Hospital Pharmacy

Volume 41, Number 2, pp 196–206

2006 Wolters Kluwer Health, Inc.

Special Feature
Drug-Induced Photosensitivity
Kimberly S. Dufner, PharmD, Lori A. Buss, PharmD, and Joseph Kizito

M
any drugs may cause the
skin to be more sensitive
to light during or after
their use. Photosensitivity may
manifest in two forms either as a
photoallergic or phototoxic reac-
tion. Phototoxicity may arise as a
result of damage to skin cells by
the drug’s light-activated chemical.
In contrast, photoallergic reaction
may occur as a result of a cell
mediated response to light-activat-
ed chemical that acts as an anti-
gen.3,5,22,23,30,31
Phototoxicity is by far the
most common reaction experi-
enced by those individuals that are
susceptible to drug-induced photo-
sensitivity, while photoallergic
reaction is less common but usual-
ly severe. Phototoxicity commonly
manifests in a matter of minutes or
hours as sunburn, which may lead
to blistering of the skin in severe
cases. However, photoallergic
reaction may appear after a day or
so as a severe itchy rash where the
skin was exposed to light that may
occasionally spread to unexposed
skin.3,5,22,23,30,31
Below are some of the drugs
that have been found or reported
to cause photosensitivity. (This list
comprises only those drugs that
are FDA approved and available
on the US market.)

Drugs That May Cause Photosensitivity

Generic Name (Brand Name Example) Therapeutic Category Frequency

Acamprosate1 (Campral) Antialcoholic < 0.1%

Acetazolamide (Diamox Sequels)
1
Carbonic anhydrase inhibitor diuretic Reported
Acitretin1 (Soriatane) Retinoid < 1%
Acyclovir1 (Zovirax) Antiviral Reported
Adapalene1 (Differin) Retinoid Reported
Alendronate (Fosamax)
1
Bisphosphonate Reported
Alitretinoin1 (Panretin) Topical retinoid Reported
Almotriptan (Axert)
1
Serotonin 5-HT1 receptor agonist < 0.1%
Aminolevulinic Acid1 (Levulan Kerastick) Photochemotherapeutic Reported
Amiodarone1,15, 41 (Cordarone) Class III antiarrhythmic Approximately 10%
Amitriptyline1 (Elavil) Tricyclic antidepressant Reported
Amoxapine1 Tricyclic antidepressant < 1%
Anagrelide1 (Agrylin) Antiplatelet 1% ≤ 5%
Aripiprazole1 (Abilify) Atypical antipsychotic 0.1% to 1%
Atenolol 2 (Tenormin) Beta-blocker Reported
Atorvastatin1,42 (Lipitor) HMG-CoA reductase inhibitor < 2%
Azelaic acid1 (Azelex) Topical anti-infective Reported
Azithromycin1,58 (Zithromax) Macrolide antibiotic < 1%
Benazepril1 (Lotensin) ACE inhibitor < 1%
Benzoyl peroxide (Brevoxyl)
1
Topical anti-infective ≥ 1%
Bexarotene1 (Targretin) Antineoplastic rexinoid Reported
Brompheniramine8 (J-Tan) First generation antihistamine Reported
(continued)

196 Volume 41, February 2006

Special Feature

Drugs That May Cause Photosensitivity (Continued)

