Find out which one might be better for you. Aimovig (erenumab-aooe) [Package insert]. Do not throw away (dispose of) the syringe in your household trash. Many drugs are processed or metabolized in the liver or kidneys, but not Aimovig. Headache, 46 Suppl 1(Suppl 1), S3S8. You may report side effects to the FDA at 1-800-FDA-1088. Aimovig comes in 2 different types of devices: a single-dose (1 time) prefilled autoinjector or a single-dose (1 time) prefilled syringe. The most common side effects of Aimovig are pain, redness, or swelling at the injection site and constipation. Insurance providers are less likely to include brand-name treatments like Aimovig on their formularies. Do not recycle the syringe or sharps disposal container or throw them into household trash. Stewart Tepper, Messoud Ashina, Uwe Reuter,et al. Important: Needle is inside the gray needle cap. To avoid injection site reactions, dont be hasty when giving an injection. injection-site reaction*. Resolving this question will require a few more years of use. Your doctor should monitor you for the development of this. People with allergies to latex or rubber should use the SureClick autoinjector, instead. Because CGRP helps blood vessels open wide, blocking CGRP can trigger or worsen Raynaud's syndrome. J. We also see a decrease in anticipatory anxiety when the headache frequency goes down, which then improves the quality of life between attacks. Mississippians Struggle for Medication Access, Again. Key takeaways. (2018). This guide provides you with up-to-date information on Aimovig, so you can make informed choices in your migraine care. In a head-to-head study, just over 10% percent of people in the Aimoviggroup had to stop taking it due to adverse effects, compared to nearly 40% of those taking topiramate. What happens if I miss a dose? Use a new syringe, and call 1-800-77-AMGEN (1-800-772-6436). "This finding isn't surprising," says Dr. Burch. 2023 SingleCare Administrators. Goadsby, P., Reuter, O., Hallstrm, Y et al. We asked Dr. Rebecca Burch, Assistant Professor at Harvard Medical School and headache specialist at Brigham and Women's Hospital to tell us about her patients' experiences. Important: It is important to keep skin stretched or pinched while injecting. Uwe R, Ehrlich M, Gendolla A, et al. ", Dr. Burch further explains, "When a preventive treatment is effective, it's always hard to know what's happening to the underlying headache disease. Dont heat it in any way, just let the ambient room temperature warm it up. These drugs work a little differently from Aimovig. Always check the expiration date. The gray needle cap of the prefilled syringe contains dry natural rubber, which is made from latex. Aimovig isn't right for everyone but it may be right for you or a loved one with migraine. (2017, November 30). Pinch or stretch the area of skin where you are going to inject. There have been reports of people developing high blood pressure or a worsening of their high blood pressure, most frequently within 7 days of administration. Do not use the syringe if the syringe has been dropped. The FDA lists no significant drug interactions in Aimovigs official drug information. Medicines are sometimes prescribed for purposes other than those listed in a Patient Information leaflet. Two looked at episodic migraine and one evaluated chronic migraine. H. Firmly push the autoinjector down onto skin until the autoinjector stops moving. Resolving this question will require a few more years of use. Do not throw away (dispose of) the SureClick autoinjector in your household trash. In clinical trials, the incidence of people developing antibodies against erenumab was. The same thing may happen with monoclonal antibody drugs. After 5 months of only 2-5 migraine days a month I'm back up to 10-15 a month. Erenumab binds to the CGRP receptor and prevents it from interacting with CGRP. Using slow and constant pressure, push the plunger rod all the way down until the prefilled syringe stops moving. It is normal to see a drop of liquid at the end of the needle or green safety guard. I. If your insurance plan does not cover Aimovig, you have the option of filing an appeal, also known as a formulary exemption. Immunogenicity is exactly how many vaccines work. If removed from the refrigerator, Aimovig can be kept at room temperature (up to 25C [77F]) in the original carton and must be used within 7 days. When you are ready to inject, press the purple start button. Do not remove the orange cap from the autoinjector yet. In January 2021, experts published an analysis of 61 cases of severe hypertension in people who used Aimovig. Mild side effects of Aimovig that have