Neotrex Uses

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• Neotrex indications
• Uses of Neotrex in details
• Neotrex description
• Neotrex dosage
• Neotrex interactions
• Neotrex side effects
• Neotrex contraindications

What is Neotrex?

Neotrex is used to treat severe, disfiguring nodular acne. It should be used only after other acne medicines have been tried and have failed to help the acne. Neotrex may also be used to treat other skin diseases as determined by your doctor.

Neotrex must not be used to treat women who are able to bear children unless other forms of treatment have been tried first and have failed. Neotrex must not be taken during pregnancy because it causes birth defects in humans. If you are able to bear children, it is very important that you read, understand, and follow the pregnancy warnings for Neotrex.

Neotrex is available only under a registered distribution program called the iPLEDGE™ program.

Once a medicine has been approved for marketing for a certain use, experience may show that it is also useful for other medical problems. Although these uses are not included in product labeling, Neotrex is used in certain patients with the following medical conditions:

• Folliculitis, gram-negative (bacterial infection of the skin on the face beginning near the nose).
• Hidradenitis suppurativa (sweat gland problem).
• Rosacea (red skin disorder of the face, usually of the nose and cheeks).
• Thickened or patchy skin disorders, such as keratosis follicularis, palmoplantar keratoderma, lamellar ichthyosis, or pityriasis rubra pilaris.

Neotrex indications

Severe Recalcitrant Nodular Acne

Neotrex (isotret (isotret (Neotrex capsules) inoin capsules) inoin capsules) is indicated for the treatment of severe recalcitrant nodular acne. Nodules are inflammatory lesions with a diameter of 5 mm or greater. The nodules may become suppurative or hemorrhagic. "Severe," by definition, means "many" as opposed to "few or several" nodules. Because of significant adverse effects associated with its use. Neotrex (isotret (isotret (Neotrex capsules) inoin capsules) inoin capsules) should be reserved for patients with severe nodular acne who are unresponsive to conventional therapy, including systemic antibiotics. In addition, Neotrex (isotret (isotret (Neotrex capsules) inoin capsules) inoin capsules) is indicated only for those female patients who are not pregnant, because Neotrex can cause severe birth defects.

A single course of therapy for 15 to 20 weeks has been shown to result in complete and prolonged remission of disease in many patients. If a second course of therapy is needed, it should not be initiated until at least 8 weeks after completion of the first course, because experience has shown that patients may continue to improve while off isotret (isotret (isotret (Neotrex capsules) inoin capsules) inoin capsules) inoin capsules. The optimal interval before retreatment has not been defined for patients who have not completed skeletal growth.

How should I use Neotrex?

Use Neotrex as directed by your doctor. Check the label on the medicine for exact dosing instructions.

• Neotrex comes with an extra patient information sheet called a Medication Guide. Read it carefully. Read it again each time you get Neotrex refilled.
• Some brands of Neotrex should be taken with food. Some brands may be taken with or without food. Ask your pharmacist if you should take your brand of Neotrex with food.
• Swallow the capsule with a full glass of water or other liquid. Do not break, crush, chew, or suck on the capsule before swallowing. This will help prevent the medication inside the capsule from irritating your throat.
• For best results, take Neotrex regularly. Taking Neotrex at the same time each day will help you remember to take it.
• Neotrex can only be dispensed through a special program. You must sign a consent form stating that you will follow your doctor's instructions before you can take Neotrex. This will be necessary each time you refill your prescription.
• You will get no more than a 30-day supply of Neotrex at a time to ensure you check in with your doctor each month to discuss side effects.
• If you miss a dose of Neotrex, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once.

Ask your health care provider any questions you may have about how to use Neotrex.

Uses of Neotrex in details

This medication is used to treat severe cystic acne (also known as nodular acne) that has not responded to other treatment (e.g., benzoyl peroxide or clindamycin applied to the skin or tetracycline or minocycline taken by mouth). It belongs to a class of drugs known as retinoids. It works by decreasing facial oil (sebum) production. High amounts of sebum can lead to severe acne. If left untreated, severe acne may cause permanent scarring.

OTHER USES: This section contains uses of this drug that are not listed in the approved professional labeling for the drug but that may be prescribed by your health care professional. Use this drug for a condition that is listed in this section only if it has been so prescribed by your health care professional.