Generic Name (Brand Name Example) Therapeutic Category Frequency

Bumetanide7 (Bumex) Loop diuretic Reported

Bupropion (Wellbutrin, Zyban)
1
Antidepressant/smoking deterrent 0.1 % to 1%
Calcipotriene39 (Dovonex) Antipsoriatic Reported
Capecitabine1 (Xeloda) Antineoplastic, antimetabolite 0.1%
Captopril1 (Capoten) ACE inhibitor Reported
Carbamazepine (Tegretol) 1
Anticonvulsant Reported
Carbinoxamine10, 87 (Palgic) First generation antihistamine Reported
Carvedilol 1,49
(Coreg) Alpha/beta-adrenergic blocker > 0.1% to ≤ 1%
Celecoxib1 (Celebrex) Selective COX-II inhibitor 0.1% to 1.9%
Cetirizine1,70(Zyrtec) Second generation antihistamine < 2%
Cetuximab1 (Erbitux) Antineoplastic, monoclonal antibody Reported
Cevimeline (Evoxac)
1
Cholinergic agonist < 1%
Chlorhexidine1 (Hibiclens) Antimicrobial < 0.1%
Chloroquine72 (Aralen) Antimalarial Reported
Chlorothiazide1 (Diuril) Thiazide diuretic Reported
Chlorpheniramine10 (Chlor-Trimeton) First generation antihistamine Reported
Chlorpromazine1 (Thorazine) Phenothiazine antipsychotic Reported
Chlorpropramide1,67 (Diabinese) Sulfonylurea Reported
Chlorthalidone1 (Thalitone) Thiazide diuretic Reported
Cidofovir 1,59
(Vistide) Antiviral Reported
Ciprofloxacin1,11,18 (Cipro) Fluoroquinolone antibiotic < 1%
Citalopram1 (Celexa) SSRI antidepressant 0.1% to 1%
Clemastine12 (Tavist-Allergy) First generation antihistamine Reported
Clomipramine (Anafranil)
1
Tricyclic antidepressant Reported
Clozapine1 (Clozaril) Atypical antipsychotic Reported
Cromolyn Sodium (Intal) 1
Mast cell stabilizer Reported
Cyclobenzaprine98 (Flexeril) Skeletal muscle relaxant < 0.1%
Cyproheptadine 26
First generation antihistamine Reported
Dacarbazine1,13,65 (DTIC-Dome) Antineoplastic, alkylating < 0.1%
Danazol 93
Gonadotropin inhibitor < 0.1%
Dantrolene1 (Dantrium) Skeletal muscle relaxant Reported
Dapsone 1
Leprostatic Reported
Demeclocycline1 (Declomycin) Tetracyclic antibiotic Reported
Desipramine82 (Norpramin) Tricyclic antidepressant Reported
Dexchlorpheniramine14 First generation antihistamine Reported
Diclofenac (Voltaren)
1
NSAID Tablets: < 1% (3% on a 90-day
treatment)
Diclofenac1 (Solaraze) Keratolytic Topical gel: 3%
(continued)

198 Volume 41, February 2006

 Special Feature

Drugs That May Cause Photosensitivity (Continued)

