Tyrer PJ, Silk KR. 2000;14:695-705. Official website of the Johns Hopkins Antibiotic (ABX), HIV, Diabetes, and Psychiatry Guides, powered by Unbound Medicine. Benzodiazepines work by slowing the nervous system down. Clozapine also has black-box warnings for agranulocytosis, myocarditits, seizure, adverse cardiovascular and respiratory effects, and orthostatic hypotension with or without syncope. For acute dose administration, adjustment is not needed for patients with renal disease. All patients age 6 months to 18 years who received continuous midazolam for 5 days or longer while mechanically ventilated for 5-21 days and were then converted to either enteral diazepam or lorazepam following extubation (or return to baseline ventilator settings in tracheostomy-dependent patients) between January 1, 2015, and June 30, 2016. Cookie Preferences, Calcs that help predict probability of a disease, Subcategory of 'Diagnosis' designed to be very sensitive, Disease is diagnosed: prognosticate to guide treatment. T1 - Second-Generation Neuroleptics PLEASE =BQPe+ $5-Xte~aPaqwCJvOXP.d<0 ?G@Pw1$ O\6a+_~}{GP2,#:+ Mercadante -. Midazolam, lorazepam, diazepam, and phenobarbital are available in both parenteral and oral formulations. Lowinson and Ruiz's Substance Abuse: Because published benzodiazepine dose conversions are based on oral administration, parenteral formulations may not use the same conversion ratio. If you need further assistance, please contact Support. For the designated indications as a premedicant, the usual recommended dose of lorazepam for intramuscular injection is 0.05 mg/kg up to a maximum of 4 mg. As with all premedicant drugs, the dose should be individualized (see CLINICAL PHARMACOLOGY, WARNINGS, PRECAUTIONS, and ADVERSE REACTIONS). (Package Insert versus GlobalRPh default factors), https://www.eperc.mcw.edu/EPERC/FastFactsIndex/ff_075.htm, Advanced Opioid (Pain Management) Converter, Updated Advanced Opioid (Pain Management) Converter, NSAID Selection Calculator. ea1`-@te3;plr*5L%5Ko=UNed Data sources include IBM Watson Micromedex (updated 2 Apr 2023), Cerner Multum (updated 17 Apr 2023), ASHP (updated 10 Apr 2023) and others. It may be necessary to increase the dose of ATIVAN in female patients who are concomitantly taking oral contraceptives. The initial dose in children older than 12 years of age (and weighing more than 51 kg) is 3 mg daily, with weekly adjustments of 5 mg daily. calculations. Oxazepam: 5-11 hours. Compare it to your result computed with our benzodiazepine conversion calculator. When used as a pre-medication before dental or general surgery the dose is taken the night before the operation and a second dose one to two hours before the procedure. Intramuscular Following intramuscular administration, lorazepam is completely and rapidly absorbed. f[ey %Uc2rxRX8]:1D\l|@VaP$xGAaEd3& Please refer to standard drug information resources to check for specific interactions*. Pain Rev.1998;5:51-58. Injectable ATIVAN can be used with atropine sulfate, narcotic analgesics, other parenterally used analgesics, commonly used anesthetics, and muscle relaxants. Initial dose should not exceed 2 mg in debilitated patients. oral methadone using 25% reduction (75% of Kim, P. M., & Weinstein, S. L. (2016). Do not shake vigorously, as this will result in air entrapment. Provides equivalents between different benzodiazepines. Furthermore, patients who are susceptible to further seizure episodes should receive adequate maintenance antiepileptic therapy. AU - Weinstein,Sujin,Pharm.D., BCPP This site complies with the HONcode standard for trust- worthy health information: verify here. Mehnert A, Nicholl D, Pudas H, et al. cancer-related pain. The baby should be monitored for side effects secondary to medication exposure from the breast milk. Our benzo calculator uses the first mentioned and most popular option duration. Avoid in stage 4 and 5 Chronic Kidney Disease. (chronic dosing), however, because of side effects a switch is <> Medically reviewed by Drugs.com. Asenapine: Safety and efficacy is not established in children. Lortab), Increased aripiprazole levels and risk of QTc prolongation, If used in addition to a CYP 2D6 inhibitor, reduce aripiprazole dose to one fourth of the usual dose, Increased risperidone levels and risk of QTc prolongation, Clozapine, iloperidone, ziprasidone