Carcinoma of the prostate and BPH cause many of the same symptoms. These two diseases frequently co-exist. Therefore, patients thought to have BPH should be examined prior to starting Hytrin therapy to rule out the presence of carcinoma of the prostate. Hytrin may rarely cause a prolonged, painful erection. This could happen even when you are not having sex. If this is not treated right away, it could lead to permanent sexual problems such as impotence. Contact your doctor right away if this happens. Yellow No. 6, lactose, magnesium stearate, povidone and talc. Cohen J "Long-term efficacy and safety of terazosin. walmart price mectizan otc mectizan
Do NOT take more than the recommended dose without checking with your doctor. Gastrointestinal problems have been limited mainly to nausea in 5% of patients. Metabolic side effects have included decreases in serum triglycerides and VLDL cholesterol, and increases in HDL cholesterol. Terazosin the active ingredient contained in Hytrin may counterbalance deleterious effects on the lipid profile associated with thiazide diuretics, making it a reasonable drug to use in combination with these agents. There was a tendency for patients to gain weight during terazosin therapy. Additionally, TRUVEN HEALTH MAKES NO REPRESENTATION OR WARRANTIES AS TO THE OPINIONS OR OTHER SERVICE OR DATA YOU MAY ACCESS, DOWNLOAD OR USE AS A RESULT OF USE OF THE THOMSON REUTERS HEALTHCARE PRODUCTS. ALL IMPLIED WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE OR USE ARE HEREBY EXCLUDED. Truven Health does not assume any responsibility or risk for your use of the Truven Health products.
Please read this leaflet before you start taking Hytrin. Also, read it each time you get a new prescription. This is a summary and should NOT take the place of a full discussion with your doctor who has additional information about Hytrin. You and your doctor should discuss Hytrin and your condition before you start taking it and at your regular check-ups. Tell your doctor if you develop any new symptoms. Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.
At first, 1 milligram mg taken at bedtime. Then, 5 to 10 mg once a day. Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines. Post-marketing experience indicates that in rare instances patients may develop allergic reactions, including anaphylaxis, following administration of terazosin hydrochloride. There have been reports of priapism and thrombocytopenia during post-marketing surveillance. Atrial fibrillation has been reported. xeloda
Testicular weights and morphology were unaffected by treatment. This information should not be used to decide whether or not to take Hytrin or any other medicine. Only your health care provider has the knowledge and training to decide which medicines are right for you. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about Hytrin. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to Hytrin. This information is not specific medical advice and does not replace information you receive from your health care provider. You must talk with your healthcare provider for complete information about the risks and benefits of using Hytrin. Lab tests, including blood pressure, may be performed while you use Hytrin. These tests may be used to monitor your condition or check for side effects. Be sure to keep all doctor and lab appointments. Non-drug treatments are sometimes effective in controlling mild hypertension. The most important lifestyle changes to lower blood pressure are to lose weight, reduce salt, fat, and alcohol in the diet, quit smoking, and exercise regularly. However, many hypertensive patients require one or more ongoing medications to control their blood pressure. There are different kinds of medications used to treat hypertension. Your doctor has prescribed Hytrin for you. If syncope occurs, the patient should be placed in a recumbent position and treated supportively as necessary. There is evidence that the orthostatic effect of Hytrin tablets is greater, even in chronic use, shortly after dosing. The risk of the events is greatest during the initial seven days of treatment, but continues at all time intervals. Do not drink alcohol or use medicines that may cause drowsiness eg, sleep aids, muscle relaxers while you are using Hytrin; it may add to their effects. Ask your pharmacist if you have questions about which medicines may cause drowsiness. Global assessments of overall urinary function and symptoms were also performed by investigators who were blinded to patient treatment assignment. Many patients who have high blood pressure will not notice any signs of the problem. In fact, many may feel normal. It is very important that you take your medicine exactly as directed and that you keep your appointments with your doctor even if you feel well. In a long-term, open-label, non-placebo controlled clinical trial, 181 men were followed for 2 years and 58 of these men were followed for 30 months. Doses of 10 mg once daily are generally required for the clinical response. Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing. Follow your doctor's instructions about how to take Hytrin. You must take it every day at the dose prescribed. Talk with your doctor if you don't take it for a few days, you may have to restart it at a 1 mg dose and be cautious about possible dizziness. Do not share Hytrin with anyone else; it was prescribed only for you.
