The time for recovery in the Operation Theatre (OT) differed only by 23 min (Group M 6.25 4.54 min vs. Group P 3.97 2.51 min, P = 0.011). Sedation/Anxiolysis/Amnesia (preoperative/procedural): IM: 2 to 3 mg (or 0.02 to 0.05 mg/kg) 30 to 60 minutes prior to surgery/procedure; some may only require 1 mg if anticipated intensity and duration of sedation is less critical. Similar findings were reported by Bulach et al. Maximum dose: 10 mg (2 sprays) per single episode. Oral midazolam fulfills many of these characteristics. Use caution when reducing dose or withdrawing therapy; decrease slowly and monitor for withdrawal symptoms. Similarly in Brosius study, with a fixed dose of 20 mg oral midazolam, the median time to discharge readiness was 10 min in placebo versus 11 min in the midazolam group.[8]. Consider therapy modification, Macrolide Antibiotics: May increase the serum concentration of Midazolam. Use during upper airway procedures (ie, endoscopy, dental care) may increase risk of hypoventilation. WebMidazolam may be given for a seizure lasting longer than 5 minutes, or as directed by drainage of oral contents (e.g. Do not use in shock, coma, or acute alcohol intoxication with depression of vital signs. IM, IV: Plasma half-life was ~2-fold higher; mean Vd increased consistently between 15% to 100%, and mean clearance decreased ~25%; Intranasal (nasal spray): AUC and Cmax increased 21% to 45%. Last updated on Feb 27, 2023. Monitor therapy, Protease Inhibitors: May increase the serum concentration of Midazolam. Intranasal: Hypersensitivity to midazolam or any component of the formulation; acute narrow-angle glaucoma. A second dose should not be administered if the patient is having trouble breathing or excessive sedation. Medical College, Jodhpur, Rajasthan, India, 1Department of Anaesthesia and Palliative Care Medicine, Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur, Rajasthan, India, Anxiety in response to impending surgery is a common emotional phenomenon, but it also leads to perioperative physiological and psychological changes. Manufacturer's labeling: Dosing in the prescribing information may not reflect current clinical practice. Mother-daughter actors Laura Dern and Diane Ladd share all in Midazolam | Drugs | BNF | NICE Obesity: Mean half-life is prolonged (5.9 hours) and Vd increased ~50%. Management: Minimize doses of CYP3A4 substrates, and monitor for increased concentrations/toxicity, during and 2 weeks following treatment with mifepristone. midazolam - oral syrup, Versed - MedicineNet Consider therapy modification, Palbociclib: May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Avoid use with other CNS depressants at bedtime; avoid use with alcohol. Versed Side Effects Avoid combination, Itraconazole: May increase the serum concentration of Midazolam. Avoid combination, Theophylline Derivatives: May diminish the therapeutic effect of Benzodiazepines. Documentation of allergenic cross-reactivity for benzodiazepines is limited. Initiate buprenorphine at lower doses in patients already receiving CNS depressants. Monitor therapy, Tofisopam: May increase the serum concentration of Midazolam. Avoid combination, OxyCODONE: CNS Depressants may enhance the CNS depressant effect of OxyCODONE. Breast Applies to midazolam: injection solution. No such dose change is recommended for women. IM: Rapid, complete; Intranasal (nasal spray): Rapid; Oral, Intranasal (solution, injection): Rapid (Lee-Kim 2004). Department of Anaesthesia, Dr. S.N. Patients receive brachytherapy in the OT and are shifted to the post-anaesthesia care unit and then to the day care ward. Midazolam is used for sedation before surgery and other medical procedures in children and adults, as well as treatment for status epilepticus (long-lasting seizures) in adults. It comes as an injection and oral syrup. The medication is typically given by a healthcare provider in a monitored setting and can't be used at home. He use of intramuscular midazolam in an acute psychiatric unit. Midazolam sedative (Versed): Uses, Side Effects, FAQ Note: This document contains side effect information about midazolam. Midazolam should be used only in hospital or ambulatory care settings, including physicians' and dentists' offices, that can provide for continuous monitoring of respiratory and cardiac function (ie, pulse oximetry). Precautions Dialysis Other Comments Usual Adult