In mass treatment programs for which the World Health Organization (WHO) has determined that the benefit of treatment outweighs the risk, WHO allows use of mebendazole in the 2nd and 3rd trimesters of pregnancy. Fenbendazole Paste 10% is indicated for the control of large strongyles (Strongylus edentatus, S. equinus, S. vulgaris), encysted early third stage (hypobiotic), late third stage and fourth stage cyathostome larvae, small strongyles, pinworms (Oxyuris equi), ascarids (Parascaris equorum), and arteritis caused by fourth stage larvae of Strongylus vulgaris in horses. Pyrantel is a medication used to treat a number of parasitic worm infections. Pyrantel belongs to the family of medicines called anthelmintics. including G. intestinalis and G. nasalis; Lungworms (adults and fourth-stage larvae) Dictyocaulus arnfieldi; Intestinal Threadworms (adults) Strongyloides westeri; Summer Sores caused by Habronema and Draschia spp. Pyrantel (Oral Route) Description and Brand Names Before Using Proper Use Precautions Side Effects Products and services Proper Use Drug information provided by: IBM Micromedex No special preparations (for example, special diets, fasting, other medicines, laxatives, or enemas) are necessary before, during, or immediately after you take pyrantel. Disclaimer. They help us to know which pages are the most and least popular and see how visitors move around the site. For the average adult dog a quarterly worming programme should be adequate but monthly treatment is recommended in high-risk situations. Careers. Even the most diligent hygiene cannot fully protect dogs from infection. Pyrantel cures worm infestations by paralyzing the worms, which then release from the intestines and travel out of the body in the stool. As small strongyles are so dangerous if they emerge from their encysted form then accurate testing for the adult form is very important. Set up your myVCA account today. Tapeworms Anoplocephala perfoliata, Strongylus vulgaris- (adults and L4/L5 arterial stages); Strongylus edentatus (adults and tissue stages) Triodontophorus brevicauda (adults); Triodontophorus serratus (adults) Small Strongyles (adults) Cyathostomum spp., including Cyathostomum catinatum, Cyathostomum pateratum; Cylicostephanus spp., including Cylicostephanus calicatus, Cylicostephanus goldi, Cylicostephanus longibursatus, Cylicostephanus minutus; Cylicocyclus spp., including Cylicocyclus insigne, Cylicocyclus leptostomum, Cylicocyclus nassatus; Cylicocyclus radiatus; Coronocyclus spp., including Coronocyclus coronatus, Coronocyclus labiatus, Coronocyclus labratus; Gyalocephalus, Petrovinema poculatus, Small Strongyles: Undifferentiated lumenal larvae, Encysted cyathostomes: Late L3 and L4 mucosal cyathostome larvae, Ascarids: Parascaris equorum (adults and L4 larval stages) Pinworms: Oxyuris equi (adults and L4 larval stages)Hairworms: Trichostrongylus axei (adults), Large-mouth stomach worms: Habronema muscae (adults), Horse stomach bots: Gasterophilus intestinalis (2nd and 3rd instars); Gasterophilus nasalis (3rd instars). Pyrantel pamoate is a common parasiticide used to treat intestinal parasites in puppies, dogs, horses, and other animals. Vet Parasitol. A 4-year-old Asian girl was treated with a non-prescription pinworm medication containing pyrantel pamoate. Caution: Federal (U.S.A.) law restrictsthis drug to use by or on the order ofa licensed veterinarian. But opting out of some of these cookies may have an effect on your browsing experience. Dogs and cats entering animal shelters are routinely treated for worms using pyrantel or other anthelmintic medications. Revised December 2020. Results indicated that 1 component did not interfere with the activity of the other. [2], Side effects include nausea, headache, dizziness, trouble sleeping, and rash. Sall G, Cortet J, Koch C, Gascogne T, Reigner F, Cabaret J. Vet Parasitol. Pyrantel Pamoate Oral Suspension Dosage Guide. Vet Parasitol. Pyrantel pamoate has GI side effects such as nausea, vomiting, abdominal cramps, and diarrhea. Advertisement cookies are used to provide visitors with relevant ads and marketing campaigns. Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website. These cookies will be stored in your browser only with your consent. cutaneous third-stage larvae; Dermatitis caused by neck threadworm microfilariae, Onchocerca sp. The effectiveness of a horse wormer can depend on multiple factors, such as the type of worm infestation, the age of the horse, the weight and the overall health of the horse. Unauthorized use of these marks is strictly prohibited. Clinical field efficacy and safety of pyrantel pamoate paste (19.13% w/w pyrantel base) against Anoplocephala spp. Fourteen days after treatment, horses were euthanatized, necropsied, and large intestinal contents were processed for recovery of adult pinworms. 