Generic Name (Brand Name Example) Therapeutic Category Frequency

Diltiazem4 (Cardizem LA) Calcium channel blocker < 2%

Dimenhydrinate (Dramamine) 1
Antiemetic/antivertigo Reported
Diphenhydramine1, 86 (Benadryl) First generation antihistamine Reported
Disopyramide (Norpace) 2
Class IA antiarrhythmic Reported
Docetaxel92 (Taxotere) Antineoplastic, antimitotic Reported
Doxepin1 (Sinequan) Tricyclic antidepressant Reported
Doxycycline1,24,29,64 (Vibramycin) Tetracycline antibiotic Reported
Duloxetine1 (Cymbalta) SNRI antidepressant 0.1% to 1%
Efavirenz40 (Sustiva) Non-nucleoside reverse Reported
transcriptase inhibitor (NNRTI)
Enalapril1 (Vasotec) ACE inhibitor 0.5% to 1%
Epirubicin (Ellence)
1
Antineoplastic, anthracycline Reported
Estazolam79 (ProSom) Benzodiazepine Reported
Estrogen/Progestin1,25, 68 (Ortho Evra) Combined oral contraceptive Reported
Eszopiclone1 (Lunesta) Hypnotic 0.1% to 1%
Ethionamide 1,66
(Trecator) Antituberculosis agent Reported
Etidronate1 (Didronel) Bisphosphonate Reported
Etodolac1 (Lodine) NSAID < 1%
Felbamate1,63 (Felbatol) Anticonvulsant Reported
Fenofibrate1 (TriCor) Fibric acid/antihyperlipidemic Reported
Floxuridine1 (FUDR) Antineoplastic, antimetabolite Reported
Flucytosine (Ancobon)
1
Antifungal Reported
Fluorouracil1,38 (Efudex) Topical pyrimidine antagonist Reported
Fluoxetine (Prozac)
1
SSRI antidepressant < 0.1%
Fluphenazine1 (Prolixin) Phenothiazine antipsychotic Reported
Flurbiprofen (Ansaid)
1
NSAID < 1%
Flutamide1,28 Antineoplastic, antiandrogen Reported
Fluvastatin 1,43
(Lescol) HMG-CoA reductase inhibitor Reported
Fluvoxamine1 (Luvox) SSRI antidepressant 0.1% to 1%
Fosinopril1 (Monopril) ACE inhibitor 0.2% to 1 %
Furosemide1 (Lasix) Loop diuretic Reported
Gabapentin (Neurontin)
1
Anticonvulsant < 0.1%
Ganciclovir91 (Cytovene) Antiviral Reported
Gemifloxacin18,57 (Factive) Fluoroquinolone antibiotic 0.039%
Gentamicin97 Anti-infective, topical Reported
Glatiramer1 (Copaxone) Immunosuppressant 0.1 % to 1%
Glimepiride1 (Amaryl) Sulfonylurea Reported
Glipizide1 (Glucotrol) Sulfonylurea Reported
Glyburide1 (DiaBeta) Sulfonylurea Reported
(continued)

Hospital Pharmacy 199

Special Feature

Drugs That May Cause Photosensitivity (Continued)

Generic Name (Brand Name Example) Therapeutic Category Frequency

Griseofulvin1 (Grifulvin V) Antifungal Reported

Haloperidol1 (Haldol) Typical antipsychotic Reported
Hexachlorophene (PHisoHex) 1
Topical antibacterial Reported
Hydralazine85 Peripheral vasodilator Reported
Hydrochlorothiazide 1
Thiazide diuretic Reported
Hydromorphone1 (Dilaudid) Narcotic agonist analgesic < 1%
Hydroxychloroquine1,62 (Plaquenil) Antirheumatic Reported
Hydroxyurea76, 83 (Hydrea) Antineoplastic, antimetabolite Reported
Imatinib1,54 (Gleevec) Tyrosine-kinase inhibitor antineoplastic 0.1% to 1%
Imipramine1 (Tofranil) Tricyclic antidepressant Reported
Imiquimod1 (Aldara) Topical immunomodulator Reported
Indapamide27 (Lozol) Thiazide diuretic Reported
Interferon Alfa-2b, Recombinant 1
Immunomodulator < 5%
(Intron A)
Interferon Beta-1a1 (Avonex) Immunomodulator Reported
Interferon Beta-1b1 (Betaseron) Immunomodulator Reported
Interferon Alfa-N3 (Alferon N) 1
Immunomodulator 1%
Isotretinoin1 (Accutane) Retinoid Reported
Itraconazole (Sporanox)
74
Antifungal Reported
Ketoprofen1,35 (Oruvail) NSAID < 1%
Labetalol (Trandate)
2
Alpha/beta adrenergic blocker Reported
Lamotrigine1,50 (Lamictal) Anticonvulsant 2%
Leuprolide1 (Lupron) Gonadotropin releasing hormone analog Reported
Levofloxacin16,18,19 (Levaquin) Fluoroquinolone antibiotic Reported
Lisinopril (Zestril)
1
ACE inhibitor 0.3% to 1%
Loratadine1 (Claritin) Second generation antihistamine Reported
Losartan 1,52
(Cozaar) Angiotensin II receptor blocker < 1%
Lovastatin1,44 (Mevacor) HMG-CoA reductase inhibitor Reported
Maprotiline1 Tetracyclic antidepressant 0.1% to 1%
Mefenamic Acid80 (Ponstel) NSAID Reported
Meloxicam1 (Mobic) NSAID < 2%
Mesalamine1,56 (Pentasa) Anti-inflammatory < 1%
Methazolamide1 Carbonic anhydrase inhibitor diuretic Reported
Methotrexate1 (Trexall) Antipsoriatic/antineoplastic/antirheumatic 3% to 10%
Methoxsalen 1,9
(Uvadex) Photochemotherapeutic Reported
Methyldopa85 Antiadrenergic agent Reported
Methylene Blue 1, 37
(Urolene Blue) Antidote/urinary antiseptic/diagnostic agent Reported
(continued)