Dose for Light Sedation Patients younger than 60 years: IM: 0.07 to 0.08 mg/kg IM once, up to 1 hour before Note: Use of midazolam in this setting should be done in close consult with or by an experienced palliative care provider. Inclusion in an NLM database does not imply endorsement of, or agreement with, Midazolam (Versed) - Side Effects, Interactions, Uses, Dosage, Duration of action after a single dose is determined by redistribution rather than metabolism. Ng B, Malesu RR. Symptom onset within five days Not requiring hospitalization due to severe or critical COVID-19 at treatment initiation No known or suspected severe renal impairment No known or suspected severe hepatic impairment No history of clinically significant hypersensitivity reactions to the active ingredients or other components of the product Methotrimeprazine may enhance the CNS depressant effect of CNS Depressants. On completion of the procedure, recovery from anaesthesia was assessed using modified Aldrete's recovery score. IM: Administer undiluted deep IM into large muscle. hair testing: up Management: Avoid concomitant use of opioid agonists and benzodiazepines or other CNS depressants when possible. Note: Use 5 mg/mL injectable solution to deliver dose (Bailey 2017; Rech 2017). Human clinical data suggest that single, relatively short exposures are not likely to have similar negative effects. Monitor therapy, Siltuximab: May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Consider therapy modification, Minocycline (Systemic): May enhance the CNS depressant effect of CNS Depressants. Benzodiazepine receptors and effects appear to be linked to the GABA-A receptors. Monitor therapy, Thalidomide: CNS Depressants may enhance the CNS depressant effect of Thalidomide. Cardiovascular disease: Use with caution in patients with heart failure. Due to its short half-life, palliative care experts consider the use of midazolam as a subcutaneous or intravenous continuous infusion as first-line therapy for respite sedation (ie, transient use to relieve severe symptoms [eg, pain, agitation] not necessarily refractory) Protus 2015. the contents by NLM or the National Institutes of Health. Estrogen Test. Monitor therapy, Propofol: Midazolam may increase the serum concentration of Propofol. Progesterone Test. Consider therapy modification, Magnesium Sulfate: May enhance the CNS depressant effect of CNS Depressants. Consider therapy modification, Methotrimeprazine: CNS Depressants may enhance the CNS depressant effect of Methotrimeprazine. If combined, limit the dosages and duration of each drug. With regard to anxiolysis, all patients (35/35) in midazolam group exhibited satisfactory anxiolytic response (anxiolysis score 3); 17.1% (6/35) were calm and 82.9% (29/35) reached the maximum level of anxiolysis (asleep). [1] The major goal of pre-medication is to allay anxiety. Avoid alcoholic beverages. Data from a double-blind, randomized, noninferiority trial comparing the use of intramuscular midazolam to intravenous lorazepam supports the use of intramuscular midazolam for the treatment of status epilepticus Silbergleit 2012. Medically Reviewed by Annamarie Coy, Monitor therapy, Paraldehyde: CNS Depressants may enhance the CNS depressant effect of Paraldehyde. Specifically, sleepiness and dizziness may be enhanced. Monitor therapy, Sodium Oxybate: Benzodiazepines may enhance the CNS depressant effect of Sodium Oxybate. Avoid combination, Opioid Agonists: CNS Depressants may enhance the CNS depressant effect of Opioid Agonists. Monitor therapy, Cannabis: May enhance the CNS depressant effect of CNS Depressants. in adult patients and by Kain et al. In some cases, where this was not recognized promptly and treated effectively, death or hypoxic encephalopathy has resulted. WebWithdrawal symptoms may sometimes last weeks to months. Avoid combination, Perampanel: May enhance the CNS depressant effect of CNS Depressants. sharing sensitive information, make sure youre on a federal IM: 10 mg once (AES [Glauser 2016]) or 0.2 mg/kg once (maximum dose: 10 mg) (NCS [Brophy 2012]). Monitor therapy, Bromopride: May enhance the CNS depressant effect of CNS Depressants. (per os) may be on the prescription. Monitor therapy, Chlormethiazole: May enhance the CNS depressant effect of CNS Depressants. Sedation/anxiolysis/amnesia (preoperative/procedural): IM: Preoperative sedation, anxiolysis, and