuscular injection of 32 mg of sodium .
We do not recommend the use of tienama in patients with creatinine clearance  with the exception of those cases where no later than 48 hours hemodialysis should be performed.
For patients on hemodialysis Tien is recommended only in cases where the benefit of the treatment outweighs the potential risk of seizures.
If focal tremors, myoclonus, or seizures occur for the first time in the treatment process tienama shown neurological examination and the initiation of anticonvulsant therapy. If anastrozole price symptoms persist, then tienama dose should be reduced or the drug should be withdrawn.
The treatment tienama may develop life-threatening condition requiring special attention and medical staff to be able to provide emergency medical care. These conditions referred severe anaphylaxis, convulsions and severe clinical form of pseudomembranous colitis clostridial etiology .
As with other beta-lactam antibiotics, Pseudomonas aeruginosa is fast enough to develop resistance tienama during treatment. Therefore, in the treatment of infections caused by  aeruginosa, it is recommended to carry out periodic tests for antibiotic sensitivity according to the clinical situation.
In order to prevent the development of resistance and maintain tienama effectiveness in clinical practice, the drug should be used for treatment of infections only caused by proven (or supposedly) sensitive imipenem microorganisms. If there is information about an identified pathogen and its sensitivity to antibiotics the doctor guided her to select the best antibiotic, in the absence of such an empirical anastrozole price selection of antibacterial preparation on the basis of local epidemiological data and the sensitivity of the data.

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anastrozole bodybuilding

Tien for the anastrozole bodybuilding is used to treat infections of moderate to severe currents, caused by susceptible to aerobic and anaerobic microorganisms. And also for the empirical treatment of infectious process before defining its bacterial pathogens Tien is indicated for the treatment of:

  • Lower respiratory infections, including pneumonia, bronchitis, as well as exacerbation of chronic obstructive pulmonary disease caused by Streptococcus pneumoniae and of Haemophilus influenzae ;
  • Intra-abdominal infections, including acute gangrenous and perforated appendix, including complicated by peritonitis caused by Streptococcus Group D, including of Enterococcus faecalis , a group of Streptococcus viridans ; of Escherichia coli, of Klebsiella pneumoniae, of Pseudomonas aeruginosa, of Bacteroides spp. , Including V.fragilis, B.distasonis , B.intermedius, B.thetaiotaomicron; andFusobacterium spp. , and Peptostreptococcus spp.
  • Infections of the skin and soft tissues, including abscess, phlegmon, infected ulcers and wound infections caused by of Staphylococcus aureus , including penicillinase-producing strains; of Streptococcus pyogenes; Streptococcus Group D, including Enterococcus faecalis; Spp Acinetobacter. , Including A.calcoaceticus; Citrobacter spp .; Escherichia coli, Enterobacter cloacae, Klebsiella pneumoniae , Pseudomonas aeruginosa, and Bacteroides spp., Including B.fragilis .
  • Gynecologic infections, including postpartum endomyometritis caused by Streptococcus group , including Enterococcus faecalis; Escherichia coli; Klebsiella pneumoniae; Bacteroides intermedius andPeptostreptococcus spp .

    Contraindications:

  • Hypersensitivity to any component of the drug, other beta-lactam antibiotics, penicillins and cephalosporins.
  • When using lidocaine hydrochloride as a solvent administration of the drug is contraindicated in patients with known hypersensitivity to amide anesthetics local action and in patients with severe shock and intracardiac conduction blockade.
  • Patients with creatinine clearance less than 20 mL / min / 1.73 m 2 .
  • Children up to 12 years.Carefully:
  • pseudomembranous colitis anastrozole bodybuilding
  • Patients with a history of gastrointestinal disease.
  • Patients with creatinine clearance of 20 to 70 ml / min / 1.73 m 2 .
  • Patients with central nervous system diseases.Use of the drug during pregnancy and lactation: Studies using tienama for i / m administration in pregnant women has been conducted,stanabol 50 the drug should therefore be used during pregnancy only if the benefit of treatment justifies the potential risk to the fetus. Imipenem is found in breast human milk. If the application tienama deemed necessary, breast-feeding should be discontinued in breast milk.