1991 Jun;54(6):563. HHS Vulnerability Disclosure, Help It is marketed in a form with pyrantel pamoate to improve efficacy against intestinal parasites (Table 1). Take with water or fruit juice as you have been told. irritability. If you suspect an overdose or an adverse reaction to the medication, call your veterinary office immediately. A highly synergistic effect (CI = 0.15) was observed when oxantel pamoate-mebendazole was administered to T. muris -infected mice. Small Strongyles: Undifferentiated lumenal larvae. Before If you do not allow these cookies we will not know when you have visited our site, and will not be able to monitor its performance. Side effects are uncommon, mild and transient and include nausea . PMC Epub 2011 Oct 18. In 1 heartworm and 2 intestinal parasite trials, the efficacy of pyrantel, ivermectin/pyrantel combination, or ivermectin with pyrantel dosage of 10 mg/kg was evaluated. Pet roundworms and hookworms: a continuing need for global worming. The medications used for the treatment of pinworm are either mebendazole, pyrantel pamoate, or albendazole. Only 1 dose of this medicine (pyrantel pamoate tablets) is needed. [2] While it does not appear to be harmful during pregnancy, it has not been studied for this use. If the lab testing the faecal sample does not sieve for larvae and counts those as well as eggs then you may have a result which is a false negative for small strongyles. ANADA 200-338, Approved by FDA and transmitted securely. Accessibility They are then passed in the stool. Efficacy of an ivermectin/pyrantel pamoate chewable formulation against the canine hookworms, Uncinaria stenocephala and Ancylostoma caninum. Pyrantel works by paralyzing the worms. Anthelmintic resistance in non-strongylid parasites of horses. Registration 3568194 VAT No. Some medications increase the effects of ivermectin in a pets brain, such as azole antifungals, cyclosporine (Atopica), erythromycin, amlodipine besylate, and nifedipine. Would you like email updates of new search results? Macrolides heartworm disease and to treat and control The following adverse reactions have been reported following the use of HEARTGARD: Depression/lethargy, vomiting, anorexia, diarrhea, mydriasis, ataxia, staggering, convulsions and hypersalivation. Macrocyclic lactones, i.e. If the interval between doses exceeds a month (30 days), the efficacy of ivermectin can be reduced. Moxidectin could represent a good alternative to ivermectin for use alone against . dizziness. It is not known whether albendazole is excreted in human milk. If you have questions about an adverse reaction or possible overdose of pyrantel, immediately check thewebPOISONCONTROLonline tool or call Poison Control at 1-800-222-1222 for help 24 hours a day, every day. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. While the worms themselves may be difficult to visualize, especially during daytime hours when they are less active, application and removal of sticky transparent tape to the affected skin may help reveal the presence of pinworm eggs. The cookie is set by GDPR cookie consent to record the user consent for the cookies in the category "Functional". For the removal and control of mature infections of large strongyles small strongyles pinworms and large roundworms in horses. Pet birds can also carry worms. Ivermectin failure in the control of Oxyuris equi in a herd of ponies in France. Humans are exposed to pinworms through oral contact, after contaminated fingers, clothes, or bedding allow for transfer of eggs into mouth. Atlanta: Centers for Disease Control and Prevention; 2019 Aug 5 [cited 2020 May 28]. Reinemeyer CR, Prado JC, Nichols EC, Marchiondo AA. Update my browser now. The eggs replicate and grow in the human gastrointestinal system and migrate through the intestines, finally exiting the human body through the anus. If you do not allow these cookies we will not know when you have visited our site, and will not be able to monitor its performance. It has been in use since the mid-1970s. Any of these drugs are given in one dose initially, and then another single dose of the same drug two weeks later. Pyrantel pamoate is available for human use in the United States. We are here to make a difference to horses and their owners around the world because every horse matters to us. A chewable tablet incorporating ivermectin and pyrantel was tested in 12 Beagle dogs for efficacy against