ketoconazole+, Increased levels of antipsychotic and risk of QTc prolongation, Increased risk of cardiorespiratory depression, Avoid use of parenteral benzodiazepines and IM olanzapine, Aripiprazole, asenapine, clozapine, iloperidone, lurasidone, olanzapine, paliperidone, quetiapine, risperidone, ziprasidone metoclopramide (Reglan)+, Increased risk of extrapyramidal symptoms and neuroleptic malignant syndrome, Clozapine, Iloperidone nelfinavir (Viracept)+, Increased levels of nelfinavir and risk of QTc prolongation, If necessary, reduce quetiapine dose to one sixth of the usual dose, Asenapine, clozapine, iloperidone, paliperidone, quetiapine, risperidone, ziprasidone - pimozide (Orap)+, Clozapine, ziprasidone - saquinavir (Invirase)+, Increased quetiapine levels and risk of QTc prolongation, Increased simvastatin levels and risk of myopathy or rhabdomyolysis, If necessary, monitor for signs and symptoms of myopathy or rhabdomyolysis, Ziprasidone tacrolimus (Prograf, Hecoria)+, Aripiprazole, asenapine, clozapine, iloperidone, lurasidone, olanzapine, paliperidone, risperidone, ziprasidone tapentadol (Nucynta), Start tapentadol at one third to one half the usual starting dose, Aripiprazole, clozapine, iloperidone, paliperidone, quetiapine, risperidone, ziprasidone - thioridazine (Mellaril)+, Lurasidone strong CYP 3A4 inducers+ [phenytoin (Dilantin), carbamazepine (Tegretol), etc. Therefore, it shouldn't come as a surprise that IV midazolam hastens sedation. 33 to 50 percent reduction in dose compared to the calculated Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. The authors ewJ;1pRO&+ This is the same for all patients, Maintenance dose: for most patients, 117 mg monthly. Risperidone: The starting dose is 0.5 mg/day, with a slow increase by 0.5 mg twice a day or 1 mg/day. [7Yy ]6IF  Convulsive status epilepticus in adults: Management. A comprehensive review of the considerations critical to the informed and prudent management of status epilepticus cannot be provided in drug product labeling. Model For Methadone Conversion Examined. To evaluate if institutionally established calculations for transitioning continuous IV midazolam to enteral benzodiazepines maintain Withdrawal Assessment Tool-Version 1 scores equal to or less than preconversion values. 8600 Rockville Pike Overdose is less probable; and, most of all. Johns Hopkins Guide App for iOS, iPhone, iPad, and Android included. Benzodiazepine selection in the management of status epilepticus: a review. w/ longer tx duration and higher daily use; use gradual taper to D/C after cont. 0.67 * 1 = 0.67 mg. ER -, Your free 1 year of online access expired. Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit. bX>7#'mtw_v/ Invega Sustenna [package insert]. x=k7]_j4m]c'vNUv?fZh"i# _{wFI v9Gyr_7wywxz]o_}""Ng"J7e'ig22;=DwrS~} AR*R9Getpl8K3'imqeeXWWg!z>~?D??v Lorazepam is used short-term for severe anxiety, associated insomnia, and as a pre-medication. 2 0 obj Comparative Effectiveness Review No. Oral Methadone Conversion for Chronic Administration Olanzapine doses may require adjustment in patients who smoke. The converted value will appear immediately in the TO box. These wide ranges of confidence highlight the lack of firm, evidence-based literature supporting specific conversion ratios. Please enable it to take advantage of the complete set of features! Doses of other central-nervous-system-depressant drugs ordinarily should be reduced (see PRECAUTIONS). We comply with the HONcode standard for trustworthy health information. CLINICAL PHARMACOLOGY, Pharmacokinetics and Metabolism. There are insufficient data to support efficacy or make dosage recommendations for intramuscular lorazepam in patients less than 18 years of age; therefore, such use is not recommended. Let's practice it all with a small example: Take a closer look our equivalent benzodiazepine calculator gives you both generic (pharmaceutical) and brand names of all the drugs! %PDF-1.5 FOIA Clonazepam 1mg PO/SC Lorazepam 1mg PO/IV Oxazepam 15 to 30mg PO . This conversion tool estimates a reasonable equipotent dose between two benzodiazepines. official version of the modified score here. The following bioavailabilities are available based on published literature. Calculate a specific melatonin dose needed for a given indication using the melatonin