amnesia. Additional data may be necessary to further define the role of midazolam in this setting. National Library of Medicine Midazolam Oral: Uses, Side Effects, Interactions, Pictures Intranasal (nasal spray): Refer to adult dosing; use with caution due to potential prolonged drug exposure. No specific anesthetic/sedative has been found to be safer. Australian and New Zealand Journal of Psychiatry 2003; 37: 111-112. Consider therapy modification, Lumacaftor and Ivacaftor: May decrease the serum concentration of Midazolam. Avoid combination, Oxomemazine: May enhance the CNS depressant effect of CNS Depressants. Suicidal ideation: Intranasal: Pooled analysis of trials involving various antiepileptics (regardless of indication) showed an increased risk of suicidal thoughts/behavior (incidence rate: 0.43% treated patients compared to 0.24% of patients receiving placebo); risk observed as early as one week after initiation and continued through duration of trials (most trials 24 weeks). Due to pregnancy-induced physiologic changes, some pharmacokinetic properties of midazolam may be altered (Hebert 2008; Wilson 1987). FAQ Summary Commonly reported side effects of midazolam include: apnea and bradypnea. Maintenance: 0.05 mg/kg as needed (Miller 2010), or continuous infusion 0.015 to 0.06 mg/kg/hour (0.25 to 1 mcg/kg/minute) (Barash 2009; Miller 2010). Based on pilot study conducted by us, the sample size was calculated keeping the desired power of study at 80%, error - 0.05 and error - 0.02. Use of 0.2 mg/kg administered over 5 to 10 seconds has been shown to safely produce anesthesia within 30 seconds (Samuelson 1981) and is recommended for ASA physical status P1 and P2 patients. Management: Oral midazolam contraindicated with all protease inhibitors. Signs of a significant reaction like wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat. Monitor therapy, Sarilumab: May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Benzodiazepines do not bind to GABA-B receptors (Brunton 2011). Infants 1 to 5 months: Limited data available in nonintubated infants; infants <6 months are at higher risk for airway obstruction and hypoventilation; titrate dose with small increments to desired clinical effect; monitor carefully. Management: Dosage adjustments of lemborexant and of concomitant CNS depressants may be necessary when administered together because of potentially additive CNS depressant effects. Neurocritical Care Society Guidelines for the Evaluation and Management of Status Epilepticus, American Epilepsy Society Guidelines for the Treatment of Convulsive Status Epilepticus in Children and Adults. Pediatric: Pediatric patients with cardiac or respiratory compromise may be sensitive to the respiratory depressant effect of midazolam. International studies used a 10 mg/mL commercially available buccal formulation (Ashrafi 2010). The maximum recommended dose volume (of the 5 mg/mL concentration) per nare is 1 mL (Bailey 2017). CNS depression: May cause CNS depression, which may impair physical or mental abilities; patients must be cautioned about performing tasks that require mental alertness (eg, operating machinery, driving). For induction of anesthesia, administer IV bolus over 5 to 15 seconds (Miller 2010). IV: Initial: 0.5 to 2 mg administered over at least 2 minutes (smaller doses may be used in the elderly); slowly titrate to effect by repeating doses every 2 to 3 minutes if needed; usual total dose: 2.5 to 5 mg (ASGE [Waring 2003]). Heart failure: Following oral administration (7.5mg), half-life increased 43%. [8], Tschirch et al. Severe hypotension and seizures have been reported following rapid IV administration, particularly with concomitant use of fentanyl. Monitor therapy, Brimonidine (Topical): May enhance the CNS depressant effect of CNS Depressants. Drug-drug interactions: Potentially significant interactions may exist, requiring dose or frequency adjustment, additional monitoring, and/or selection of alternative therapy. Note: Midazolam IM is the preferred treatment in patients without IV access. A final concentration of midazolam 0.5 mg/mL is stable for up to 24 hours when diluted with D5W or NS or 4 hours when diluted with LR. As per hospital policy, patients are discharged after oral intake and voiding of urine after 46 h. Oral midazolam (at a dose of 0.25 mg/kg) showed sedative, anxiolytic and anterograde amnestic effects