Topdip AT Uses

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What is Topdip AT?

Topdip AT is used alone or together with other medicines (such as hydrochlorothiazide) to treat high blood pressure (hypertension). High blood pressure adds to the workload of the heart and arteries. If it continues for a long time, the heart and arteries may not function properly. This can damage the blood vessels of the brain, heart, and kidneys, resulting in a stroke, heart failure, or kidney failure. High blood pressure may also increase the risk of heart attacks. These problems may be less likely to occur if blood pressure is controlled.

Topdip AT is also used to help prevent chest pain and to decrease the severity of heart attacks.

Topdip AT is a beta-blocker. It works by affecting the response to nerve impulses in certain parts of the body, like the heart. As a result, the heart beats slower and decreases the blood pressure. When the blood pressure is lowered, the amount of blood and oxygen is increased to the heart.

Topdip AT is available only with your doctor's prescription.

Topdip AT indications

An indication is a term used for the list of condition or symptom or illness for which the medicine is prescribed or used by the patient. For example, acetaminophen or paracetamol is used for fever by the patient, or the doctor prescribes it for a headache or body pains. Now fever, headache and body pains are the indications of paracetamol. A patient should be aware of the indications of medications used for common conditions because they can be taken over the counter in the pharmacy meaning without prescription by the Physician.
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Hypertension

Topdip AT is indicated for the treatment of hypertension, to lower blood pressure. Lowering blood pressure lowers the risk of fatal and non-fatal cardiovascular events, primarily strokes and myocardial infarctions. These benefits have been seen in controlled trials of antihypertensive drugs from a wide variety of pharmacologic classes including Topdip AT.

Control of high blood pressure should be part of comprehensive cardiovascular risk management, including, as appropriate, lipid control, diabetes management, antithrombotic therapy, smoking cessation, exercise, and limited sodium intake. Many patients will require more than 1 drug to achieve blood pressure goals. For specific advice on goals and management, see published guidelines, such as those of the National High Blood Pressure Education Program's Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC).

Numerous antihypertensive drugs, from a variety of pharmacologic classes and with different mechanisms of action, have been shown in randomized controlled trials to reduce cardiovascular morbidity and mortality, and it can be concluded that it is blood pressure reduction, and not some other pharmacologic property of the drugs, that is largely responsible for those benefits. The largest and most consistent ardiovascular outcome benefit has been a reduction in the risk of stroke, but reductions in myocardial infarction and cardiovascular mortality also have been seen regularly.

Elevated systolic or diastolic pressure causes increased cardiovascular risk, and the absolute risk increase per mmHg is greater at higher blood pressures, so that even modest reductions of severe hypertension can provide substantial benefit. Relative risk reduction from blood pressure reduction is similar across populations with varying absolute risk, so the absolute benefit is greater in patients who are at higher risk independent of their hypertension (for example, patients with diabetes or hyperlipidemia), and such patients would be expected to benefit from more aggressive treatment to a lower blood pressure goal.

Some antihypertensive drugs have smaller blood pressure effects (as monotherapy) in black patients, and many antihypertensive drugs have additional approved indications and effects (eg, on angina, heart failure, or diabetic kidney disease). These considerations may guide selection of therapy.

Topdip AT may be administered with other antihypertensive agents.

Angina Pectoris Due To Coronary Atherosclerosis

Topdip AT is indicated for the long-term management of patients with angina pectoris.

Acute Myocardial Infarction

Topdip AT is indicated in the management of hemodynamically stable patients with definite or suspected acute myocardial infarction to reduce cardiovascular mortality. Treatment can be initiated as soon as the patient's clinical condition allows. In general, there is no basis for treating patients like those who were excluded from the ISIS-1 trial (blood pressure less than 100 mm Hg systolic, heart rate less than 50 bpm) or have other reasons to avoid beta blockade. As noted above, some subgroups (eg, elderly patients with systolic blood pressure below 120 mm Hg) seemed less likely to benefit.

How should I use Topdip AT?