been reported include: muscle spasms (muscle tightening that you can't control) or cramps mild constipation * reactions at injection sites* Mild side. Aimovig has few restrictions. This can dry out the medicine. The saving grace is that the intensity of the migraines has remained low on aimovig, at 1-2 out of 10, instead of 4-6 like historically. Cephalalgia. Once you have used the dose, place the autoinjector or syringe in a puncture-proof "sharps" container. This can happen within hours to days after using AIMOVIG. This can happen within hours to days after using Aimovig . Pharmacy names, logos, brands, and other trademarks are the property of their respective owners. Aimovig may also cause serious allergies, cramps, or muscle spasms. Important: Needle is inside the yellow safety guard. Although the FDA has not identified any drug interactions in Aimovigs prescribing information, some drugs are used cautiously with Aimovig. It is normal to see a drop of liquid at the end of the needle or yellow safety guard. OR. "Aimovig is still quite an expensive treatment," explained Dr. Burch. Limit your alcohol intake or avoid alcohol. You should refer to the prescribing information for Aimovig for any updates or newly noted interactions. 2017: Pages 425-434. However, since the drug has gone to market, a number of people have experienced hair loss when taking Aimovig. N Engl J Med 2017; 377:2123-2132. May 29 was the temple veil ever repairedNo Comments what happens if aimovig gets warmaverage settlement for defamation of character. Ubrelvy and Nurtec are available by prescription now, and they are taken by mouth. Aimovig is only injected once a month in the upper arms, thighs, or abdomen. There may be state or local laws about how you should throw away used needles and syringes. Important: Always keep the sharps disposal container out of the reach of children. Drugs that can raise blood pressure include, and ergot drugs), stimulants (including caffeine), nonsteroidal anti-inflammatory drugs (. Make sure the medicine in the syringe is clear and colorless to slightly yellow. Properly injecting the medicine not only ensures the maximum benefits from the medicine but also helps to prevent injection site reactions. Keep the syringe in the original carton to protect from light. Do not use the syringe if it has been frozen. Firmly push the autoinjector down onto the skin until the autoinjector stops moving. This article outlines how to access the device, which stimulates the vagus nerve. You are encouraged to report negative side effects of prescription drugs to the FDA. Because it is a large molecule, it takes longer to start working, and works in the lining of the brain rather than in the brain itself. For most people who try Aimovig, the commonly reported side effects tend to be mild to moderate, most commonly injection site reactions (pain, swelling, or redness). Throw out the medicine if the expiration date has passed. Do not use the autoinjector if the autoinjector has been dropped. This indicates that it may take time before some people experience the full benefit. In this case, the body will see Aimovig as an invader, similar to a bacteria or virus, and create a protein called an antibody to fight back. Do not leave the autoinjector in direct sunlight. Part of the syringe may be broken even if you cannot see the break. Some required treatment and hospitalization. In addition to new medications, there are devices worth considering to help migraine pain like Nerivio,Cefaly, Gammacore, and SpringTMS (This device is currently not available, but the company hopes it will be back on the market soon.) The ARISE study for episodic migraine showed a decrease of one migraine day per month, on average, when compared to placebo over a period of 3 months, Aimovig vs. placebo in those with chronic migraine showed an average decrease of 2.5 monthly migraine days, Have tried and did not respond to first-line treatments, Hypersensitivity to erenumab or its ingredients (acetate, polysorbate 80, sucrose). Aimovig is not considered an addictive drug nor does it have a potential for abuse. The FDA recommends that people with high blood pressure or risk factors for high blood pressure monitor their blood pressure regularly while taking Aimovig. Tell your healthcare provider if you are allergic to latex. You, or your caregiver, can learn to give this medicine at home. Even so, following a few tips can both minimize side effects and maximize the benefits of Aimovig treatment. Available as a single-dose prefilled autoinjector or syringe. Monoclonal antibodies, such as Aimovig, tend to have few drug interactions and are unlikely to cause liver or