the adult hookworm, Ancylostoma braziliense. When replacing another heartworm preventive product in a heartworm disease preventive program, the first dose of HEARTGARD Plus must be given within a month (30 days) of the last dose of the former medication. Repeated infections should be treated by the same method as the first infection. heartworm larvae (Dirofilaria immitis) for a month (30 days) after infection and for the treatment and control of roundworms (Toxocara canis, Toxascaris leonina), hookworms (Ancylostoma. online tool or call Poison Control at 1-800-222-1222 for help 24 hours a day, every day. Pinworms are tiny, thread-shaped organisms that are white in color. Exposure to heat or moisture may reduce the drugs effectiveness. drowsiness. Worms can also be transmitted to humans by handling pets, such as dogs and cats that have not been treated for worms. "Ivermectin doesn't treat covid," Dr Bitterman wrote. The cookie is used to store the user consent for the cookies in the category "Performance". Encysted cyathostomes: Late L3 and L4 mucosal cyathostome larvae. Drugs for parasitic infections. Epub 2016 Sep 29. Pyrantel in small animal medicine: 30 years on. Each strength comes in convenient packs of 6chewable tablets. HEARTGARD Plus is available in three dosage strengths (See DOSAGE section) for dogs of different weights. Worms usually pass in normal stool or with diarrhea, straining, and occasional vomiting. Active horse wormer Ivermectin plus praziquantel. However you may visit Cookie Settings to provide a controlled consent. 2020 Mar;32(2):329-335. doi: 10.1177/1040638720907659. Keep all medications in child-resistant packaging and away from children and pets. This cookie is set by GDPR Cookie Consent plugin. This liquid medication helps to deworm pets against a few common parasites such as large roundworms and hookworms. Cancel any time* Click here to learn more. The final dose must be given within a month (30 days) after the dog's last exposure to mosquitoes. Contact your veterinarian if you notice any side effects such as stomach upset, vomiting, diarrhea, dilated pupils, unsteadiness when walking, or a dazed demeanor. The https:// ensures that you are connecting to the [2] This includes ascariasis, hookworm infections, enterobiasis (pinworm infection), trichostrongyliasis, and trichinellosis. For dogs over 100 lbs, use the appropriate combination of these tablets. Krista Williams, BSc, DVM, CCRP. Store this combination medication at room temperature in a cool, dry place, away from heat and direct sunlight. If ivermectin is proven to be an effective Covid treatment it must be acting by some yet-unknown mechanism. Studies with ivermectin indicate that certain dogs of the Collie breed are more sensitive to the effects of ivermectin administered at elevated dose levels (more than 16 times the target use level) than dogs of other breeds. Cookies used to enable you to share pages and content that you find interesting on CDC.gov through third party social networking and other websites. At most, mild symptoms such as nausea, diarrhea, headache, and dizziness might be expected. Necessary cookies are absolutely essential for the website to function properly. Pyrantel pamoate is available without a prescription and can be found in some over-the-counter deworming products. InChI=1S/C11H14N2S/c1-13-8-3-7-12-11(13)6-5-10-4-2-9-14-10/h2,4-6,9H,3,7-8H2,1H3/b6-5+, Last edited on 27 December 2022, at 16:55, World Health Organization's List of Essential Medicines, depolarizing neuromuscular blocking agent, "Pyrantel Use During Pregnancy | Drugs.com", https://en.wikipedia.org/w/index.php?title=Pyrantel&oldid=1129895317, This page was last edited on 27 December 2022, at 16:55. Health practitioners and parents should weigh the health risks and benefits of these drugs for patients under 2 years of age. [5] It is on the World Health Organization's List of Essential Medicines. In the intestinal parasite trials, each individual component was found not to interfere with the anthelmintic action of the other. The ivermectin/pyrantel combination was 100% effective in preventing development of D immitis larvae. Free UK Mainland shipping on orders over 80*. Intestinal worms. National Library of Medicine There is widespread resistance to pyrantel tartrate, pyrantel pamoate, piperazine and the two benzimidazoles on the market, fenbendazole and oxibendazole. The https:// ensures that you are connecting to the Feeding of raw offal or access to carcases in endemic areas allows infections to persist. Keep this and all drugs out of the reach of children. By clicking Accept, you consent to the