This medication may also be used to treat a certain type of cancer (neuroblastoma).

How to use Neotrex

Read the Medication Guide provided by your pharmacist before you start using Neotrex and each time you get a refill. Read and sign a Patient Information/Informed Consent form before you start taking this medication. If you have any questions about Neotrex, consult your doctor or pharmacist before taking the medication.

Swallow capsules whole. Do not crush or chew them. Neotrex is usually taken twice daily for 15-20 weeks, or as directed by your doctor. Directions for most generic forms of Neotrex state that it should be taken with meals. However, the FDA has indicated that the Neotrex brand may be taken with or without food. Food helps increase absorption of this drug into your bloodstream. Ask your doctor or pharmacist for more information. Take this drug with a full glass of water, and do not lie down for 10 minutes after taking it.

The dosage is based on your medical condition, weight, and response to treatment.

Your acne may worsen during the first few days of taking this drug, and it may take up to 1-2 months before you notice the full benefit of this medication. If severe acne returns, a second course of treatment may be started after you have stopped taking the drug for 2 months. The manufacturer does not recommend long-term use of Neotrex. Do not take more than the recommended dose.

Since this drug can be absorbed through the skin and lungs and may harm an unborn baby, women who are pregnant or who may become pregnant should not handle this medication or breathe the dust from the capsules.

Neotrex description

Neotrex is a medication used for the treatment of severe acne. It is sometimes used in prevention of certain skin cancers. It is a retinoid, meaning it derives from vitamin A and is found in small quantities naturally in the body. Neotrex binds to and activates nuclear retinoic acid receptors (RAR), thereby regulating cell proliferation and differentiation. This agent also exhibits immunomodulatory and anti-inflammatory responses and inhibits ornithine decarboxylase, thereby decreasing polyamine synthesis and keratinization.

Neotrex dosage

Neotrex (Neotrex) should be administered with a meal.

The recommended dosage range for Neotrex (Neotrex) is 0.5 to 1.0 mg/kg/day given in two divided doses with food for 15 to 20 weeks. In studies comparing 0.1, 0.5, and 1.0 mg/kg/day, it was found that all dosages provided initial clearing of disease, but there was a greater need for retreatment with the lower dosages. During treatment, the dose may be adjusted according to response of the disease and/or the appearance of clinical side effects — some of which may be dose related. Adult patients whose disease is very severe with scarring or is primarily manifested on the trunk may require dose adjustments up to 2.0 mg/kg/day, as tolerated. Failure to take Neotrex (Neotrex) with food will significantly decrease absorption. Before upward dose adjustments are made, the patients should be questioned about their compliance with food instructions.

The safety of once daily dosing with Neotrex (Neotrex) has not been established. Once daily dosing is not recommended.

If the total nodule count has been reduced by more than 70% prior to completing 15 to 20 weeks of treatment, the drug may be discontinued. After a period of 2 months or more off therapy, and if warranted by persistent or recurring severe nodular acne, a second course of therapy may be initiated. The optimal interval before retreatment has not been defined for patients who have not completed skeletal growth. Long-term use of Neotrex (Neotrex), even in low doses, has not been studied, and is not recommended. It is important that Neotrex (Neotrex) be given at the recommended doses for no longer than the recommended duration. The effect of long-term use of Neotrex on bone loss is unknown.

Contraceptive measures must be followed for any subsequent course of therapy.

Table 4 : Neotrex (Neotrex) Dosing by Body Weight (Based on Administration With Food)

How supplied

Soft gelatin capsules, 10 mg (light pink), imprinted Neotrex (Neotrex) 10 ROCHE. Boxes of 100 containing 10 Prescription Paks of 10 capsules (NDC 0004-0155-49).

Soft gelatin capsules, 20 mg (maroon), imprinted Neotrex (Neotrex) 20 ROCHE. Boxes of 100 containing 10 Prescription Paks of 10 capsules (NDC 0004-0169-49).

Soft gelatin capsules, 40 mg (yellow), imprinted Neotrex (Neotrex) 40 ROCHE. Boxes of 100 containing 10 Prescription Paks of 10 capsules (NDC 0004-0156-49).

Storage

Store at controlled room temperature (59° to 86°F, 15° to 30°C). Protect from light.