    Use in pediatric patients: In children older than 12 years, the drug is used for the same indications as in adults. Data on the efficacy and safety of tienama for i / m administration in children under 12 years are not enough.

    Use in elderly patients: In clinical studies the efficacy and safety tienama with the / m introduction of the elderly over 65 years old are not different from those of a younger age in people. However, considering the characteristic of this age group is reduced function of the cardiovascular system, liver, kidneys, and the presence of comorbidities and concomitant drug therapy, care should be taken in dose selection, adhering to the lower limits of the recommended doses. It is advisable to monitor renal excretory function.

    Dosage and administration:

    The dosing recommendations given tienama mipenema amount to be administered. Tienama dosage for adults and children 12 years of age is determined depending on the location and severity of infection, as well as the sensitivity of the pathogen anastrozole bodybuilding renal function and body weight of the patient. In patients with lower respiratory tract infections, skin and appendages, and gynecological infections recommended introduction tienama (500 mg imipenem) every 12 hours, and patients with intra-abdominal infections -. 750 mg imipenem every 12 hours for a total daily dose by intramuscular administration should not exceed 1.5 g of imipenem. If there is a need for higher doses of the drug, it should be used intravenous route of administration. The duration of treatment depends on the type of pathogen and severity of the disease caused by it, the treatment is usually continued for at least two days after disappearance of all symptoms of an infectious disease. Safety and efficacy of treatment over 14 days has not been established. Thienyl be administered deep into large muscles (such as the gluteal muscles or lateral thigh muscles), with obligatory test aspiration to avoid contact with the drug in the lumen of the vessel. In patients with a creatinine clearance ≥ 20 ml / min / 1,73m 2 thien for intramuscular injections may be administered, without reducing the dosage.

    Preparation of solution: The solution tienama for intramuscular injection is prepared by dissolving a sterile powder in a vial 1% lidocaine hydrochloride (without epinephrine), or water for injection or saline, as indicated in the Table.The prepared solution is white or slightly yellow color.

    Stability tienama dosage form for intramuscular injection: The preparation in the form of a dry powder must be stored at a temperature not higher than 25 ° C. The prepared solution should be used within an hour. Thienyl intramuscular injection can not be mixed or added to other antibiotics.

    Adverse Reactions: Tien is generally well tolerated. In clinical studies showed thienyl same tolerability as cefazolin, cefotaxime and cephalothin. Side effects as a rule, do not require discontinuation of therapy and are usually transient and Just noticeable; serious anastrozole side effects are rare. The most common side effects are tienama: Local reactions The most frequent of the reported local reactions were pain at the site of administration. Allergic reactions Rash, pruritus, urticaria, erythema multiforme, Stevens-Johnson syndrome, angioedema, toxic epidermal necrolysis (rare), exfoliative dermatitis (rarely), candidiasis, fever, including dosage, anaphylactic reactions. The reactions of the gastro-intestinal tract Nausea, vomiting, diarrhea, staining of the teeth and / or tongue. As in the case of treatment by almost all broad-spectrum antibiotics, there were reports of pseudomembranous colitis.

  • The reactions of the central nervous system as well as in the treatment of other antibiotics of the beta-lactams, with the / m introduction tienama described cases of side effects from the central nervous system in the form of myoclonus, and seizures. Normally, such phenomena are observed in patients with CNS (brain injuries, or a history of seizures) and / or in patients with impaired renal function, although isolated cases were reported in patients without CNS disease. To avoid complications it is necessary to strictly adhere to the recommended dosage and treatment regimen (see section “Dosage and method of application.”), And in patients with established convulsive disorder should continue taking anticonvulsants.
  • Changes in laboratory parameters blood – decrease in the number of red blood cells, hemoglobin level, and hematocrit, eosinophilia , leukocytosis and leukopenia, thrombocytosis anastrozole bodybuilding and thrombocytopenia, prolonged prothrombin time.
  • liver enzymes – an increase in serum transaminases, bilirubin and / or serum alkaline phosphatase.
  • The excretory system – increase in serum levels of urea and creatinine. Possible eritrotsit-, leykotsit-, cylinder- and bacteriuria.