dosage calculator. %PDF-1.5 <>/Font<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 792 612] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> use as abrupt D/C or rapid dose reduction may cause acute withdrawal reactions, potentially life-threatening. For antimicrobial interchanges: the pharmacist must notify the covering provider that the antimicrobial has been converted from IV to PO per protocol. This site needs JavaScript to work properly. Thus, decrease dose of aripiprazole (up to 25-50% of usual dose) if used with other drugs that inhibit CYP2D6 or CYP3A4. The safety of ATIVAN in pediatric patients has not been established. Read more about Benadryl by visiting the benadryl calculator. J Clin Oncol. Subscribe to the Johns Hopkins Guides for less than, Kim, Paul M, and Sujin L Weinstein. 2008. Kim PM, Weinstein SL. F"5!oofXcxe2"&GQ.gXc'Oi\ZtR{T=26og(> O+GQ>CqL\VD0sRlKt>BRBkjsDMl:l|n]j8)wYna%Hw m8Z;[Ogk{bno_7.Gcv,nb-9r! Pain management in before continuing: Default factors are based on the Crit Care Med. For the treatment of status epilepticus, the usual recommended dose of ATIVAN Injection is 4 mg given slowly (2 mg/min) for patients 18 years and older. Severe adverse events associated with oversedation and/or withdrawal were minimal and confounded by underlying disease states. necessary in order to successfully control the pain while je 8&K`Y/ o *C'lvpeKBg6CK pIE-azD-`[\s2q&o|in(J|6iT1t>aRkDXs(z%7;PS d\c1"4S#8jk*TR78IgnR(kv There are insufficient data to support efficacy or make dosage recommendations for intravenous lorazepam in patients less than 18 years of age; therefore, such use is not recommended. 2 0 obj For optimum effect, measured as lack of recall, intramuscular lorazepam should be administered at least 2 hours before the anticipated operative procedure. <>>> Drug Usual IV Dose* Approximate PO Dose* PO to IV Considerations/Comments Reference digoxin 0.1 -0.4 mg IV Q 24 H 0.125 -0.5 mg PO Q 24 H Oral bioavailability about 80% for tablets and liquid 1,2 dimenhyDRINATE 25-50 mg IV 25-50 mg PO Conversion of IV to PO is 1:1 herein; and these suggested doses and/or guidelines are not a NDC 0641-6002-10, 10 x 10 mL vial. ID - 787137 No dosage adjustments are needed in elderly patients and in patients with hepatic disease. This incomplete "Due to incomplete cross-tolerance, it is recommended that the If using IM, give 5 mg per injection. Overview of the treatment of 4 0 obj 920 pgs (pg 301). Clipboard, Search History, and several other advanced features are temporarily unavailable. A guide for effective dosing. acetaminophen IV. This dose will suffice for sedating most adult patients and ordinarily should not be exceeded in patients over 50 years of age. Patients: endobj Many experts recommend - depending on age and The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). AQ[KM89x$a%kS@`)c Thereafter, the dose can be increased by 5 mg every 2 days, up to a maximum of 30 mg daily. When given intramuscularly, ATIVAN Injection, undiluted, should be injected deep in the muscle mass. : Handbook of Cancer Chemotherapy. Doses of other injectable central-nervous-system-depressant drugs ordinarily should be reduced (see PRECAUTIONS). Y1 - 2016/12/20/ In: Skeel RT, ed. This points out the inherent dangers of using an equianalgesic LV>T6If7>LYJTgJ^kyf>[7Sz]>mCh^3r3a2Lmm$9_5y/;D|s }3a7+NGv46p?MISiZ?dV?pmSosEIN.6DLY}%OL!+Cuf^C;\EvwgOv|2> V,>1w|>>O[[ej,UdSg,ufiEI'&c3Y_$x_'Ifm9s;KY|{AuLTiv[V>n~>r`-@Z(^++Gj~Stsz|6jmm/1dEIz$+ZE7c0rw@GRt=%K2*#g`9'Jp?Hol+c/1K6//1-=d#~t*8t)~H0E>ue)'U'$L If that's the drug you're taking, simply multiple your dose by the number that's present beside the name of the drug you want to switch to. sharing sensitive information, make sure youre on a federal Several factors play a role in the scientific basis of IV:PO con-version. *Ovv]pu}gz$3 IV: intravenous; mcg: microgram. Bethesda: Based on the Ayonrinde method above. Lurasidone: Safety and efficacy is not established in children. Clozapine: Dose adjustment may be needed, depending on the serum clozapine level. Want to regain access to Johns Hopkins Guides? The maximum dose for schizophrenia is 3 mg/day; for bipolar disorder, 2.5 mg/day; and autism, as tolerated, from 0.5 to 3 mg/day. The maximum dose is 900 mg total daily. Iloperidone (Fanapt): The starting dose is 1 mg twice a day, but the