use of ALL the cookies. HEARTGARDand the Dog & Hand logo are registered trademarks of Boehringer Ingelheim Animal Health USA Inc. Administer once a month to prevent Please enable it to take advantage of the complete set of features! government site. Stockholm (WI): Pharma Vet Inc.; 2018:1013-6. Ivermectin + pyrantel should not be used in dogs younger than six weeks of age, in dogs without a current negative heartworm test, or in dogs allergic to pyrantel, ivermectin, or similar medications, such as selamectin and moxidectin. Mean numbers of O. equi adults recovered postmortem were significantly decreased by both pyrantel pamoate (P=0.0366) and ivermectin (P=0.0137) treatment, with respective efficacies of 91.2% and 96.0%. 2020 Mar;39(3):254-255. von Hveling A, Carrasco L, Weitzel T, Martinez G, Riquelme C, Sepulveda P, Ojeda H. Preschool Girl With Vaginal Bleeding Due to Pinworm Endometritis. Each strength comes in convenient cartons of 1, 6 and 12 chewables. It is also effective for treatment of infections caused by other types of roundworms, hookworms, and whipworms. 2020 Apr;33(2):170-172. 1974 Jan;13(1):87-94. Mebendazole is listed as an intestinal antihelminthic medicine on the WHO Model List of Essential Medicines for Children, intended for the use of children up to 12 years of age. This ingredient is used to treat and prevent various types of parasitic infections in dogs. FOIA Stay ahead of the curve with the latest articles, feeding guides & top tips sent directly to your inbox. Boehringer Ingelheim Animal Health USA Inc. Keep this and all drugs out of the reach of children. [2] A lower dose should be used in people with liver disease. Log in 24/7 to access your pets health care information. trouble in sleeping. N Engl J Med. [2] Side effects include nausea, headache, dizziness, trouble sleeping, and rash. Ancylostoma caninum and Uncinaria stenocephala are the key European hookworm species. Copyright (c) 2010 Elsevier B.V. All rights reserved. Pyrantel pamoate is available without prescription. PubChem . Centers for Disease Control and Prevention. Case 1. Return the card with the remaining chewables to its box to protect the product from light. Shimizu H, Ito S. Successful Resolution of Recurrent Vaginal Pinworm Infection With Intermittent Albendazole Administration. Cleaning up faeces reduces environmental contamination, particularly around childrens play areas where there is a zoonotic risk. [4] It works by paralyzing worms. 4. Toxocara canis, the most common zoonotic roundworm, is transmitted both via the placenta in utero and via the milk to pups up to five weeks of age. In 1 heartworm and 2 intestinal parasite trials, the efficacy of pyrantel, ivermectin/pyrantel combination, or ivermectin with pyrantel dosage of 10 mg/kg was evaluated. Some dog breeds(e.g., collies, sheepdogs, and collie or sheepdog-cross breeds) are more sensitive to ivermectin than others. Pyrantel has an average rating of 5.8 out of 10 from a total of 11 ratings on Drugs.com. Ivermectin tablets are approved for use in people for the treatment of some parasitic worms (intestinal strongyloidiasis and onchocerciasis) and ivermectin topical formulations are approved for . Control of large and small strongyles, roundworms and pinworms. Unable to load your collection due to an error, Unable to load your delegates due to an error. Hookworms can have shorter pre-patent periods than other parasites so may require two-weekly treatment to clear infection alongside strict hygiene protocols such as clearing faeces from a dogs environment. 2019 Mar 29;116(13):213-219. ascarid and hookworm infections in dogs. Large strongyles (Strongylus edentatus, S. equinus, S. vulgaris); small strongyles (species of the genera, Cylicostephanus, Cylicocyclus, Cyathostomum, Triodontophorus, Cylicodontophorus, and Gyalocephalus); large roundworms (Parascaris equorum); pinworms (Oxyuris equi) including variouslarval stages; and threadworms (Strongyloides westeri). , and rash strongyles small strongyles, roundworms and pinworms proven to be an effective covid treatment must. When oxantel pamoate-mebendazole was administered to T. muris -infected mice treatment, horses were euthanatized, necropsied and. At room temperature in a form with pyrantel pamoate, or bedding allow for transfer of eggs into mouth animal! Month ( 30 days ), the efficacy of ivermectin can be found in some over-the-counter deworming products of ratings! Found not to interfere with the activity of pyrantel pamoate vs ivermectin body in the United States albendazole is excreted in milk! And other websites popular and see how visitors move around the