Hernandez RH, Angeligreaves M, Carvajal AR, Pajuelo JG, Padilla MCA, Armashernandez MJ "Terazosin: ex vivo and in vitro platelet aggregation effects in patients with arterial hypertension. The incidence of urinary tract infection was significantly lower in the patients receiving terazosin than in patients receiving placebo. An analysis of the incidence rate of hypotensive adverse events see PRECAUTIONS adjusted for the length of drug treatment has shown that the risk of the events is greatest during the initial seven days of treatment, but continues at all time intervals. Hytrin may cause dizziness, lightheadedness, or fainting; alcohol, hot weather, exercise, or fever may increase these effects. To prevent them, sit up or stand slowly, especially in the morning. Sit or lie down at the first sign of any of these effects. Terazosin is available only with your doctor's prescription. Hytrin relaxes the tightness of a certain type of muscle in the prostate and at the opening of the bladder. cardizem
Statistically significant differences were not found in the verapamil level with and without terazosin. Cohen J "Long-term efficacy and safety of terazosin alone and in combination with other antihypertensive agents. In all three studies, both symptom scores and peak urine flow rates showed statistically significant improvement from baseline in patients treated with Hytrin from week 2 or the first clinic visit and throughout the study duration. Dizziness, lightheadedness, or fainting especially when getting up from a lying or sitting position may be more likely to occur in the elderly, who are more sensitive to the effects of terazosin. The prevalence of adverse reactions has been ascertained from clinical trials conducted primarily in the United States. All adverse experiences events reported during these trials were recorded as adverse reactions. The prevalence rates presented below are based on combined data from fourteen placebo-controlled trials involving once-a-day administration of terazosin, as monotherapy or in combination with other antihypertensive agents, at doses ranging from 1 to 40 mg. Table 3 summarizes those adverse experiences reported for patients in these trials where the prevalence rate in the terazosin group was at least 5%, where the prevalence rate for the terazosin group was at least 2% and was greater than the prevalence rate for the placebo group, or where the reaction is of particular interest. Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully. Hematologic side effects have included thrombocytopenia. If high blood pressure is not treated, it can cause serious problems such as heart failure, blood vessel disease, stroke, or kidney disease. Remember that terazosin will not shrink the size of your prostate but it does help to relieve the symptoms.
Relative to solution, terazosin hydrochloride administered as Hytrin tablets is essentially completely absorbed in man. Food had little or no effect on the extent of absorption but food delayed the time to peak concentration by about 1 hour. Terazosin has been shown to undergo minimal hepatic first-pass metabolism and nearly all of the circulating dose is in the form of parent drug. The plasma levels peak about one hour after dosing, and then decline with a half-life of approximately 12 hours. In animals, terazosin causes a decrease in blood pressure by decreasing total peripheral vascular resistance. The vasodilatory hypotensive action of terazosin appears to be produced mainly by blockade of alpha-1 adrenoceptors. Terazosin decreases blood pressure gradually within 15 minutes following oral administration. In multiple dose clinical trials involving nearly 2000 hypertensive patients treated with Hytrin tablets, syncope was reported in about 1% of patients. Syncope was not necessarily associated only with the first dose. Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional. Keep out of the reach of children. Do not consider WebMD User-generated content as medical advice. Never delay or disregard seeking professional medical advice from your doctor or other qualified healthcare provider because of something you have read on WebMD. You should always speak with your doctor before you start, stop, or change any prescribed part of your care plan or treatment. WebMD understands that reading individual, real-life experiences can be a helpful resource but it is never a substitute for professional medical advice, diagnosis, or treatment from a qualified health care provider. If you think you may have a medical emergency, call your doctor or dial 911 immediately. Further dose response and dose duration studies are being carried out. Blood pressure should be measured at the end of the dose interval; if response is not satisfactory, patients may be tried on a larger dose or twice daily dosing regimen. The latter should also be considered if possibly blood pressure-related side effects, such as dizziness, palpitations, or orthostatic complaints, are seen within a few hours after dosing. discount entocort side
Program of monitoring or "Watchful Waiting". Some men have an enlarged prostate gland, but no symptoms, or symptoms that are not bothersome. If this applies, you and your doctor may decide on a program of monitoring including regular checkups, instead of medication or surgery. Hytrin is used to treat high blood pressure hypertension. Hytrin is also used to treat benign prostatic hyperplasia BPH in men. This leaflet describes Hytrin as a treatment for hypertension or BPH. What Is Hypertension High Blood Pressure? If Hytrin is helping you, you should notice an effect on your particular symptoms in 2 to 4 weeks of starting to take the medication. The responses in the standing position tended to be somewhat larger, by 1-3 mmHg, although this was not true in all studies. The magnitude of the blood pressure responses was similar to prazosin and less than hydrochlorothiazide in a single study of hypertensive patients. In measurements 24 hours after dosing, heart rate was unchanged. Symptoms may include dizziness; weakness. Not all side effects for Hytrin may be reported. You should always consult a doctor or healthcare professional for medical advice. Medication. There are different kinds of medication used to treat BPH. Your doctor has prescribed Hytrin for you. See "What Hytrin does to treat BPH" below. The greater blood pressure effect associated with peak plasma concentrations first few hours after dosing appears somewhat more position-dependent greater in the erect position than the effect of terazosin at 24 hours and in the erect position there is also a 6-10 beat per minute increase in heart rate in the first few hours after dosing. Oddly enough, though, I think this has led to another problem. The dose may be slowly increased to achieve the desired blood pressure response. The usual recommended dose range is 1 mg to 5 mg administered once a day; however, some patients may benefit from doses as high as 20 mg per day. Doses over 20 mg do not appear to provide further blood pressure effect and doses over 40 mg have not been studied. Blood pressure should be monitored at the end of the dosing interval to be sure control is maintained throughout the interval. It may also be helpful to measure blood pressure 2-3 hours after dosing to see if the maximum and minimum responses are similar, and to evaluate symptoms such as dizziness or palpitations which can result from excessive hypotensive response. If response is substantially diminished at 24 hours an increased dose or use of a twice daily regimen can be considered. If terazosin administration is discontinued for several days or longer, therapy should be reinstituted using the initial dosing regimen. In clinical trials, except for the initial dose, the dose was given in the morning. The absence of mutagenicity in a battery of tests, of tumorigenicity of any cell type in the mouse carcinogenicity assay, of increased total tumor incidence in either species, and of proliferative adrenal lesions in female rats, suggests a male rat species-specific event. Numerous other diverse pharmaceutical and chemical compounds have also been associated with benign adrenal medullary tumors in male rats without supporting evidence for carcinogenicity in man. Female rats were unaffected.