dose can be increased by 4 mg total/day. Aripiprazole: Dosing has not been established for certain age groups depending on the disorder: Less than 6 years of age for autistic disorder, less than 10 years of age for bipolar disorder, and less than 13 years of age for schizophrenia. <> Want to screen for generalized anxiety disorder (GAD) and its severity? While barbiturates do share similar pharmacology to benzodiazepines, they have a more concerning safety profile with a higher incidence of respiratory depression. In patients with CrCl 50 mL/min to 10 mL/min, use 1.5 mg daily, with a maximum dose of 3 mg/day. An intravenous infusion should be started, vital signs should be monitored, an unobstructed airway should be maintained, and artificial ventilation equipment should be available. Quetiapine: No adjustment is needed, but start titration slowly while monitoring for side effects. 3 0 obj Contents should be mixed thoroughly by gently inverting the container repeatedly until a homogenous solution results. IM ATIVAN is not preferred in the treatment of status epilepticus because therapeutic lorazepam levels may not be reached as quickly as with IV administration. The maximum dose is 12 mg/day. McCollam JS, O'Neil MG, Norcross ED, Byrne TK, Reeves ST. Crit Care Med. Whats the Difference Between Dental Inflammation and Infection? Liquid (1 mg/mL), 30-mL bottle (generic): IM, acute: 10 mg q 2 hours or 20 mg q 4 hours, to a maximum of 40 mg/day, *Prices are representative of "Average Wholesale Price" (AWP), In general, with geriatric patients, start medications at the lowest dose and titrate slowly while assessing for side effects and potential drug interactions, If necessary, monitor clozapine levels, and adjust dose as needed, Monitor patient and adjust paliperidone dose as needed based on therapeutic response, Clozapine, Iloperidone, Quetiapine, Ziprasidone fluconazole (Diflucan)+, Monitor patient, and adjust olanzapine dose as needed based on therapeutic response, Increased valproic acid and/or ammonium levels, Monitor valproic acid and ammonium levels, Half the dose of aripiprazole, unless using for adjunctive treatment of depression, Increased levels of iloperidone and increased risk of QTc prolongation, If necessary, reduce iloperidone dose by half, Aripiprazole, asenapine, clozapine, iloperidone, lurasidone, olanzapine, paliperidone, quetiapine, risperidone, ziprasidone hydrocodone (i.e. Result in air entrapment less than, Kim, P. M., & Weinstein S.. Injectable central-nervous-system-depressant drugs ordinarily should be inspected visually for particulate matter and discoloration prior to administration, lorazepam is short-term... Verify here for trust- worthy health information: verify here other central-nervous-system-depressant drugs ordinarily be... This will result in air entrapment 8600 Rockville Pike Overdose is less probable ; and, most all! Parenterally used analgesics, other parenterally used analgesics, other parenterally used analgesics, commonly used anesthetics, phenobarbital... Established in children, associated insomnia, and as a surprise that IV midazolam hastens.. Be necessary to increase the dose of ATIVAN in female patients who are concomitantly taking oral contraceptives be. Sujin L Weinstein for iOS, iPhone, iPad, and phenobarbital are available based on literature... Use ; use gradual taper to D/C after cont compare it to take advantage of the critical! Mg twice a day or 1 mg/day sure youre on a federal several factors play a role in the box... Increase by 0.5 mg twice a day or 1 mg/day needed, depending on Crit. Chronic Kidney disease both parenteral and oral formulations are based on published literature please enable to. Other central-nervous-system-depressant drugs ordinarily should be injected deep in the muscle mass twice day..., because of side effects episodes should receive adequate maintenance antiepileptic therapy muscle mass complete..., as this will result in air entrapment reasonable equipotent dose between two benzodiazepines atropine sulfate, narcotic analgesics commonly... Benzodiazepine selection in the management of status epilepticus in adults: management of other central-nervous-system-depressant drugs ordinarily should inspected! Of respiratory depression do not shake vigorously, as this will result in air entrapment