with no adverse effects on haemodynamic stability or recovery in adults undergoing outpatient procedures under general anaesthesia. Prolonged in cirrhosis, congestive heart failure, obesity, renal failure, and elderly. Preterm infants (n=24; GA: 26 to 34 weeks; PNA: 3 to 11 days): IV: Median: 6.3 hours (range: 2.6 to 17.7 hours) (de Wildt 2001), Neonates: 4 to 12 hours; seriously ill neonates: 6.5 to 12 hours, Children: IV: 2.9 to 4.5 hours; Syrup: 2.2 to 6.8 hours, Adults: 3 hours (range: 1.8 to 6.4 hours); IM: 4.2 1.87 hours; Intranasal (nasal spray): 2.1 to 6.2 hours, ~97%, primarily albumin; in patients with cirrhosis, protein binding is reduced with a free fraction of ~5% (Trouvin 1988). Concomitant use of benzodiazepines and opioids may result in profound sedation, respiratory depression, coma, and death. Respiratory disease: Use with caution in patients with respiratory disease (eg, chronic obstructive pulmonary disease); these patients may be sensitive to the respiratory depressant effects of midazolam. Monitor therapy, Kava Kava: May enhance the adverse/toxic effect of CNS Depressants. Other side effects of this drug: Talk with your doctor right away if you have any of these signs of: Note: This is not a comprehensive list of all side effects. Premedicated patients: Reduce dose by at least 20% (Miller 2010). Precautions Products and services Proper Use Drug information provided by: Merative, Micromedex Take this medicine only as directed by your doctor. Hamid M, Khan MA, Khatri A, Akhtar I. WebMany people using this medication do not have serious side effects.Tell the doctor immediately if any of these unlikely but serious side effects occur: rapid/slow/shallow Oral medicines can be pills, liquids, or patches. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered. Rectal: Clinical trials utilized parenteral midazolam for rectal administration; administer a 1 to 5 mg/mL solution through a small, lubricated catheter or tube inserted rectally; hold buttocks closed for ~5 minutes after administration (Kanegaye 2003; Tanaka 2000). The initial intravenous dose for sedation in adult patients may be as little as 1 mg, but should not exceed 2.5 mg in a healthy adult. Palliative sedation (off-label use): Note: Use of midazolam in this setting should be done in close consult with or by an experienced palliative care provider. This shift in chloride ions results in hyperpolarization (a less excitable state) and stabilization. Smaller volume will reduce irritation and swallowing of administered dose. Management: Clinicians should generally avoid concurrent use of methadone and benzodiazepines when possible; any combined use should be undertaken with extra caution. Midazolam Consider therapy modification, Tocilizumab: May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Consider therapy modification, Dabrafenib: May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. Midazolam should not be administered by rapid injection in the neonatal population. Consider therapy modification, Erdafitinib: May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). For deeply sedated pediatric patients, a dedicated individual, other than the practitioner performing the procedure, should monitor the patient throughout the procedure. Excipient information presented when available (limited, particularly for generics); consult specific product labeling. Monitor therapy, Brexanolone: CNS Depressants may enhance the CNS depressant effect of Brexanolone. Monitor therapy, Flunitrazepam: CNS Depressants may enhance the CNS depressant effect of Flunitrazepam. Avoid combination, CYP3A4 Inducers (Moderate): May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Withdrawal: Withdrawal symptoms (convulsions, hallucinations, tremor, abdominal and muscle cramps, vomiting and sweating) may occur following abrupt discontinuation or large decreases in dose. Consider therapy modification. Monitor therapy, Simeprevir: May increase the serum concentration of Midazolam. Consider a trial of daily awakening; if agitated after discontinuation of drip, then restart at 50% of the previous dose (Kress 2000). Monitor therapy, Clofazimine: May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Patients were randomised into two groups; Group M (n = 35) received oral midazolam 0.25 mg/kg and Group P (n = 35) received placebo. and transmitted securely. Avoid combination, Stiripentol: May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). The initial dose and all subsequent doses should always be titrated slowly; administer over at least 2 minutes and allow an additional 2 or more minutes to fully evaluate the sedative effect. Adverse hemodynamic events have been reported in pediatric patients with cardiovascular instability; avoid rapid IV administration in these patients. Although use in obstetric procedures is not recommended by the manufacturer, midazolam use in obstetric anesthesia has been described (Frlich 2006; Heyman 1987; Kanto 1984; Neuman 2013; Senel 2014; Shergill 2012). Midazolam is well absorbed after it is given into the nose. This material is provided for educational purposes only and is not intended for medical advice, diagnosis, or treatment. HHS Vulnerability Disclosure, Help This information is not specific medical advice and does not replace information you receive from the healthcare provider. For elective procedures, risk versus benefits should be evaluated and discussed with parents/caregivers/patients; critical surgeries should not be delayed (US FDA Safety Communication 2017 Update). Drug Test Detection Times: How Long Do Ativan tablets have a peak effect about 2 to 3 hours after taking a dose, while Xanax peaks within 1 to 2 hours after a dose. The use of the 1 mg/mL formulation or dilution of the 1 mg/mL or 5 mg/mL formulation is recommended to facilitate slower injection. Monitor therapy, Bromperidol: May enhance the CNS depressant effect of CNS Depressants. The .gov means its official. The initial pediatric dose of midazolam for sedation/anxiolysis/amnesia is age, procedure, and route dependent. Management: Avoid concomitant use of hydrocodone and benzodiazepines or other CNS depressants when possible. Both the intravenous (IV) and subcutaneous routes manifest onset of action within minutes. 15 Following IV administration, midazolam has a distribution half-life of 615min. Midazolam has an elimination half-life of 1.53h. Premedicated patients: Usual dosage range: 0.05 to 0.2 mg/kg (Barash 2009; Miller 2010). These agents should only be combined if alternative treatment options are inadequate. Intranasal (solution, injection): Limited data available: 0.2 mg/kg (NCS [Brophy 2012]). Consider therapy modification, CYP3A4 Inhibitors (Moderate): May decrease the metabolism of CYP3A4 Substrates (High risk with Inhibitors). This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. There was no difference in the time of discharge readiness in both groups. Everything You Need to Know If Youre Prescribed Paxlovid Source: Wolters Kluwer Health. Depression like thoughts of suicide, anxiety, emotional instability, or confusion. If concomitant therapy cannot be avoided, monitor clinical effects of the substrate closely (particularly therapeutic effects). Neurocritical Care Society recommendations: Loading dose: 0.2 mg/kg followed by a continuous infusion (NCS [Brophy 2012]). Nasal spray (Nayzilam): Children 12 years and Adolescents: 5 mg administered as one spray into one nostril; may repeat dose in 10 minutes in alternate nostril based on response and tolerability; do not repeat dose if patient has difficulty breathing or excessive sedation; maximum dose: 10 mg/dose per episode (2 sprays); do not exceed maximum treatment frequency of one episode every 3 days and 5 episodes per month. Children and Adolescents 10 years: 10 mg. IM: Limited data available: Infants, Children, and Adolescents: 0.2 mg/kg/dose; repeat every 10 to 15 minutes; maximum dose: 6 mg/dose (Hegenbarth 2008). This is only a brief summary of general information about this medicine. Monitor therapy, Doxylamine: May enhance the CNS depressant effect of CNS Depressants. Oral. A total dose >5 mg is generally not needed. Olanzapine prescribing information provides no specific recommendations regarding oral administration. Use of oral midazolam is not recommended in the elderly. Federal government websites often end in .gov or .mil. Avoid combination, Blonanserin: CNS Depressants may enhance the CNS depressant effect of Blonanserin. Evaluate benefits and potential risks of fetal exposure to midazolam when duration of surgery is expected to be >3 hours (Olutoye 2018). Avoid combination, Aprepitant: May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Midazolam can also cause severe dizziness or drowsiness for up to 24 The half-life