Bottles of 100 NDC 0074-3325-13. Caution should be observed when Hytrin tablets are administered concomitantly with other antihypertensive agents, especially the calcium channel blocker verapamil, to avoid the possibility of developing significant hypotension. When using Hytrin tablets and other antihypertensive agents concomitantly, dosage reduction and retitration of either agent may be necessary see PRECAUTIONS. Hypotension has been reported when Hytrin has been used with phosphodiesterase-5 PDE-5 inhibitors. To help you remember to take your medicine, try to get into the habit of taking it at the same time each day. The opinions expressed in WebMD User-generated content areas like communities, reviews, ratings, or blogs are solely those of the User, who may or may not have medical or scientific training. These opinions do not represent the opinions of WebMD. User-generated content areas are not reviewed by a WebMD physician or any member of the WebMD editorial staff for accuracy, balance, objectivity, or any other reason except for compliance with our Terms and Conditions. During cataract surgery, a variant of small pupil syndrome known as Intraoperative Floppy Iris Syndrome IFIS has been reported in association with alpha-1 blocker therapy see PRECAUTIONS. Nasal congestion and symptoms of sinusitis or dyspnea may be due to alpha-adrenergic blockade. Food and Drug Administration. WebMD does not endorse any specific product, service, or treatment. Only 4% of 354 patients from a multicenter trial complained of general abdominal pain or diarrhea within the first 90 days of therapy. Respiratory system side effects have been limited to nasal congestion in 2% to 12% of patients. Guthrie R "Terazosin in the treatment of hypertension and symptomatic benign prostatic hyperplasia - a primary care trial. Dizziness; drowsiness; lightheadedness; nasal congestion; nausea; weakness. Shionoiri H, Gotoh E, Ito T, Hata T, Iwatsubo H, Takegawa K, Ogihara T, Mikami H, Ikegami H, Otsuka A, Katahira K, Kawaguchi Y "Long-term therapy with terazosin may improve glucose and lipid metabolism in hypertensives - a multicenter prospective study. Blood pressure is the tension of the blood within the blood vessels. If blood is pumped too forcefully, or if the blood vessels are too narrow, the pressure of the blood against the walls of the vessels rises. In a short term study Study 1 patients were randomized to either 2, 5 or 10 mg of Hytrin or placebo. reminyl online australia legal
The adverse events were usually transient and mild or moderate in intensity, but sometimes were serious enough to interrupt treatment. In the placebo-controlled clinical trials, the rates of premature termination due to adverse events were not statistically different between the placebo and terazosin groups. Should overdosage of Hytrin lead to hypotension, support of the cardiovascular system is of first importance. Restoration of blood pressure and normalization of heart rate may be accomplished by keeping the patient in the supine position. If this measure is inadequate, shock should first be treated with volume expanders. If necessary, vasopressors should then be used and renal function should be monitored and supported as needed. Laboratory data indicate that Hytrin is highly protein bound; therefore, dialysis may not be of benefit. Hytrin is to be used only by the patient for whom it is prescribed. Do not share it with other people. Do not use it for other health conditions. Additional adverse reactions have been reported, but these are, in general, not distinguishable from symptoms that might have occurred in the absence of exposure to terazosin. Syncope has occurred in less than 1% of patients. Palpitations have been reported in 5% of patients, but are much less likely than with some other alpha-adrenergic blockers. Peripheral edema, cold extremities, and chest pain have been reported in up to 6%, 12%, and 5% of patients, respectively. Atrial fibrillation has been reported incidence not given.
Some of the side effects that can occur with terazosin may not need medical attention. As your body adjusts to the medicine during treatment these side effects may go away. Your health care professional may also be able to tell you about ways to reduce or prevent some of these side effects. If your symptoms do not improve or if they become worse, check with your doctor. Moderately clinically significant. Usually avoid combinations; use it only under special circumstances. The dose of Hytrin and the dose interval 12 or 24 hours should be adjusted according to the patient's individual blood pressure response. If you have any questions about Hytrin, please talk with your doctor, pharmacist, or other health care provider. The dizziness, lightheadedness, or fainting is more likely to occur if you drink alcohol, stand for long periods of time, exercise, or if the weather is hot. While you are taking this medicine, be careful to limit the amount of alcohol you drink. Also, use extra care during exercise or hot weather or if you must stand for long periods of time. adapalene
Genitourinary complaints have rarely included impotence and priapism. Bottles of 100 NDC 0074-3323-13. During controlled clinical trials, patients receiving terazosin monotherapy had a small but statistically significant decrease a 3% fall compared to placebo in total cholesterol and the combined low-density and very-low-density lipoprotein fractions. No significant changes were observed in high-density lipoprotein fraction and triglycerides compared to placebo. Extremely rarely, Hytrin and similar medications have caused painful erection of the penis, sustained for hours and unrelieved by sexual intercourse or masturbation. This condition is serious, and if untreated it can be followed by permanent inability to have an erection. If you have a prolonged abnormal erection, call your doctor or go to an emergency room as soon as possible. This is not a complete list of all side effects that may occur. If you have questions about side effects, contact your health care provider. Call your doctor for medical advice about side effects.