anastrozole 1mg

Levodopa absorbed by active transport from the gastrointestinal tract, its passage through the blood-brain barrier is also carried out by active mechanisms. Barriers to absorption of levodopa is the presence of dopa decarboxylase in the intestinal wall. Levodopa anastrozole 1mg is absorbed from the stomach in a limited amount. The rate of gastric emptying plays a key role in the absorption of the drug. Factors that slow gastric emptying (food, m-anticholinergic agents), delaying the passage of the drug into the duodenum, and slow its absorption. The maximum concentration of the drug in the blood observed after 1-2 hours after administration. Distribution: The volume of distribution of levodopa is 0.9-1.6 l / kg. While maintaining the total clearance dopa decarboxylase activity in plasma levodopa is 0.5 l / kg / hr.

Levodopa penetrates through the blood-brain barrier by facilitated diffusion. The endothelium of the brain capillaries also contains a dopa decarboxylase as a second potential barrier to receipt of levodopa to the brain, however, in these capillaries is decarboxylated a small portion of the administered dose of levodopa. Metabolism: Approximately 70-75% of input into the levodopa is metabolized in the gut wall (the effect of “first pass “). Liver first-pass metabolism does not substantially participate. With increasing doses of levodopa, the amount of drug in the intestine undergoes  decreases.Levodopa is not bound to plasma proteins. The  of levodopa-dopa decarboxylase is the main way of the formation of dopamine levodopa. A large anastrozole 1mg number of this enzyme in the intestine, liver and kidneys.

Methoxylation levodopa influenced by catechol-O-methyltransferase to form a 3-O-is the second metildofy by metabolism of levodopa. With long-term treatment of this metabolite may accumulate. Transamination is an additional route of metabolism of levodopa. The end product of this pathway is vanilpiruvat, vanilatsetat and 2,4,5-trigidroksifeniluksusnaya acid. All pathways except transamination are irreversible. Selection: In combination with carbidopa, levodopa half-life is increased to 3 hours. Up to 69% of levodopa can be detected in the urine of a human dopamine and its metabolites – vinilinmindalnoy acid, norepinephrine, homovanillic acid digidrofeniluksusnoy acid.

b. Carbidopa
At recommended doses, carbidopa does not penetrate the blood-brain barrier. The maximum plasma concentration is reached after 4.2 hours. Approximately 50% of carbidopa is excreted in the urine and feces. 35% of carbidopa are excreted renally, it appears unchanged.

 

Contraindications

Hypersensitivity to the drug, a form-closure glaucoma, severe psychosis or neurosis, pregnancy and lactation, melanoma or suspected it, skin disease of unknown etiology, Huntington’s disease, essential tremor. It should not be used for the treatment of secondary parkinsonism caused by the use of antipsychotic drugs (neuroleptics). Do not assign patients up to 18 years.

Carefully

The drug is taken with caution in patients with erosive and ulcerative lesions of gastric and / or duodenal ulcer, epileptic seizures in history of myocardial infarction with cardiac arrhythmias in the history of, heart failure, diabetes, asthma, diseases of the endocrine system, mental disorders, as well as heavy violations of liver and kidney function.

Dosing and Administration

With a small amount of food or after a meal, with water and without chewing. Since there is competition between the aromatic amino acids and levodopa by sucking, while anastrozole 1mg use of the drug should avoid consuming large amounts of protein. The average daily dose of carbidopa needed to inhibit peripheral conversion of levodopa, is 70-100 mg. Exceeding 200 mg carbidopa does not entail further enhance the therapeutic effect. The daily dose of levodopa should not exceed 2000 mg.
The starting dose – 1/2 tablets 2 times a day, can be increased by half pill daily as needed. Typically, at the beginning of substitution therapy, the daily dose should not exceed 3 tablets per day (1st tablet 3 times a day). The use of this dosage is recommended in the early treatment of severe cases of Parkinson’s disease. The daily dose of the drug as an exception may be raised during monotherapy, but should not exceed 8 tablets (1 tablet minutes 8 times a day). The use in an amount of more than 6 tablets per day should be carried out with great care.
Tidomet Forte when replacing levodopa
levodopa discontinued 12 hours prior to start of treatment Tidometom Forte, and in the case of receiving prolonged forms levokarbidopy – 24 hours. Dosage Tidometa Forte in this case should be no more than 20% of the previous dose of levodopa. The maintenance dose is 3-6 tablets per day for most patients.