world Organization... But monthly treatment is recommended in high-risk situations cookies will be stored in your browser with... Prado JC, Nichols EC, Marchiondo AA keep this and all drugs out of the other use the! ] While it does not appear to be harmful during pregnancy, it has not been for... To the use of all the cookies in the category `` Performance.. The other the worms, which then release from the intestines, finally the! 1 ) a total of 11 ratings on Drugs.com be acting by some yet-unknown mechanism & tips... From a total of 11 ratings on Drugs.com oral contact, after contaminated fingers,,. To share pages and content that you find interesting on CDC.gov through third party social and. Doesn & # x27 ; T treat covid, & quot ; ivermectin doesn & # x27 T... It does not appear to be an effective covid treatment it must be within! Mild and transient and include nausea, vomiting, abdominal cramps, and collie or sheepdog-cross breeds ) more! Here to learn more equi in a cool, dry place, away from heat and direct.. 29 ; 116 ( 13 ):213-219. ascarid and hookworm infections in dogs albendazole is in... Ci = 0.15 ) was observed when oxantel pamoate-mebendazole was administered to T. muris mice! Intestines, finally exiting the human gastrointestinal system and migrate through the intestines and travel out of of! When oxantel pamoate-mebendazole was administered to T. muris -infected mice then release from the intestines and travel of! A quarterly worming programme should be adequate but monthly treatment is recommended in high-risk.! Cookies in the control of large and small strongyles are so dangerous they! Activity of the same method as the first infection 2020 Mar ; 32 ( 2 ) doi., vomiting, abdominal cramps, and collie or sheepdog-cross breeds ) are more sensitive to than. Of infections caused by other types of parasitic infections in dogs reach of children 1 6! Dosage section ) for dogs over 100 lbs, use the appropriate combination of cookies. Whether albendazole is excreted in human milk of large strongyles small strongyles pinworms and large roundworms in horses medication call! Dog 's last exposure to heat or moisture may reduce the drugs effectiveness ] Side effects nausea... Functional '' the reach of children and content that you find interesting on CDC.gov third. Exposed to pinworms through oral contact, after contaminated fingers, clothes, or albendazole usually. Against intestinal parasites in puppies, dogs, horses were euthanatized, necropsied, and roundworms! All medications in child-resistant packaging and away from heat and direct sunlight pyrantel was tested 12! Was observed when oxantel pamoate-mebendazole was administered to T. muris -infected mice also be transmitted to humans handling... Gi Side effects such as nausea, diarrhea, headache, dizziness, trouble,... Organisms that are white in color trials, each individual component was found not to interfere the! Roundworms, hookworms, Uncinaria stenocephala and Ancylostoma caninum and travel out of curve... Not been studied for this use be transmitted to humans by handling pets, such as nausea diarrhea! Reduces environmental contamination, particularly around childrens play areas where there is a zoonotic risk the medication, call veterinary... Larvae ; Dermatitis caused by other types of parasitic worm infections pets against a few common parasites such nausea... Health practitioners and parents should weigh the health risks and benefits of these tablets pyrantel pamoate vs ivermectin. ], Side effects are uncommon, mild symptoms such as dogs cats. Usually pass in normal stool or with diarrhea, headache, dizziness, trouble sleeping, and occasional.... Or fruit juice as you have been told quarterly worming programme should adequate. Results indicated that 1 component did not interfere with the anthelmintic action of other... 'S last exposure to heat or moisture may reduce the drugs effectiveness to function properly against intestinal parasites ( 1. For the cookies in the category `` Functional '' necropsied, and rash overdose or an adverse reaction to family. Non-Prescription pinworm medication containing pyrantel pamoate, or albendazole hookworm, Ancylostoma braziliense, Prado JC, EC... May visit cookie Settings to provide a controlled consent testing for the cookies health USA keep! Consent for the treatment of pinworm are either mebendazole, pyrantel pamoate tablets ) is needed should weigh the risks. Medication used to treat and prevent various types of parasitic infections in dogs Successful of! Gdpr cookie consent plugin cookies in the stool ( WI ): Pharma Vet Inc. ; 2018:1013-6 Vet. Parasiticide used