200 Volume 41, February 2006

 Special Feature

Drugs That May Cause Photosensitivity (Continued)

Generic Name (Brand Name Example) Therapeutic Category Frequency

Metolazone1 (Zaroxolyn) Thiazide diuretic Reported

Minocycline77 (Minocin) Tetracycline antibiotic < 0.1%
Mirtazapine1 (Remeron) Tetracyclic antidepressant 0.1% to 1%
Mitomycin83 (Mutamycin) Antineoplastic, antibiotic Reported
Moexipril1 (Univasc) ACE inhibitor < 1%
Nabumetone1 (Relafen) NSAID < 1%
Nalidixic acid (NegGram) 1
Quinolone antibiotic Reported
Naproxen1 (Aleve) NSAID < 1%
Naratriptan (Amerge)
1
Serotonin 5-HT1 receptor agonist < 0.1%
Nefazodone1 Phenylpiperazine antidepressant 0.1% to 1%
Nifedipine (Procardia XL)
1
Calcium channel blocker < 1%
Nimodipine7 (Nimotop) Calcium channel blocker Reported
Nisoldipine 7, 89
(Sular) Calcium channel blocker Reported
Norfloxacin1,18 (Noroxin) Fluoroquinolone antibiotic Reported
Nortriptyline (Pamelor)
1
Tricyclic antidepressant Reported
Ofloxacin1,18 (Floxin) Fluoroquinolone antibiotic < 1%
Olanzapine1 (Zyprexa) Atypical antipsychotic 0.1% to 1%
Olsalazine1 (Dipentum) Anti-inflammatory Reported
Omeprazole1 (Prilosec) Proton pump inhibitor < 1%
Oxaprozin1 (Daypro) NSAID < 1%
Oxcarbazepine (Trileptal) 1
Anticonvulsant Reported
Oxycodone1 (OxyContin) Narcotic agonist/analgesic < 3%
Pamidronate (Aredia) 1
Bisphosphonate Reported
Pantoprazole1,17,34 (Protonix) Proton pump inhibitor Reported
Paroxetine1 (Paxil) SSRI antidepressant 0.1% to 1%
Pentosan Polysulfate Sodium1 (Elmiron) Interstitial cystitis ≤ 1%
Pentostatin1 (Nipent) Antineoplastic, antimetabolite < 3%
Perphenazine1 Phenothiazine antipsychotic Reported
Phenytoin (Dilantin)
2
Anticonvulsant Reported
Pilocarpine1 (Salagen) Cholinergic < 1%
Piroxicam (Feldene)
1
NSAID < 1%
Poly- L – Lactic Acid1,48 (Sculptra) Physical adjunct/lipoatrophy agent Reported
Porfimer 1,55
(Photofrin) Antineoplastic, miscellaneous Approximately 20%
NOTE: percentage varies with
specific type of cancer being
treated
Pravastatin1,45 (Pravachol) HMG-CoA reductase inhibitor < 0.1%
Prochlorperazine1 (Compazine) Phenothiazine antivertigo/antiemetic Reported
(continued)

Hospital Pharmacy 201

Special Feature

Drugs That May Cause Photosensitivity (Continued)