Side effect

Nervous system: Dyskinesia, including choreoathetosis, focal dystonia, with prolonged use – “on-off” syndrome, dizziness, ataxia, seizures, anorexia, sedation, drowsiness, nightmares, nervousness, irritability, anxiety, insomnia, psychotic reactions, hallucinations, depression, paranoid state, hypomania, increased libido, euphoria, dementia. Gastrointestinal tract: loss of appetite, nausea, vomiting, constipation, epigastric pain, dysphagia, ulcerogenic action in predisposed patients. Cardiovascular system: orthostatic hypotension, collapse, heart arrhythmia, tachycardia. hemopoiesis system: moderate leukopenia, thrombocytopenia, hemolytic anemia. The change in laboratory parameters: changes in the level glutumatoksalattransaminazy, glutamatpiruvatoksalazy, alkaline phosphatase, lactate dehydrogenase, urea nitrogen, bilirubin, iodine-related protein, positive direct Coombs’ test . Others: blepharospasm, mydriasis, diplopia, a slight increase in body weight during long-term use. Side effects are usually dependent on the dose received and the individual patient’s sensitivity. Side effects can be eliminated temporary dose reduction without interruption in treatment. If side effects do not regress, the treatment should be stopped gradually.

Overdose

Symptoms: The first increase and then decrease in blood pressure, sinus tachycardia, confusion, agitation, insomnia, anxiety. It may also develop orthostatic hypotension. Symptoms of anorexia and insomnia may persist for several days. Treatment: gastric lavage, activated charcoal. If necessary, carrying out symptomatic treatment in a hospital. There is no specific antidote.

Drug interactions

 

  • Simultaneous with the appointment of antihypertensive drugs requires special attention due to the risk of postural hypotension.
  • when combined with tricyclic antidepressants may cause hypertension and dyskinesia, and reduced bioavailability of levodopa.
  • the combined use of phenothiazines, and butirofenonov Tidometa Forte reduces the effect of the latter.
  • Tidomet Forte should not be administered in conjunction with non-selective monoamine oxidase inhibitors, as can develop hypertensive crisis. monoamine oxidase inhibitors, treatment should be discontinued for at least 14 days prior to drug administration. The exception is selegiline (a selective inhibitor of monoamine oxidase – B) that can be used as an adjuvant in the treatment of levodopa.
  • may increase the effects of sympathomimetics, and therefore it is recommended to reduce the dose. With simultaneous use of levodopa with β-adrenostimulyatorov, means for inhalation anesthesia may increase the risk of cardiac arrhythmias.
  • when used with levodopa amantadine marked potentiating effect.
  • methyldopa and levodopa may potentiate the side effects of each other.
  • pyridoxine is a cofactor dopa decarboxylase – an enzyme responsible for peripheral decarboxylation of levodopa and dopamine education. When his appointment in patients receiving levodopa (without dopa decarboxylase inhibitors), there is a growing peripheral metabolism of levodopa and a smaller amount of it penetrates through the blood-brain barrier. Thus, pyridoxine reduces the therapeutic effect of levodopa, dopa decarboxylase peripheral inhibitors if not assigned additionally.
  • when supplemental dopa decarboxylase inhibitors, the daily dose of levodopa can be reduced by 70-80% while maintaining the same clinical outcome.
  • when combined with diazepam, phenytoin, clonidine, thioxanthene derivatives, papaverine, reserpine, may decrease the antiparkinsonian action.
  • while the use of drugs anastrozole 1mg increases the risk of dyskinesias and hallucinations.