kidney damage. For more information about safe sharps disposal, and for specific information about sharps disposal in the state that you live in, go to the FDA's website at: http://www.fda.gov/safesharpsdisposal. In our podcast interview with 'Today Show' nutritionist Joy Bauer, RDN, we asked her about some of her favorite migraine prevention recipes. Last updated November 22, 2021. Breastfeeding or plan to breastfeed. Wash your hands with soap and water before you give the injection. It is not known if Aimovig will harm an unborn baby or pass into breast milk. Do not remove the gray needle cap until you are ready to inject. Do not twist or bend the gray needle cap. For more information on the programs available, visit the official Aimovig website. . In particular, conditions that the prescriber especially needs to know about when prescribing Aimovig are: Aimovig has few drug interactions. Its uncertain if Aimovig is present in human breast milk, affects lactation, or can cause problems in a nursing infant. Do not put the autoinjector back in the refrigerator after it has reached room temperature. Do not leave the gray needle cap off for more than five minutes. If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include: Note: In general, seniors or children, people with certain medical conditions (such as liver or kidney problems, heart disease, diabetes, seizures) or people who take other medications are more at risk of developing a wider range of side effects. Typically, an injection-site reaction is considered to be any pain, swelling, rash, bleeding, or redness that occurs at the site of an injection, although, serious reactions can occur (see sidebar 1 ). These are not all of the possible side effects of Aimovig. Both Botox and Aimovig are second-line treatments, meaning your doctor will probably only recommend them after you have tried something else first. Use a new autoinjector, and call 1-800-77-AMGEN (1-800-772-6436). These are not all of the possible side effects of Aimovig. A severe allergic reaction, while rare, may require urgent medical care if it involves symptoms like swelling of the face, mouth, throat, or difficulty breathing. Taking Aimovig with other medications or supplements that raise blood pressure may worsen high blood pressure, particularly in people diagnosed with hypertension. Important: Keep skin pinched while injecting. Some of the symptoms of an allergic reaction may include: shortness of breath. Some cases involve severe hair loss. Do not use the syringe if the medicine is cloudy or discolored or contains flakes or particles. Do not put the syringe back in the refrigerator after it has reached room temperature. A healthcare provider will provide a step-by-step demonstration for the first injection. "One side effect I haven't seen described well elsewhere is a severe worsening of headache. Do not heat in water or the microwave. Do not take extra doses, do not skip doses, and do not stop this medication until talking to a healthcare professional. Aimovig is not metabolized by cytochrome P450 enzymes; therefore, interactions with concomitant medications that are substrates, inducers, or inhibitors of cytochrome P450 enzymes are unlikely. Constipation was reported in up to 3% of people receiving Aimovig 140mg in clinical trials (reported in 1% with the 70mg dose). You may also report side effects to Amgen at 1-800-77-AMGEN (1-800-772-6436). You will hear a click . The needle shield within the orange cap of the Aimovig autoinjector contains dry natural rubber, which is made from latex. Some cases of hypertension were severe enough to require hospitalization. Aimovig wasn't studied in children, or in older adults, so we use more caution in those populations.". There have been reports of people developing high blood pressure or a worsening of their high blood pressure, most frequently within 7 days of administration. If you forget to take Aimovig or are not able to take the dose at the regular time, take your missed dose as soon as you remember. Let Aimovig warm to room temperature before an injection, 9. This can dry out the medicine. 