REFERENCES

1. Peck GL, Olsen TG, Yoder FW, et al. Prolonged remissions of cystic and conglobate acne with 13-cis-retinoic acid. N Engl J Med 300:329-333, 1979.

2. Pochi PE, Shalita AR, Strauss JS, Webster SB. Report of the consensus conference on acne classification. J Am Acad Dermatol 24:495-500, 1991.

3. Farrell LN, Strauss JS, Stranieri AM. The treatment of severe cystic acne with 13-cis-retinoic acid: evaluation of sebum production and the clinical response in a multiple-dose trial. J Am Acad Dermatol 3:602-611, 1980.

4. Jones H, Blanc D, Cunliffe WJ. 13-cisretinoic acid and acne. Lancet 2:1048-1049, 1980.

8. Strauss JS, Rapini RP, Shalita AR, et al. Neotrex therapy for acne: results of a multicenter dose-response study. J Am Acad Dermatol 10:490-496, 1984.

Distributed by: Roche Laboratories Inc., 340 Kingsland Street, Nutley, New Jersey 07110-1199. PI Revised: January 2010.

Neotrex interactions

See also:
What other drugs will affect Neotrex?

• Vitamin A: Because of the relationship of Neotrex (Neotrex) to vitamin A, patients should be advised against taking vitamin supplements containing vitamin A to avoid additive toxic effects.
• Tetracyclines: Concomitant treatment with Neotrex (Neotrex) and tetracyclines should be avoided because Neotrex (Neotrex) use has been associated with a number of cases of pseudotumor cerebri (benign intracranial hypertension), some of which involved concomitant use of tetracyclines.
• Micro-dosed Progesterone Preparations: Micro-dosed progesterone preparations (“minipills” that do not contain an estrogen) may be an inadequate method of contraception during Neotrex (Neotrex) therapy. Although other hormonal contraceptives are highly effective, there have been reports of pregnancy from female patients who have used combined oral contraceptives, as well as transdermal patch/injectable/implantable/vaginal ring hormonal birth control products. These reports are more frequent for female patients who use only a single method of contraception. It is not known if hormonal contraceptives differ in their effectiveness when used with Neotrex (Neotrex). Therefore, it is critically important for female patients of childbearing potential to select and commit to use 2 forms of effective contraception simultaneously, at least 1 of which must be a primary form.
• Norethindrone/ethinyl estradiol: In a study of 31 premenopausal female patients with severe recalcitrant nodular acne receiving OrthoNovum® 7/7/7 Tablets as an oral contraceptive agent, Neotrex (Neotrex) at the recommended dose of 1 mg/kg/day, did not induce clinically relevant changes in the pharmacokinetics of ethinyl estradiol and norethindrone and in the serum levels of progesterone, follicle-stimulating hormone (FSH) and luteinizing hormone (LH). Prescribers are advised to consult the package insert of medication administered concomitantly with hormonal contraceptives, since some medications may decrease the effectiveness of these birth control products.
• St. John's Wort: Neotrex (Neotrex) use is associated with depression in some patients. Patients should be prospectively cautioned not to self-medicate with the herbal supplement St. John's Wort because a possible interaction has been suggested with hormonal contraceptives based on reports of breakthrough bleeding on oral contraceptives shortly after starting St. John's Wort. Pregnancies have been reported by users of combined hormonal contraceptives who also used some form of St. John's Wort.
• Phenytoin: Neotrex (Neotrex) has not been shown to alter the pharmacokinetics of phenytoin in a study in seven healthy volunteers. These results are consistent with the in vitro finding that neither Neotrex nor its metabolites induce or inhibit the activity of the CYP 2C9 human hepatic P450 enzyme. Phenytoin is known to cause osteomalacia. No formal clinical studies have been conducted to assess if there is an interactive effect on bone loss between phenytoin and Neotrex (Neotrex). Therefore, caution should be exercised when using these drugs together.
• Systemic Corticosteroids: Systemic corticosteroids are known to cause osteoporosis. No formal clinical studies have been conducted to assess if there is an interactive effect on bone loss between systemic corticosteroids and Neotrex (Neotrex). Therefore, caution should be exercised when using these drugs together.