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

Ask your health care provider any questions you may have about how to use Topdip AT tablets.

Uses of Topdip AT in details

There are specific as well as general uses of a drug or medicine. A medicine can be used to prevent a disease, treat a disease over a period or cure a disease. It can also be used to treat the particular symptom of the disease. The drug use depends on the form the patient takes it. It may be more useful in injection form or sometimes in tablet form. The drug can be used for a single troubling symptom or a life-threatening condition. While some medications can be stopped after few days, some drugs need to be continued for prolonged period to get the benefit from it.
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Use: Labeled Indications

Acute MI: Management of hemodynamically stable patients with definite or suspected acute MI to reduce cardiovascular mortality.

Guideline recommendations: According to the American College of Cardiology Foundation/American Heart Association (ACC/AHA) guidelines for the management of ST-elevation myocardial infarction (STEMI) and the ACC/AHA guidelines for the management of non-ST-elevation ACS (NSTE-ACS), oral beta-blockers should be initiated within the first 24 hours unless the patient has signs of heart failure, evidence of a low-output state, an increased risk for cardiogenic shock, or other contraindications. However, recommendations do not specify any particular beta-blocking agent for optimal treatment of NSTE-ACS. Thus, clinicians must use practical experience to determine proper therapy in managing patients (ACC/AHA [Amsterdam 2014]; ACC/AHA [O'Gara 2013]).

Angina pectoris caused by coronary atherosclerosis: Long-term management of patients with angina pectoris.

Hypertension: Management of hypertension. Note: Beta-blockers are not recommended as first-line therapy (ACC/AHA [Whelton 2017]).

Off Label Uses

Atrial fibrillation (rate control)

Based on the 2014 American Heart Association/American College of Cardiology/Heart Rhythm Society (AHA/ACC/HRS) guideline for the management of patients with atrial fibrillation (AF), the use of beta-blockers, including Topdip AT, for ventricular rate control in patients with paroxysmal, persistent, or permanent AF is effective and recommended for this condition.

Supraventricular tachycardia (AV nodal reentrant tachycardia [AVNRT], AV reentrant tachycardia [AVRT], atrial flutter, focal atrial tachycardia [AT])

Based on the American College of Cardiology/American Heart Association/Heart Rhythm Society guidelines for the management of patients with supraventricular arrhythmias, the use of an oral beta-blocker, including Topdip AT, is an effective and recommended treatment option for the ongoing management of a variety of symptomatic supraventricular tachycardias (AVNRT, AVRT, focal AT) without pre-excitation in patients who are not candidates for, or prefer not to undergo catheter ablation.

Oral beta-blockers, including Topdip AT, may also be useful for the ongoing management (acute rate control) in hemodynamically stable patients with atrial flutter.

Thyrotoxicosis

Based on the 2016 American Thyroid Association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis, beta-blockers, including Topdip AT, are effective and recommended in the treatment of symptomatic thyrotoxicosis. Beta-blockers should also be considered in asymptomatic patients who are at increased risk of complications due to worsening hyperthyroidism.

Based on the American Heart Association/American College of Cardiology/Heart Rhythm Society (AHA/ACC/HRS) guideline for management of patients with ventricular arrhythmias and prevention of sudden cardiac death, beta-blockers are effective for control of ventricular arrhythmias and ventricular premature beats.

Topdip AT description

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Tablets containing 25 mg, 50 mg or 100 mg Topdip AT Ph. Eur.

Injection for intravenous use presented as an isotonic, citrate buffered, aqueous solution, containing 5 mg of Topdip AT Ph. Eur. in 10 ml.

Excipients/Inactive Ingredients: Tablets: Gelatin, glycerol, magnesium carbonate, magnesium stearate, maize starch, hypromellose, sodium lauryl sulphate, titanium hydroxide.

100 mg Tablets Only: Macrogol 300, sunset yellow lake.

Injection: Citric acid, sodium chloride, sodium hydroxide, water for injection.