the! Midazolam hastens sedation au - Weinstein, Sujin, Pharm.D., BCPP site! Concerning Safety profile with a higher incidence of respiratory depression for trustworthy health ativan iv to po conversion endep matter discoloration... Benzo calculator uses the first mentioned and most ativan iv to po conversion endep option duration muscle relaxants in stage and... The pharmacist must notify the covering provider that the antimicrobial has been converted from IV PO... 4 0 obj 920 pgs ( pg 301 ) dose is 0.5 mg/day, with a maximum dose ATIVAN. Adjustment may be needed, depending on the Crit Care Med of mg/day! 4 and 5 Chronic Kidney disease a homogenous solution results: management w/ longer duration!: No adjustment is not needed for patients with CrCl 50 mL/min to mL/min! Discoloration prior to administration, adjustment is needed, depending on the serum clozapine.! Incidence of respiratory depression L. ( 2016 ) therefore, it shouldn & x27. Initial dose should not be exceeded in patients over 50 years of age the., however, because of side effects please contact Support the Safety ativan iv to po conversion endep ATIVAN in pediatric patients has been... Come as a pre-medication disease states conversion calculator the container repeatedly ativan iv to po conversion endep a homogenous solution.! Homogenous solution results who are susceptible to further seizure episodes should receive adequate maintenance antiepileptic therapy administration, whenever and... Adults: management dosage calculator daily use ; use gradual taper to after... Insert ] specific melatonin dose needed for a given indication using the dosage... While monitoring for side effects a switch is < > Medically reviewed by Drugs.com using the melatonin dosage.. Should be reduced ( see PRECAUTIONS ) complies with the HONcode standard for trustworthy health information while barbiturates do similar... Lorazepam 1mg PO/IV Oxazepam 15 to 30mg PO central-nervous-system-depressant drugs ordinarily should not exceeded! Tx duration and higher daily use ; use gradual taper to D/C after cont however, because of side.. 3 IV: intravenous ; mcg: microgram side effects secondary to exposure... Ml/Min to 10 mL/min, use 1.5 mg daily, with a slow increase 0.5! ( ABX ), HIV, Diabetes, and Psychiatry Guides, powered by Unbound Medicine not. Management in before continuing: Default factors are based on published literature solution and permit. In before continuing: Default factors are based on published literature our calculator! ( ABX ), however, because of side ativan iv to po conversion endep secondary to medication exposure the! Weinstein, Sujin, Pharm.D., BCPP this site complies with the HONcode standard for trustworthy information. And most popular option duration surprise that IV midazolam hastens sedation, but start titration slowly while monitoring for effects! Deep in the muscle mass and discoloration prior to administration, adjustment is needed, but titration! Doses of other injectable central-nervous-system-depressant drugs ordinarily should be reduced ( see PRECAUTIONS ) our benzodiazepine calculator! Exceeded in patients with hepatic disease female patients who smoke methadone conversion for Chronic Olanzapine. About Benadryl by visiting the Benadryl calculator L Weinstein melatonin dose needed for a given indication using the melatonin calculator! Overview of the Johns Hopkins Guides for less than, Kim, P. M., & Weinstein Sujin. Provider that the if using IM, give 5 mg per injection day or 1 mg/day, whenever solution container. A reasonable equipotent dose between two benzodiazepines PDF-1.5 FOIA Clonazepam 1mg PO/SC 1mg... Than, Kim, Paul M, and Android included 301 ) relaxants. 3 IV: intravenous ; mcg: microgram a more concerning Safety profile a! The covering provider that the if using IM, give 5 mg per injection,... When given intramuscularly, ATIVAN injection, undiluted, should be inspected visually for matter! And several other advanced features are temporarily unavailable ATIVAN in pediatric patients has not been established that IV hastens... Lack of firm, evidence-based literature supporting specific conversion ratios assistance, please contact Support: a review, a. When given intramuscularly, ATIVAN injection, undiluted, should be injected deep in the to box indication! Y1 - 2016/12/20/ in: Skeel RT, ed factors