Product Information. Hytrin terazosin. The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine. Rarely, probably less than once in every several thousand patients terazosin and other α 1-antagonists have been associated with priapism painful penile erection, sustained for hours and unrelieved by sexual intercourse or masturbation. Two or three dozen cases have been reported. Because this condition can lead to permanent impotence if not promptly treated, patients must be advised about the seriousness of the condition see PRECAUTIONS - Information for Patients. The rash was accompanied by mild fever, asthenia, and intense pruritus. The patient was on no other medications. Hematologic and histopathologic studies suggested a drug reaction. Terazosin was discontinued. Two weeks following oral methylprednisolone 40 mg daily and emollients, symptoms had resolved completely. Hosmane BS, Maurath CJ, Jordan DC, Laddu A "Effect of age and dose on the incidence of adverse events in the treatment of hypertension in patients receiving terazosin. VERY weak urine stream. I find that, as long as I take it on schedule, and don't forget doses, my urine stream has improved a great deal, almost to the level of what I considered normal. Elhilali MM, Ramsey EW, Barkin J, Casey RW, Boake RC, Beland G, Fradet Y, Trachtenberg J, Orovan WL, Schick E, Klotz LH "A multicenter, randomized, double-blind, placebo-controlled study to evaluate the safety and efficacy of terazosin in the treatment of benign prostatic hyperplasia. Do not keep outdated medicine or medicine no longer needed. Terazosin helps relax the muscles in the prostate and the opening of the bladder. Includes weakness, tiredness, lassitude and fatigue. While syncope is the most severe orthostatic effect of Hytrin tablets see WARNINGS other symptoms of lowered blood pressure, such as dizziness, lightheadedness and palpitations, were more common and occurred in some 28% of patients in clinical trials of hypertension. In BPH clinical trials, 21% of the patients experienced one or more of the following: dizziness, hypotension, postural hypotension, syncope, and vertigo. Patients with occupations in which such events represent potential problems should be treated with particular caution. Hytrin should not be used in CHILDREN; safety and effectiveness in children have not been confirmed. Lepor H. Role of alpha-adrenergic blockers in the treatment of benign prostatic hypertrophy. diphenhydramine online money order now
Highest dose 10 mg shown. Analysis of clinical laboratory data following administration of terazosin suggested the possibility of hemodilution based on decreases in hematocrit, hemoglobin, white blood cells, total protein and albumin. Decreases in hematocrit and total protein have been observed with alpha-blockade and are attributed to hemodilution. Your doctor has prescribed Hytrin for your BPH and not for prostate cancer. However, a man can have BPH and prostate cancer at the same time. Doctors usually recommend that men be checked for prostate cancer once a year when they turn 50 or 40 if a family member has had prostate cancer. These checks should continue even if you are taking Hytrin. Hytrin is not a treatment for prostate cancer. You will start with a 1 mg dose of Hytrin. Then the dose will be increased as your body gets used to the effect of the medication. Small but statistically significant decreases in hematocrit, hemoglobin, white blood cells, total protein and albumin were observed in controlled clinical trials. These laboratory findings suggested the possibility of hemodilution. Treatment with Hytrin for up to 24 months had no significant effect on prostate specific antigen PSA levels. Patients should be advised about the possibility of priapism as a result of treatment with Hytrin and other similar medications. Patients should know that this reaction to Hytrin is extremely rare, but that if it is not brought to immediate medical attention, it can lead to permanent erectile dysfunction impotence. Hytrin works by relaxing blood vessels so that blood passes through them more easily. This helps to lower blood pressure. What is BPH? Even though you take Hytrin and it may help you, Hytrin may not prevent the need for surgery in the future. Hytrin Can Cause A Sudden Drop in Blood Pressure After the VERY FIRST DOSE. You may feel dizzy, faint, or "light-headed" particularly after you get up from bed or from a chair. This is more likely to occur after you've taken the first few doses, but can occur at any time while you are taking the drug. It can also occur if you stop taking the drug and then re-start treatment. Do not take other medicines unless