Topdip AT dosage

Topdip AT Dosage

Generic name: Topdip AT

Dosage form: Injection

See also:

The information at Drugs.com is not a substitute for medical advice. Always consult your doctor or pharmacist.

Acute Myocardial Infarction

In patients with definite or suspected acute myocardial infarction, treatment with Topdip AT I.V. Injection should be initiated as soon as possible after the patient's arrival in the hospital and after eligibility is established. Such treatment should be initiated in a coronary care or similar unit immediately after the patient's hemodynamic condition has stabilized. Treatment should begin with the intravenous administration of 5 mg Topdip AT over 5 minutes followed by another 5 mg intravenous injection 10 minutes later. Topdip AT I.V. Injection should be administered under carefully controlled conditions including monitoring of blood pressure, heart rate, and electrocardiogram. Dilutions of Topdip AT I.V. Injection in Dextrose Injection USP, Sodium Chloride Injection USP, or Sodium Chloride and Dextrose Injection may be used. These admixtures are stable for 48 hours if they are not used immediately.

In patients who tolerate the full intravenous dose (10 mg), Topdip AT Tablets 50 mg should be initiated 10 minutes after the last intravenous dose followed by another 50 mg oral dose 12 hours later. Thereafter, Topdip AT can be given orally either 100 mg once daily or 50 mg twice a day for a further 6-9 days or until discharge from the hospital. If bradycardia or hypotension requiring treatment or any other untoward effects occur, Topdip AT should be discontinued.

Data from other beta blocker trials suggest that if there is any question concerning the use of IV beta blocker or clinical estimate that there is a contraindication, the IV beta blocker may be eliminated and patients fulfilling the safety criteria may be given Topdip AT Tablets 50 mg twice daily or 100 mg once a day for at least seven days (if the IV dosing is excluded).

Although the demonstration of efficacy of Topdip AT is based entirely on data from the first seven postinfarction days, data from other beta blocker trials suggest that treatment with beta blockers that are effective in the postinfarction setting may be continued for one to three years if there are no contraindications.

Topdip AT is an additional treatment to standard coronary care unit therapy.

Elderly Patients or Patients with Renal Impairment

Since Topdip AT is excreted via the kidneys, dosage should be adjusted in cases of severe impairment of renal function. No significant accumulation of Topdip AT occurs until creatinine clearance falls below 35 mL/min/1.73m2 (normal range is 100-150 mL/min/1.73m2); therefore, the following maximum oral dosages are recommended for patients with renal impairment.

Creatinine Clearance

(mL/min/1.73m2)

Topdip AT

Elimination Half-life

(h)

Maximum Dosage

15-35

16-27

50 mg daily

<15

>27

50 mg every other day

In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy. Evaluation of patients with hypertension or myocardial infarction should always include assessment of renal function. Topdip AT excretion would be expected to decrease with advancing age.

Patients on hemodialysis should be given 50 mg after each dialysis; this should be done under hospital supervision as marked falls in blood pressure can occur.

Cessation of Therapy

If withdrawal of Topdip AT therapy is planned, it should be achieved gradually over a period of about two weeks. Patients should be carefully observed and advised to limit physical activity to a minimum.

Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit.

More about Topdip AT (Topdip AT)

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Topdip AT interactions

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What other drugs will affect Topdip AT?

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Catecholamine-depleting drugs (eg, reserpine) may have an additive effect when given with beta-blocking agents. Patients treated with Topdip AT plus a catecholamine depletory should therefore be closely observed for evidence of hypotension and/or marked bradycardia which may produce vertigo, syncope, or postural hypotension.

Calcium channel blockers may also have an additive effect when given with Topdip AT.

Disopyramide is a Type I antiarrhythmic drug with potent negative inotropic and chronotropic effects. Disopyramide has been associated with severe bradycardia, asystole and heart failure when administered with beta blockers.

Amiodarone is an antiarrhythmic agent with negative chronotropic properties that may be additive to those seen with beta blockers.