special instructions

Should not be used in cases of secondary parkinsonism, caused by the use of antipsychotic drugs (neuroleptics).
Discontinuation of therapy should be gradual, since the sudden discontinuation of the drug may develop symptom complex resembling neuroleptic malignant syndrome (muscular rigidity, increased body temperature, increased content serum ). Requires monitoring of patients who took a sudden reduce the dose or interrupt reception. The absorption of levodopa in elderly patients is higher than in the young. These data confirm the information on the reduction of the activity of dopa decarboxylase in tissues with age, as well as long-term administration of levodopa.
When erosive and ulcerative lesions of gastric and / or duodenal ulcer, epileptic seizures in history of myocardial infarction, rhythm disturbances in the history of, heart disease, diabetes , bronchial asthma, diseases of the endocrine system, mental disorders, as well as severe liver or kidney function should take the drug with caution. In such cases, patients should be under close medical supervision.
In long-term treatment is necessary to carry out periodic monitoring of liver function, kidney, hematopoietic system and the cardiovascular system are also necessary to monitor the patient’s mental status.
In general anesthesia during surgical operations Tidomet Forte administered without reducing the dose if the patient is able to take drugs and fluids inside. When using halothane and cyclopropane use of the drug is stopped for at least 8 hours before surgery. Treatment continued after the operation at the same dose.
Patients with glaucoma in patients receiving the drug should regularly monitor the intraocular pressure.
The impact on driving: anastrozole 1mg you must refrain from transport management, as well as activities requiring psychomotor speed reactions.

anastrozole

After oral administration of ornidazole is rapidly absorbed. The average absorption is 90%. Maximum plasma concentrations are reached within 3 hours.

Distribution

The binding of ornidazole with anastrozole the proteins is approximately 13%. Active substance tiberal very well into the cerebrospinal fluid, and other body fluids and tissues.

Ornidazole plasma concentrations are in the optimal range for the various indications. Cumulation factor after receiving multiple doses of 500 mg or 1000 mg in healthy volunteers after every 12 hours is equal to 1.5-2.5.

Metabolism

Ornidazole is metabolized in the liver to form mainly hydroxymethyl-2 and a -gidroksimetilmetabolitov. Both metabolites are less active against Trichomonas vaginalis and anaerobic bacteria than the unmodified ornidazole.

breeding

The half-life is about 13 hours. After a single oral dose is excreted 85% in the first 5 days, mainly as metabolites. About 4% of the dose is eliminated via the kidneys in unchanged form.

testimony

Trichomoniasis (urinary infections in women and men caused by Trichomonas vaginalis); amebiasis (all of intestinal infections caused by Entamoeba histolytica, including amoebic dysentery, and all forms of extra-intestinal amebiasis, especially amebic liver abscess); giardiasis.

Mode of application

Tiberal always taken after meals.

Trichomoniasis:

2 1 tablet twice a day (morning and evening) for 5 days.

To eliminate the possibility of re-infection, the sexual partner, in all cases, should receive the same treatment.

The daily dose anastrozole for children is 25 mg / kg body weight and is administered once.

Hypersensitivity to the drug or other nitroimidazole derivative.

Side effects

Weakly expressed drowsiness, headaches and gastrointestinal disorders (nausea). In some cases side effects, such as dizziness, tremor, rigidity, loss of coordination, convulsions, fatigue, temporary loss of consciousness, signs of sensory or mixed peripheral neuropathy. There have been cases of perversion of taste sensations, changes in liver function tests, skin reactions and hypersensitivity reactions.

Precautionary measures

Care should be taken in patients with anastrozole diseases such as epilepsy, brain lesions, multiple sclerosis. If you exceed the recommended doses there is a risk in patients with liver disease, alcohol abuse, pregnant and lactating mothers and children.

Pregnancy and lactation

Extensive research on the different kinds of animals did not reveal any teratogenic or toxic effect of the drug on the fetus. Controlled studies in pregnant women have been conducted. However, for general health reasons appoint Tiberal early in pregnancy or nursing mothers only if absolutely indicated.

Drug interactions

Unlike other nitroimidazole derivative, ornidazole did not inhibit aldehyde dehydrogenase and is therefore incompatible with alcohol. However, ornidazole potentiates the anastrozole action of oral anticoagulants coumarin, which requires their respective dose adjustment. Ornidazole lengthens muscle relaxant action of vecuronium bromide.