Generic Name (Brand Name Example) Therapeutic Category Frequency

Promethazine78, 88 (Phenergan) Phenothiazine/first-generation Reported

antihistamine/antiemetic/sedative
Propranolol2 (Inderal) Beta-blocker Reported
Protriptyline1 (Vivactil) Tricyclic antidepressant Reported
Pyrazinamide 1,60
Antituberculosis agent < 0.1%
Quetiapine1 (Seroquel) Atypical antipsychotic 0.1% to 1 %
Quinapril (Accupril)
1
ACE inhibitor < 0.5%
Quinidine1,61 Class IA antiarrhythmic Reported
Quinine Sulfate 1,71
Antimalarial Reported
Rabeprazole1 (AcipHex) Proton pump inhibitor ≤ 0.1%
Ramipril1 (Altace) ACE inhibitor < 1%
Riluzole1 (Rilutek) Glutamatergic inhibitor 0.1% to 1%
Risedronate (Actonel)
1
Bisphosphonate Reported
Risperidone1 (Risperdal) Atypical antipsychotic ≥ 1%
Ritonavir (Norvir)
1
Antiretroviral protease inhibitor < 2%
Rizatriptan1 (Maxalt) Serotonin 5-HT1 receptor agonist < 0.1%
Ropinirole95 (Requip) Dopamine agonist < 0.1%
Rosuvastatin1,47 (Crestor) HMG-CoA reductase inhibitor < 1%
Saquinavir (Invirase)
1
Antiretroviral protease inhibitor < 2%
Selegiline1 (Eldepryl) MAOI/antiparkinson agent Reported
Sertraline1 (Zoloft) SSRI antidepressant 0.1% to 1%
Sibutramine1 (Meridia) Anorexiant Reported
Sildenafil73 (Viagra) Phosphodiesterase type 5 inhibitor < 2%
Simvastatin1,46 (Zocor) HMG-CoA reductase inhibitor < 0.1%
Sotalol1,90 (Betapace) Beta-blocker < 0.1%
Sparfloxacin1 (Zagam) Fluoroquinolone antibiotic 3.6% to 7.9%
Spironolactone 1,20
(Aldactone) Potassium-sparing diuretic Reported
Sulfacetamide Sodium1(Bleph-10) Ophthalmic sulfonamide antibiotic Reported
Sulfadiazinem
z
a
a1F
l
Sulfonamide antibiotic Reported
Sulfasalazine32 (Azulfidine) Antirheumatic/ulcerative agent Reported
Sulfisoxazole (Gantrisin Pediatric)
1
Sulfonamide antibiotic Reported
Sulindac1 (Clinoril) NSAID < 1%
Sumatriptan1 (Imitrex) Serotonin 5-HT1 receptor agonist Reported
Tacrolimus1 (Prograf) Immunosuppressant > 1%
Tar-Containing Preparations1 Photochemotherapeutic Reported
(Ionil T Plus)
Tazarotene1 (Tazorac) Topical retinoid Reported
Terconazole75 (Terazol) Vaginal antifungal (dermal application) Reported
Tetracycline (Sumycin)
1
Tetracycline antibiotic Reported
Thalidomide1 (Thalomid) Immunomodulator Reported
(continued)

202 Volume 41, February 2006

Special Feature

Drugs That May Cause Photosensitivity (Continued)