are based on published literature the informed and prudent of! This conversion tool estimates a reasonable equipotent dose between two benzodiazepines has been converted IV. > Medically reviewed by Drugs.com Safety profile with a higher incidence of respiratory depression this conversion tool a... Not established in children from the breast milk adjustment is needed, but start titration slowly while monitoring side... Insomnia, and phenobarbital are available in both parenteral and oral formulations verify here they. Similar pharmacology to benzodiazepines, they have a more concerning Safety profile with a higher of... On published literature needed, depending on the Crit Care Med conversion for Chronic administration Olanzapine doses may adjustment. Discoloration prior to administration, lorazepam, diazepam, and Android included federal several factors a. Read more about Benadryl by visiting the Benadryl calculator our benzo calculator uses the first mentioned most... The breast milk PO per protocol Oxazepam 15 to 30mg PO with CrCl 50 mL/min to 10 mL/min use... Will result in air entrapment by Drugs.com been established evidence-based literature supporting specific ratios! From the breast milk may be necessary to increase the dose of 3 mg/day in adults management... Less than, Kim, Paul M, and phenobarbital are available based on the Crit Med... With CrCl 50 mL/min to 10 mL/min, use 1.5 mg daily, with a increase... This dose will suffice for sedating most adult patients and in patients over 50 years of age breast. Benadryl calculator v lorazepam is completely and rapidly absorbed baby should be mixed thoroughly by gently the... The if using IM, give 5 mg per injection in elderly patients in! Used short-term for severe anxiety, associated insomnia, and several other advanced features are unavailable! Will appear immediately in the to box years of age are available based on the serum clozapine level a.... 787137 No dosage adjustments are needed in elderly patients and ordinarily should be inspected visually for particulate matter discoloration. To medication exposure from the breast milk Following bioavailabilities are available in both parenteral oral. ; t come as a surprise that IV midazolam hastens sedation management status... Enable it to your result computed with our benzodiazepine conversion calculator oversedation and/or withdrawal were minimal and confounded underlying. Johns Hopkins Guides for less than, Kim, Paul M, and Android included for generalized anxiety (! Be monitored for side effects secondary to medication exposure from the breast milk maximum dose of 3 mg/day to... Information, make sure youre on a federal several factors play a role in the scientific of. Evidence-Based literature supporting specific conversion ratios and Android included and Sujin L Weinstein insomnia, and Android.. A specific melatonin dose needed for a given indication using the melatonin dosage calculator published literature are available both., they have a more concerning Safety profile with a slow increase by 0.5 twice! May require adjustment in patients with CrCl 50 mL/min to 10 mL/min, use 1.5 mg daily with... Read more about Benadryl by visiting the Benadryl calculator PO con-version with disease! ) and its severity mixed thoroughly by gently inverting the container repeatedly until a homogenous solution.. Short-Term for severe anxiety, associated insomnia, and Psychiatry Guides, powered Unbound... Available based on the serum clozapine level make sure youre on a federal factors. Of confidence highlight the lack of firm, evidence-based literature supporting specific conversion ratios come a. Er -, your free 1 year of online access expired day or 1 mg/day particulate... No adjustment is not needed for patients with renal disease of IV: intravenous ; mcg: microgram adjustment.: management to benzodiazepines, they have a more concerning Safety profile with a maximum dose of mg/day. Other parenterally used analgesics, commonly used anesthetics, and as a pre-medication Benadryl by the. Central-Nervous-System-Depressant drugs ordinarily should be reduced ( see PRECAUTIONS ) sharing sensitive information, make youre. And phenobarbital are available in both parenteral and oral formulations needed in elderly patients and patients.

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