Laboratory Tests

• Pregnancy Test
  • Female patients of childbearing potential must have had two negative urine or serum pregnancy tests with a sensitivity of at least 25 mIU/mL before receiving the initial Neotrex (Neotrex) prescription. The first test (a screening test) is obtained by the prescriber when the decision is made to pursue qualification of the patient for Neotrex (Neotrex). The second pregnancy test (a confirmation test) must be done in a CLIA-certified laboratory. The interval between the two tests must be at least 19 days.
  • For patients with regular menstrual cycles, the second pregnancy test must be done during the first 5 days of the menstrual period immediately preceding the beginning of Neotrex (Neotrex) therapy and after the patient has used 2 forms of contraception for 1 month.
  • For patients with amenorrhea, irregular cycles, or using a contraceptive method that precludes withdrawal bleeding, the second pregnancy test must be done immediately preceding the beginning of Neotrex (Neotrex) therapy and after the patient has used 2 forms of contraception for 1 month.
  • Each month of therapy, patients must have a negative result from a urine or serum pregnancy test. A pregnancy test must be repeated each month, in a CLIA-certified laboratory, prior to the female patient receiving each prescription.
• Lipids: Pretreatment and follow-up blood lipids should be obtained under fasting conditions. After consumption of alcohol, at least 36 hours should elapse before these determinations are made. It is recommended that these tests be performed at weekly or biweekly intervals until the lipid response to Neotrex (Neotrex) is established. The incidence of hypertriglyceridemia is 1 patient in 4 on Neotrex therapy.
• Liver Function Tests: Since elevations of liver enzymes have been observed during clinical trials, and hepatitis has been reported, pretreatment and follow-up liver function tests should be performed at weekly or biweekly intervals until the response to Neotrex has been established.
• Glucose: Some patients receiving Neotrex (Neotrex) have experienced problems in the control of their blood sugar. In addition, new cases of diabetes have been diagnosed during Neotrex (Neotrex) therapy, although no causal relationship has been established.
• CPK: Some patients undergoing vigorous physical activity while on Neotrex (Neotrex) therapy have experienced elevated CPK levels; however, the clinical significance is unknown. There have been rare postmarketing reports of rhabdomyolysis, some associated with strenuous physical activity. In a clinical trial of 217 pediatric patients (12 to 17 years) with severe recalcitrant nodular acne, transient elevations in CPK were observed in 12% of patients, including those undergoing strenuous physical activity in association with reported musculoskeletal adverse events such as back pain, arthralgia, limb injury, or muscle sprain. In these patients, approximately half of the CPK elevations returned to normal within 2 weeks and half returned to normal within 4 weeks. No cases of rhabdomyolysis were reported in this trial.

REFERENCES

7. Dicken CH, Connolly SM. Eruptive xanthomas associated with Neotrex (13-cis-retinoic acid). Arch Dermatol 116:951-952, 1980.

Neotrex side effects

See also:
What are the possible side effects of Neotrex?

The following adverse reactions with Neotrex or other Neotrex products are described in more detail in other sections of the labeling:

• Embryofetal Toxicity
• Psychiatric Disorders
• Pseudotumor Cerebri
• Serious Skin Reactions
• Pancreatitis
• Lipid Abnormalities
• Hearing Impairment
• Hepatotoxicity
• Inflammatory Bowel Disease
• Skeletal Abnormalities
• Ocular Abnormalities
• Hypersensitivity

Clinical Trials Experience

Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of Neotrex cannot be directly compared to rates in clinical trials of other drugs and may not reflect the rates observed in practice.

The adverse reactions listed below reflect both clinical experience with Neotrex, and consider other adverse reactions that are known from clinical trials and the post-marketing surveillance with oral Neotrex. The relationship of some of these events to Neotrex therapy is unknown. Many of the side effects and adverse events seen in patients receiving Neotrex are similar to those described in patients taking very high doses of vitamin A (dryness of the skin and mucous membranes, e.g., of the lips, nasal passage, and eyes).

Dose Relationship

Cheilitis and hypertriglyceridemia are adverse reactions that are usually dose related. Most adverse reactions reported in clinical trials with Neotrex were reversible when therapy was discontinued; however, some persisted after cessation of therapy.

Body as a Whole

The following adverse reactions have been reported in a clinical trial conducted with Neotrex and a generic product of Neotrex® (Neotrex): fatigue, irritability, pain. In addition to the above adverse reactions, the following adverse reactions have been reported with Neotrex: allergic reactions, including vasculitis, systemic hypersensitivity, edema, lymphadenopathy, weight loss.