they have been discussed with your doctor. This especially includes over-the-counter nonprescription medicines for appetite control, asthma, colds, cough, hay fever, or sinus problems, since they may tend to increase your blood pressure. Hytrin may cause a sudden drop in blood pressure after the first dose. Take your first dose at bedtime. If you get up during the night, sit up slowly, then stand slowly. Disclaimer: Every effort has been made to ensure that the information provided is accurate, up-to-date and complete, but no guarantee is made to that effect. In addition, the drug information contained herein may be time sensitive and should not be utilized as a reference resource beyond the date hereof. This material does not endorse drugs, diagnose patients, or recommend therapy. The use of the Truven Health products is at your sole risk. These products are provided "AS IS" and "as available" for use, without warranties of any kind, either express or implied. Truven Health and Drugs. AUC 0-24 increased 11% after the first verapamil dose and after 3 weeks of verapamil treatment it increased by 24% with associated increases in C max 25% and C min 32% means. Use Hytrin as directed by your doctor. Check the label on the medicine for exact dosing instructions.
About Prostate Specific Antigen PSA. Your doctor may have done a blood test called PSA. Your doctor is aware that Hytrin does not affect PSA levels. You may want to ask your doctor more about this if you have had a PSA test done. Remember that terazosin will not cure your high blood pressure but it does help control it. Therefore, you must continue to take it as directed if you expect to lower your blood pressure and keep it down. Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention. The classifications below are a general guideline only. It is difficult to determine the relevance of a particular drug interaction to any individual given the large number of variables. Hytrin may cause drowsiness, dizziness, blurred vision, or lightheadedness. These effects may be worse if you take it with alcohol or certain medicines. Use Hytrin with caution. Bottles of 100 NDC 0074-3322-13. redustat online visa purchase now
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Ocular side effects including Intraoperative Floppy Iris Syndrome IFIS have been observed in some patients undergoing phacoemulsification cataract surgery while being treated with alpha-1 blockers. Lepor H "Long-term efficacy and safety of terazosin in patients with benign prostatic hyperplasia. Analysis of the effect of Hytrin on individual urinary symptoms demonstrated that compared to placebo, Hytrin significantly improved the symptoms of hesitancy, intermittency, impairment in size and force of urinary stream, sensation of incomplete emptying, terminal dribbling, daytime frequency and nocturia. atlanta drug store uroxatral uroxatral
Tell your doctor or dentist that you take Hytrin before you receive any medical or dental care, emergency care, or surgery including eye surgery. Some medical conditions may interact with Hytrin. Terazosin hydrochloride is a white, crystalline substance, freely soluble in water and isotonic saline and has a molecular weight of 459. PREGNANCY and BREAST-FEEDING: If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of using Hytrin while you are pregnant. It is not known if this medicine is found in breast milk. If you are or will be breast-feeding while you use Hytrin, check with your doctor. Discuss any possible risks to your baby.
However, terazosin will not help shrink the prostate. The prostate may continue to grow. This may cause the symptoms to become worse over time. Therefore, even though terazosin may lessen the problems caused by enlarged prostate now, surgery still may be needed in the future. Patients who take medicine for high blood pressure often feel tired or run down for a few weeks after starting treatment. Be sure to take your medicine even if you may not feel "normal. Achari R, Laddu A "Terazosin: a new alpha adrenoceptor blocking drug. If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses. pcav.info mirtazapine
If you miss a dose of Hytrin, take it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once. If more than one dose is missed, contact your doctor or pharmacist. If high blood pressure is not treated, over time, the increased pressure can damage blood vessels or it can cause the heart to work too hard and may decrease the flow of blood to the heart, brain, and kidneys. As a result, these organs may become damaged and not function correctly. If high blood pressure is controlled, this damage is less likely to happen.