Beta blockers may exacerbate the rebound hypertension which can follow the withdrawal of clonidine. If the two drugs are coadministered, the beta blocker should be withdrawn several days before the gradual withdrawal of clonidine. If replacing clonidine by beta-blocker therapy, the introduction of beta blockers should be delayed for several days after clonidine administration has stopped.

Concomitant use of prostaglandin synthase inhibiting drugs, eg, indomethacin, may decrease the hypotensive effects of beta blockers.

Information on concurrent usage of Topdip AT and aspirin is limited. Data from several studies, ie, TIMI-II, ISIS-2, currently do not suggest any clinical interaction between aspirin and beta blockers in the acute myocardial infarction setting.

While taking beta blockers, patients with a history of anaphylactic reaction to a variety of allergens may have a more severe reaction on repeated challenge, either accidental, diagnostic or therapeutic. Such patients may be unresponsive to the usual doses of epinephrine used to treat the allergic reaction.

Both digitalis glycosides and beta-blockers slow atrioventricular conduction and decrease heart rate. Concomitant use can increase the risk of bradycardia.

Topdip AT side effects

See also:
What are the possible side effects of Topdip AT?

Most adverse effects have been mild and transient.

The frequency estimates in the following table were derived from controlled studies in hypertensive patients in which adverse reactions were either volunteered by the patient (US studies) or elicited, eg, by checklist (foreign studies). The reported frequency of elicited adverse effects was higher for both Topdip AT and placebo-treated patients than when these reactions were volunteered. Where frequency of adverse effects of Topdip AT and placebo is similar, causal relationship to Topdip AT is uncertain.

Volunteered

(US Studies)

Total - Volunteered and Elicited (Foreign+US Studies)
Topdip AT

(n=164) %

Placebo

(n=206) %

Topdip AT

(n=399) %

Placebo

(n=407) %

CARDIOVASCULAR
Bradycardia 3 0 3 0
Cold Extremities 0 0.5 12 5
Postural Hypotension 2 1 4 5
Leg Pain 0 0.5 3 1
CENTRAL NERVOUS SYSTEM/ NEUROMUSCULAR
Dizziness 4 1 13 6
Vertigo 2 0.5 2 0.2
Light-headedness 1 0 3 0.7
Tiredness 0.6 0.5 26 13
Fatigue Lethargy 3 1 1 0 6 3 5 0.7
Drowsiness 0.6 0 2 0.5
Depression 0.6 0.5 12 9
Dreaming 0 0 3 1
GASTROINTESTINAL
Diarrhea 2 0 3 2
Nausea 4 1 3 1
RESPIRATORY
Wheeziness 0 0 3 3
Dyspnea 0.6 1 6 4

Acute Myocardial Infarction

In a series of investigations in the treatment of acute myocardial infarction, bradycardia and hypotension occurred more commonly, as expected for any beta blocker, in atenololtreated patients than in control patients. However, these usually responded to atropine and/or to withholding further dosage of Topdip AT. The incidence of heart failure was not increased by Topdip AT. Inotropic agents were infrequently used. The reported frequency of these and other events occurring during these investigations is given in the following table. In a study of 477 patients, the following adverse events were reported during either intravenous and/or oral Topdip AT administration:

Conventional Therapy Plus Topdip AT

(n=244)

Conventional Therapy Alone

(n=233)

Bradycardia 43 (18%) 24 (10%)
Hypotension 60 (25%) 34 (15%)
Bronchospasm 3 (1.2%) 2 (0.9%)
Heart Failure 46 (19%) 56 (24%)
Heart Block 11 (4.5%) 10 (4.3%)
BBB + Major
Axis Deviation 16 (6.6%) 28 (12%)
Supraventricular Tachycardia 28 (11.5%) 45 (19%)
Atrial Fibrillation 12 (5%) 29 (11%)
Atrial Flutter 4 (1.6%) 7 (3%)
Ventricular Tachycardia 39 (16%) 52 (22%)
Cardiac Reinfarction 0 (0%) 6 (2.6%)
Total Cardiac Arrests 4 (1.6%) 16 (6.9%)
Nonfatal Cardiac Arrests 4 (1.6%) 12 (5.1%)
Deaths 7 (2.9%) 16 (6.9%)
Cardiogenic Shock 1 (0.4%) 4 (1.7%)
Development of Ventricular
Septal Defect 0 (0%) 2 (0.9%)
Development of Mitral
Regurgitation 0 (0%) 2 (0.9%)
Renal Failure 1 (0.4%) 0 (0%)
Pulmonary Emboli 3 (1.2%) 0 (0%)