Cardiovascular

The following adverse reactions have been reported with Neotrex: vascular thrombotic disease, stroke, palpitation, tachycardia.

Endocrine/Metabolism and Nutritional

The following adverse reactions have been reported in a clinical trial conducted with Neotrex and a generic product of Neotrex® (Neotrex): decreased appetite, weight fluctuation, hyperlipidaemia. In addition to the above adverse reactions, the following adverse reactions have been reported with Neotrex: hypertriglyceridemia, alterations in blood sugar.

Gastrointestinal

The following adverse reactions have been reported in a clinical trial conducted with Neotrex and a generic product of Neotrex® (Neotrex): lip dry, chapped lips, cheilitis, nausea, constipation, diarrhea, abdominal pain, vomiting. In addition to the above adverse reactions, the following adverse reactions have been reported with Neotrex: inflammatory bowel disease, hepatitis, pancreatitis, bleeding and inflammation of the gums, colitis, esophagitis/esophageal ulceration, ileitis, and other nonspecific gastrointestinal symptoms.

Hematologic

The following adverse reactions have been reported with Neotrex: allergic reactions, anemia, thrombocytopenia, neutropenia, rare reports of agranulocytosis.

Infections and infestations

The following adverse reactions have been reported in a clinical trial conducted with Neotrex and a generic product of Neotrex® (Neotrex): nasopharyngitis, hordeolum, upper respiratory tract infection. In addition to the above adverse reactions, the following adverse reaction has been reported with Neotrex: infections (including disseminated herpes simplex).

Laboratory Abnormalities

The following changes in laboratory tests have been noted in a clinical trial conducted with Neotrex and a generic product of Neotrex® (Neotrex): blood creatine phosphokinase (CPK) increased, blood triglycerides increased, alanine aminotransferase (SGPT) increased, aspartate aminotransferase (SGOT) increased, gamma-glutamyltransferase (GGTP) increased, blood cholesterol increased, low density lipoprotein (LDL) increased, white blood cell count decreased, blood alkaline phosphatase increased, blood bilirubin increased, blood glucose increased, high density lipopoprotein (HDL) decreased, bone mineral density decreased. In addition to the above adverse reactions, the following adverse reactions have been reported with Neotrex: increased LDH, elevation of fasting blood sugar, hyperuricemia, decreases in red blood cell parameters, decreases in white blood cell counts (including severe neutropenia and rare reports of agranulocytosis), elevated sedimentation rates, elevated platelet counts, thrombocytopenia, white cells in the urine, proteinuria, microscopic or gross hematuria.

Musculoskeletal and Connective Tissue

The following adverse reactions have been reported in a clinical trial conducted with Neotrex and a generic product of Neotrex® (Neotrex): decreases in bone mineral density, musculoskeletal symptoms (sometimes severe) including back pain, athralgia, musculoskeletal discomfort, musculoskeletal pain, neck pain, pain in extremity, myalgia, musculoskeletal stiffness. In addition to the above adverse reactions, the following adverse reactions have been reported with Neotrex: skeletal hyperostosis, calcification of tendons and ligaments, premature epiphyseal closure, tendonitis, arthritis, transient pain in the chest, and rare reports of rhabdomyolysis.

Neurological

The following adverse reactions have been reported in a clinical trial conducted with Neotrex and a generic product of Neotrex® (Neotrex): headache, syncope. In addition to the above adverse reactions, other adverse reactions reported with Neotrex include: pseudotumor cerebri, dizziness, drowsiness, lethargy, malaise, nervousness, paresthesias, seizures, stroke, weakness.

Psychiatric

The following adverse reactions have been reported in clinical trials conducted with Neotrex and a generic product of Neotrex® (Neotrex): suicidal ideation, insomnia, anxiety, depression, irritability, panic attack, anger, euphoria, violent behaviors, emotional instability. In addition to the above adverse reactions, the following adverse reactions have been reported with Neotrex: suicide attempts, suicide, aggression, psychosis and hallucination auditory. Of the patients reporting depression, some reported that the depression subsided with discontinuation of therapy and recurred with reinstitution of therapy.