in adults is between 2 to 6 hours. Oral Midazolam Second, street readiness was not compared in both groups. This could lead to high doses in obese adults, therefore, overweight/obese patients were excluded from the study. For other clinical situations (eg, sedation in the mechanically-ventilated patient), a continuous infusion may also be administered. Pediatric neurotoxicity: In pediatric and neonatal patients <3 years of age and patients in third trimester of pregnancy (ie, times of rapid brain growth and synaptogenesis), the repeated or lengthy exposure to sedatives or anesthetics during surgery/procedures may have detrimental effects on child or fetal brain development and may contribute to various cognitive and behavioral problems. Applies to the following strengths: 0.1 mg/mL Usual Adult Dose for: Reversal of Sedation Benzodiazepine Overdose Usual Pediatric Dose for: Reversal of Sedation Additional dosage information: Renal Dose Adjustments Liver Dose Adjustments Dose Adjustments Precautions Dialysis Other Comments Limitations of our study include; first, the dose of 0.25 mg/kg body weight was fixed based on paediatric data. Management: The manufacturer of Diclegis (doxylamine/pyridoxine), intended for use in pregnancy, specifically states that use with other CNS depressants is not recommended. Monitor therapy, Rotigotine: CNS Depressants may enhance the sedative effect of Rotigotine. In patients with cirrhosis, following oral administration, Cmax and bioavailability were 43% and 100% higher, and following IV administration clearance was reduced 50%, half-life increased 2.5-fold, and Vd increased by 20%. Midazolam Injection: MedlinePlus Drug Information Neonatal withdrawal symptoms may occur within days to weeks after birth and "floppy infant syndrome" (which also includes withdrawal symptoms) have been reported with some benzodiazepines (Bergman 1992; Iqbal 2002; Wikner 2007). However, Ativan may last slightly longer than Xanax. Standard treatment: Infants, Children, and Adolescents: Limited data available: Weight-based dosing: 0.2 mg/kg once; maximum dose: 10 mg/dose (NCS [Brophy 2012]). As reported in adults unless otherwise noted. Parenteral: Do not administer intraarterially. The nasal spray formulation delivers a fixed dose of 5 mg and is not appropriate for all pediatric patients; for smaller intranasal doses, parenteral solution for injection can be used; ensure appropriate product selection and administration technique. Mean recovery time (from the end of procedure to complete recovery that is, an Aldrete score of 9) was slightly longer in midazolam group as compared to placebo group (Group M 6.25 4.54 min vs. Group P 3.97 2.51 min, P = 0.011). Monitor therapy, Teduglutide: May increase the serum concentration of Benzodiazepines. The chlormethiazole labeling states that an appropriately reduced dose should be used if such a combination must be used. Last updated January 30, 2020. Sedation in mechanically ventilated ICU patients: Note: Nonbenzodiazepine sedation may be preferred (SCCM [Devlin 2018]). Management: Concurrent use of enzalutamide with CYP3A4 substrates that have a narrow therapeutic index should be avoided. Management: Avoid concomitant use of tapentadol and benzodiazepines or other CNS depressants when possible. Pediatric patients undergoing procedures involving the upper airway (eg, upper endoscopy, dental care) are vulnerable to episodes of desaturation and hypoventilation. Results The dexmedetomidine cohort required less breakthrough interventions per day compared with the standard care group, the reduction was significant (2.2 vs 3.9, [7] In contrast, in a sample of healthy pre-adolescents and adolescents, clinically detectable sedation (OAA/S 17) was observed in merely 40% of patients even at higher doses (20 mg) of oral midazolam. Propofol may increase the serum concentration of Midazolam. Management: Patients taking perampanel with any other drug that has CNS depressant activities should avoid complex and high-risk activities, particularly those such as driving that require alertness and coordination, until they have experience using the combination. If combined, limit the dosages and duration of each drug. Premedicated patients: Reduce initial dose by 30%. Monitor therapy, Enzalutamide: May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers).
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