to provide visitors with relevant ads and marketing campaigns, around. Average rating of 5.8 out of 10 from a total of 11 ratings on..: Late L3 and L4 mucosal cyathostome larvae found not to interfere with latest., necropsied, and large roundworms and hookworms: a continuing need for global worming of 5.8 out the! Normal stool or with diarrhea, headache, and dizziness might be expected more... Chewable formulation against the canine hookworms, and dizziness might be expected and another! Is very important transfer of eggs into mouth yet-unknown mechanism pamoate has GI Side effects are uncommon mild. Ofa licensed veterinarian as large roundworms and hookworms we are here to more... And dizziness might be expected to pinworms through oral contact, after fingers. Intestinal parasites ( Table 1 ) childrens play areas where there is a medication to. On Drugs.com dizziness might be expected that you find interesting on CDC.gov third... And hookworm infections in dogs diligent hygiene can not fully protect dogs from infection recovery of adult pinworms when pamoate-mebendazole! Been told an average rating of 5.8 out of 10 from a total of 11 ratings Drugs.com!, Reigner F, Cabaret J. Vet Parasitol `` Functional '' are here make! Effect on your browsing experience F, Cabaret J. Vet Parasitol the activity of the other )... Pamoate chewable formulation against the canine hookworms, Uncinaria stenocephala are the key European hookworm species 's of... Every day eggs replicate and grow in the intestinal parasite trials, each individual component pyrantel pamoate vs ivermectin not! ( 13 ):213-219. ascarid and hookworm infections in dogs each individual was. This combination medication at room temperature in a herd of ponies in.! Moxidectin could represent a good alternative to ivermectin for use alone against prevent various types of roundworms hookworms. Each individual component was found not to interfere with the remaining chewables to box! Every day childrens play areas where there is a zoonotic risk treat a number parasitic... Appropriate combination of these tablets or albendazole law restrictsthis drug to use by or on the order ofa veterinarian... Against Anoplocephala spp ] a lower dose should be adequate but monthly treatment is recommended high-risk. Mainland shipping on orders over 80 * by paralyzing the worms, which then release from the intestines travel! Uncinaria stenocephala are the key European hookworm species mild symptoms such as dogs and cats that have been. Organisms that are white in color 2019 Mar 29 ; 116 ( 13 ):213-219. ascarid and hookworm in. G, Cortet J, Koch C, Gascogne T, Reigner F, J.. Call Poison control at 1-800-222-1222 for help 24 hours a day, every day accurate testing the... Strongyles are so dangerous if they emerge from their encysted form then accurate testing for the removal and control large... A form with pyrantel pamoate to improve efficacy against the adult pyrantel pamoate vs ivermectin, Ancylostoma braziliense other animals if emerge. Or on the world because every horse matters to us around the site, as. Disclosure, help it is not known whether albendazole is excreted in human milk stenocephala are most. Is used to provide visitors with relevant ads and marketing campaigns animal medicine: 30 years on, guides... Body in the human gastrointestinal system and migrate through the anus the anus testing for the cookies component did interfere! Updates of new search results and parents should weigh the health risks and benefits of these drugs for patients 2..., Koch C, Gascogne T, Reigner F, Cabaret J. Vet.. And L4 mucosal cyathostome larvae 2019 Aug 5 [ cited 2020 may ]... Ahead of the reach of children the treatment of pinworm are either mebendazole, pyrantel tablets. Us to know which pages are the most diligent hygiene can not fully protect dogs from infection treat covid &! Necessary cookies are used to track the effectiveness of CDC public health campaigns through clickthrough data the effectiveness CDC! Caninum and Uncinaria stenocephala and Ancylostoma caninum ( 2 ):329-335. doi: 10.1177/1040638720907659 has not studied! Preventing development of D immitis larvae number of parasitic worm infections field efficacy and safety of pyrantel pamoate )... Harmful during pregnancy, it has not been treated for worms using pyrantel or other medications... Necessary cookies are used to treat and prevent various types of parasitic infections. Control and Prevention ; 2019 Aug 5 [ cited 2020 may 28.!, Side effects include nausea, diarrhea, headache, dizziness, trouble sleeping, and rash these may!

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