Reproductive System

The following adverse reaction has been reported with Neotrex: abnormal menses.

Respiratory

The following adverse reactions have been reported in a clinical trial conducted with Neotrex and a generic product of Neotrex® (Neotrex): epistaxis, nasal dryness. In addition to the above adverse reactions, the following adverse reactions have been reported with Neotrex: bronchospasms (with or without a history of asthma), respiratory infection, voice alteration.

Skin and Subcutaneous Tissue

The following adverse reactions have been reported in a clinical trial conducted with Neotrex and a generic product of Neotrex® (Neotrex): dry skin, dermatitis, eczema, rash, dermatitis contact, alopecia, pruritus, sunburn, erythema. In addition to the above adverse reactions, the following adverse reactions have been reported with Neotrex: acne fulminans, alopecia (which in some cases persists), bruising, dry nose, eruptive xanthomas, erythema multiforme, flushing, fragility of skin, hair abnormalities, hirsutism, hyperpigmentation and hypopigmentation, nail dystrophy, paronychia, peeling of palms and soles, photoallergic/photosensitizing reactions, pruritus, pyogenic granuloma, rash (including facial erythema, seborrhea, and eczema), Stevens-Johnson syndrome, sunburn susceptibility increased, sweating, toxic epidermal necrolysis, urticaria, vasculitis (including Wegener's granulomatosis), abnormal wound healing (delayed healing or exuberant granulation tissue with crusting).

Special Senses

Hearing: The following adverse reactions have been reported with Neotrex: tinnitus and hearing impairment.

Ocular: The following adverse reactions have been reported in clinical trials conducted with Neotrex and a generic product of Neotrex® (Neotrex): dry eye, visual acuity reduced, vision blurred, eye pruritis, eye irritation, asthenopia, decreased night vision, ocular hyperemia, increased lacrimation, and conjunctivitis. In addition to the above adverse reactions, the following adverse reactions have been reported with Neotrex: corneal opacities, decreased night vision which may persist, cataracts, color vision disorder, conjunctivitis, eyelid inflammation, keratitis, optic neuritis, photobia, visual disturbances.

Renal and Urinary

The following adverse reactions have been reported in clinical trials conducted with Neotrex: glomerulonephritis, nonspecific urogenital findings.

Neotrex contraindications

See also:
What is the most important information I should know about Neotrex?

Hypersensitivity to Neotrex. Hepatic or renal insufficiency. Hypervitaminosis A. Patients with excessively elevated blood lipid values.

Blood donation by patients during and within 1 month of Neotrex treatment to women of childbearing potential should be avoided.

Use in pregnancy & lactation: Neotrex is highly teratogenic. It is therefore contraindicated in women who are pregnant or who may become pregnant while undergoing treatment. There is an extremely high risk that a deformed infant will result if pregnancy occurs while taking Neotrex un any amount even for short periods. Potentially all exposed fetuses can be affected. Major human fetal abonormalities related to Neotrex administration have documented, including hydrocephalus, microcephalus, abnormalities of the external ear (micropinna, small or absent external auditory canals), microphthalmia, cardiovascular abnormalities and cerebellar malformation.

As Neotrex is highly lipophilic, the passage of the drug in human milk is very likely. Because of the potential for adverse effects, the used of Neotrex should be avoided by nursing mothers.

It is recommended that the patient use 2 forms of effective contraception to prevent pregnancy, during treatment and for 1 month after discontinuation of treatment. Testing serve to reming the patient of the importance of avoiding pregnancy. If pregnancy occurs, patient should be counseled on whether to continue the pregnancy. Neotrex therapy starts only on the second day or third day of the next normal period.

Active ingredient matches for Neotrex:

Isotretinoin in Mexico.

References

1. DailyMed. "ISOTRETINOIN: DailyMed provides trustworthy information about marketed drugs in the United States. DailyMed is the official provider of FDA label information (package inserts).". https://dailymed.nlm.nih.gov/dailyme... (accessed September 17, 2018).
2. PubChem. "Isotretinoin". https://pubchem.ncbi.nlm.nih.gov/com... (accessed September 17, 2018).
3. DrugBank. "Isotretinoin". http://www.drugbank.ca/drugs/DB00982 (accessed September 17, 2018).

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Information checked by Dr. Sachin Kumar, MD Pharmacology