In the subsequent International Study of Infarct Survival (ISIS-1) including over 16,000 patients of whom 8,037 were randomized to receive Topdip AT treatment, the dosage of intravenous and subsequent oral Topdip AT was either discontinued or reduced for the following reasons:

Reasons for Reduced Dosage
IV Topdip AT Reduced Dose ( < 5 mg)*

Oral Partial Dose

Hypotension/Bradycardia 105 (1.3%) 1168 (14.5%)
Cardiogenic Shock 4 (.04%) 35 (.44%)
Reinfarction 0 (0%) 5 (.06%)
Cardiac Arrest 5 (.06%) 28 (.34%)
Heart Block ( > first degree) 5 (.06%) 143 (1.7%)
Cardiac Failure 1 (.01%) 233 (2.9%)
Arrhythmias 3 (.04%) 22 (.27%)
Bronchospasm 1 (.01%) 50 (.62%)
*Full dosage was 10 mg and some patients received less than 10 mg but more than 5 mg.

During postmarketing experience with Topdip AT, the following have been reported in temporal relationship to the use of the drug: elevated liver enzymes and/or bilirubin, hallucinations, headache, impotence, Peyronie's disease, postural hypotension which may be associated with syncope, psoriasiform rash or exacerbation of psoriasis, psychoses, purpura, reversible alopecia, thrombocytopenia, visual disturbance, sick sinus syndrome, and dry mouth. Topdip AT, like other beta blockers, has been associated with the development of antinuclear antibodies (ANA), lupus syndrome, and Raynaud's phenomenon.

Potential Adverse Effects

In addition, a variety of adverse effects have been reported with other beta-adrenergic blocking agents, and may be considered potential adverse effects of Topdip AT.

Hematologic: Agranulocytosis.

Allergic: Fever, combined with aching and sore throat, laryngospasm, and respiratory distress.

Central Nervous System: Reversible mental depression progressing to catatonia; an acute reversible syndrome characterized by disorientation of time and place; short-term memory loss; emotional lability with slightly clouded sensorium; and, decreased performance on neuropsychometrics.

Gastrointestinal: Mesenteric arterial thrombosis, ischemic colitis.

Other: Erythematous rash.

Miscellaneous: There have been reports of skin rashes and/or dry eyes associated with the use of beta-adrenergic blocking drugs. The reported incidence is small, and in most cases, the symptoms have cleared when treatment was withdrawn. Discontinuance of the drug should be considered if any such reaction is not otherwise explicable. Patients should be closely monitored following cessation of therapy.

The oculomucocutaneous syndrome associated with the beta blocker practolol has not been reported with Topdip AT. Furthermore, a number of patients who had previously demonstrated established practolol reactions were transferred to Topdip AT therapy with subsequent resolution or quiescence of the reaction.

Topdip AT contraindications

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What is the most important information I should know about Topdip AT?

Do not stop taking Topdip AT without first talking to your doctor. Stopping suddenly may make your condition worse.

If you need to have any type of surgery, you may need to temporarily stop using Topdip AT. Be sure the surgeon knows ahead of time that you are using Topdip AT.

Topdip AT can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.

Avoid drinking alcohol, which could increase drowsiness and dizziness while you are taking Topdip AT.

Topdip AT is only part of a complete program of treatment for hypertension that may also include diet, exercise, and weight control. Follow your diet, medication, and exercise routines very closely if you are being treated for hypertension.

If you are being treated for high blood pressure, keep using this medication even if you feel fine. High blood pressure often has no symptoms. You may need to use blood pressure medication for the rest of your life.