Generic Name (Brand Name Example) Therapeutic Category Frequency

Thioguanine83 (Tabloid) Antineoplastic, antimetabolite Reported

Thioridazine 1
Phenothiazine antipsychotic < 0.1%
Thiothixene1 (Navane) Thioxanthene antipsychotic Reported
Tiagabine (Gabitril)
96
Anticonvulsant 0.1% to 1%
Tolazamide94 Sulfonylurea Reported
Tolbutamide1 Sulfonylurea Reported
Topiramate1,51 (Topamax) Anticonvulsant/antimigraine < 0.1%
Torsemide (Demadex)
1
Loop diuretic Reported
Trazodone1 (Desyrel) Triazolopyridine antidepressant Reported
Tretinoin (Retin-A)
1
Topical retinoid Reported
Triamcinolone1 (Azmacort) Inhaled corticosteroid 1% to 3%
Triamterene1 (Dyrenium) Potassium-sparing diuretic Reported
Trifluoperazine1 Phenothiazine antipsychotic Reported
Trimethoprim75 (Proloprim) Folate antagonist antibiotic Reported
Trimipramine99 (Surmontil) Tricyclic antidepressant Reported
Valacyclovir1 (Valtrex) Antiviral Reported
Valproic acid1 (Depakene) Anticonvulsant Reported
Valsartan84 (Diovan) Angiotensin II receptor blocker Reported
Vardenafil1 (Levitra) Phosphodiesterase type 5 inhibitor < 2%
Venlafaxine 1,53
(Effexor) SNRI antidepressant 0.1% to 1%
Verteporfin1 (Visudyne) Ophthalmic phototherapy Reported
Vinblastine1 Antineoplastic, antimitotic Reported
Voriconazole1,6 (Vfend) Antifungal (long-term treatment) < 1%
Warfarin85 (Coumadin) Anticoagulant Reported
Zalcitabine1 (Hivid) Nucleoside reverse transcriptase < 1%
inhibitor (NRTI)
Zaleplon1 (Sonata) Hypnotic < 1%
Ziprasidone (Geodon)
1
Atypical antipsychotic > 1%
Zolmitriptan1 (Zomig) Serotonin 5-HT1 receptor agonist 0.1% to 1%
Zolpidem (Ambien)
1
Hypnotic < 0.1%
“Reported” indicates that photosensitivity has been observed in either post-marketing reports or no sufficient data are available to deter-
mine the frequency.

Drug-Induced Reactions. In: Pharma- MendelsonD, Park A. Photoaging and

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56. Vistide [package insert]. Gilead Sci-
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Hospital Pharmacy 205
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57. Pyrazinamide [package insert].
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58. Quinidine Gluconate Inj [package
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59. Hydroxychloroquine Sulfate [pack-
age insert]. Mylan Pharmaceuticals, Inc;
2004.
60. Felbatol [package insert]. Med-
Pointe Pharmaceuticals; 2003.
61. Doxycylcine Hyclate [package
insert]. Mutual Pharmaceutical Co., Inc;
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62. Dacarbazine [package insert].
Faulding Pharmaceutical Co; 2002.
63. Trecator [package insert]. Wyeth
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64. Diabinese [package insert]. Pfizer
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65. Cooper SM, George S. Photosensi-
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66. Zyrtec [package insert]. Pfizer Labs;
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68. Martin-Garcia RF, del R Camacho
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69. Viagra [package insert]. Pfizer Labs;
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206 Volume 41, February 2006
70. Sporanox [package insert]. Abbott
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71. Terazol [package insert]. Ortho-
McNeil Pharmaceutical Inc; 2001.
72. Cutaneous drug reaction case
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73. Minocycline HCl [package insert].
Par Pharmaceuticals, Inc; 2004.
74. Trimethoprim [package insert]. Teva
Pharmaceuticals, Inc; 2003.
75. ProSom [package insert]. Abbott
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76. Mefenamic Acid [package insert].
First Horizon Pharmaceuticals Corpora-
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77. Phenergan [package insert]. Wyeth
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78. Norpramin [package insert]. Aventis
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79. Koppel RA, Boh EE. Cutaneous
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82. Diphenhydramine [package insert].
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83. Palgic [package insert]. Pamlab,
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84. Phenergan [package insert]. Wyeth
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85. Sular [package insert]. First Horizon
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86. Betapace [package insert]. Berlex
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87. Cytovene [package insert]. Roche;
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88. Eich D; Scharffetter-Kochanek K,
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90. Tolazamide [package insert]. Mylan
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91. Requip [package insert]. Glaxo
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92. Gabitril [package insert]. Cephalon,
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93. Gentamicin [package insert]. Taro
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94. Flexeril [package insert]. McNeil
Consumer; 2005.
95. Surmontil [package insert]. Odyssey
Pharmaceuticals; 2001. ■