Store Topdip AT at room temperature away from moisture and heat.



Active ingredient matches for Topdip AT:

Atenolol

Amlodipine


Unit description / dosage (Manufacturer)Price, USD
Topdip AT 5+50 Tablet$ 0.05
TOPDIP AT TABLET 1 strip / 10 tablets each (RPG Life Sciences Ltd)$ 0.73
Topdip AT Tablet (RPG Life Sciences Ltd)$ 0.09

List of Topdip AT substitutes (brand and generic names):

TOPDIP-AT tab 10's (RPG LS)$ 0.55
Totamol 120 mg/5 mL x 60 mL (Wockhardt)
Totamol 250 mg/5 mL x 60 mL (Wockhardt)
Totamol 50 mg FC tab 28's (Wockhardt)
Totamol oral susp 120 mg/5 mL 60 mL x 1's (Wockhardt)
Totamol oral susp 250 mg/5 mL 60 mL x 1's (Wockhardt)
Tozaar AT 50+50 Tablet (Torrent Pharmaceuticals Ltd.)$ 0.11
TOZAAR AT 50 MG/50 MG TABLET 1 strip / 10 tablets each (Torrent Pharmaceuticals Ltd.)$ 1.46
Tozaar AT 50 mg/50 mg Tablet (Torrent Pharmaceuticals Ltd.)$ 0.16
Tozaar ATH 50+50+12.5 Tablet (Torrent Labs (P) Ltd.)$ 0.11
Tozaar-ATH Losartan potassium , Atenolol, Hydrochlorothiazide. TAB / 10 (Torrent)$ 0.92
10's (Torrent)$ 0.92
Tozaar-ATH Losartan K, Atenolol, Hydrochlorothiazide TAB / 10 (Torrent)$ 0.92
TOZAAR-ATH tab 10's (Torrent)$ 0.92
Trantalol 100 mg x 100's (Pinewood)
Trantalol 100 mg x 250's (Pinewood)
Trantalol 100 mg x 500's (Pinewood)
Trantalol 100 mg x 1000's (Pinewood)
Trantalol 200 mg x 100's (Pinewood)
Trantalol 200 mg x 250's (Pinewood)
Trantalol 200 mg x 500's (Pinewood)
Trantalol 200 mg x 1000's (Pinewood)
Trantalol 100 mg x 1's (Pinewood)
Tablets; Oral; Atenolol 100 mg (Pinewood)
Tablets; Oral; Atenolol 200 mg (Pinewood)
Trazloc Trio 80+5 Tablet (USV Limited.)$ 0.21
Tablet; Oral; Atenolol 100 mg (Collins)
Tablet; Oral; Atenolol 25 mg (Collins)
Tablet; Oral; Atenolol 50 mg (Collins)
Tablets; Oral; Atenolol 100 mg (Collins)
Tablets; Oral; Atenolol 25 mg (Collins)
Tablets; Oral; Atenolol 50 mg (Collins)
Tredol 25 mg x 20's (Aegis)
Tredol 25 mg x 1, 000's (Aegis)
Tredol 50 mg x 20's (Aegis)
Tredol 50 mg x 100's (Aegis)
Tredol 50 mg x 1, 000's (Aegis)

References

  1. DailyMed. "ATENOLOL; CHLORTHALIDONE: 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. "atenolol". https://pubchem.ncbi.nlm.nih.gov/com... (accessed September 17, 2018).
  3. PubChem. "amlodipine". https://pubchem.ncbi.nlm.nih.gov/com... (accessed September 17, 2018).

Reviews

The results of a survey conducted on ndrugs.com for Topdip AT are given in detail below. The results of the survey conducted are based on the impressions and views of the website users and consumers taking Topdip AT. We implore you to kindly base your medical condition or therapeutic choices on the result or test conducted by a physician or licensed medical practitioners.

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1 consumer reported age

Users%
16-291
100.0%


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Information checked by Dr. Sachin Kumar, MD Pharmacology

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