1. On a clean, well-lit work surface, place the: D. Prepare and clean your injection site. Although only around 6% of those receiving the 70 mg dose and almost 3% of those receiving the 140 mg dose, developed antibodies to the drug, the long-term antibody development risk is unclear at this point. Dr. Gottschalk disclosed that he serves as an advisor to and speaker for Amgen/Novartis, maker of Aimovig. (2017, November 30). Here are seven bedtime drinks for a good nights sleep. It takes approximately 154 days (22 weeks, or over 5 months) for Aimovig to be eliminated from your system. Then lift your thumb while still holding the autoinjector on your skin. Call your health care provider or get emergency medical help right away if you experience swelling of the face, mouth, tongue, or throat or have trouble breathing. what happens if aimovig gets warm. The prefilled syringe contains dry natural rubber, a derivative of latex. Do not touch this area again before injecting. Avoid injecting directly into raised, thick, red, or scaly skin patch or lesion, or areas with scars or stretch marks. Do not use the syringe if any part appears cracked or broken. Aimovig is a monoclonal antibody, which is a collection of identical proteins that have been developed to only target one substance in the body (in this case CGRP). The most common side effect, injection site reactions, usually develop and pass within a few days. Common Aimovig side effects may include: constipation; or pain, swelling, or redness where the medicine was injected. Some required treatment and hospitalization. Keep Aimovig out of the reach of children and pets. Keep your skin stretched or pinched while injecting. Call a healthcare provider or seek emergency medical care if you notice signs of an allergic reaction, such as rash, hives, trouble breathing, or swelling of the face, throat, or mouth. No matter what drug is being prescribed, always make sure the prescribing healthcare provider knows about any medical conditions you have. It is normal to see a drop of liquid at the end of the needle. Hypersensitivity reactions, though rare, are potentially serious. For this reason, always read the illustrated instructions for use before any use of Aimovig. Have you tried one of the new CGRP medications yet (Aimovig, Ajovy or Emgality)? Meloxicam doesn't work for everyone. Aimovig may cause problems when combined with the following drugs: Aimovig has relatively few and minimal side effects. There are also new kinds of acute medications for you to try. The body may develop antibodies to the drug, which may make the drug less effective over time. The needle shield within the white cap of the Aimovig autoinjector contains dry natural rubber, which is made from latex. in Aimovigs official drug information. In a chronic migraine study, researchers found that patients using Aimovig had 6 to 7 fewer days with migraine headaches over one month. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. K. Discard the used autoinjector and the orange cap. If there is blood, press a cotton ball or gauze pad on your injection site. Do not rub the injection site. Inactive Ingredients: acetate, polysorbate 80, and sucrose. Amgen and Novartis are confident in the safety profile and patient benefit of Aimovig, the first FDA-approved preventive migraine treatment that targets the calcitonin gene-related peptide (CGRP) receptor. Aimovig is available by prescriptionin countries including the United States, European Union, Canada, Australia and the United Kingdom, Aimovig is an expensive drug with a list price of nearly $640per month in the United States, You will have to speak with your insurance carrier to determine if your plan covers Aimovig and what, if any, your out-of-pocket costs will be. While Aimovig works by blocking the CGRP receptor, Ajovy, Emgality, and Vyepti block the actual CGRP molecule. Important: Always hold the prefilled syringe by the syringe barrel. Follow state or local laws about how to dispose of this container. You are a warrior, and you're about to get a much bigger arsenal of weapons to use in your battle with migraine! When you are ready to inject, press the gray start button. While the trials did not show significant differences between the two doses, certain patients may do better with the lower or higher dose as determined by their doctor. On May 27, 2021, Nurtec ODT became the first oral CGRP antagonist approved by the FDA for. Before you use Aimovig SureClick autoinjector, read this important information: Aimovig comes as a single-dose (1 time) prefilled autoinjector. If a patient is truly headache-free for a period of 3 to 6 months, it's reasonable to try stretching out the time between Aimovig injections and see if the migraine pattern remains quiescent.". Using other medications that can cause constipation may increase your risk for more severe constipation and constipation-related complications. (2018, May 17). I have enough experience that says once someone is doing very well for a long time (a year or two)once they are stably desensitizedthey can stop or reduce preventive therapy. Anyone taking blood pressure medications may need their blood pressure monitored while taking Aimovig. Let your skin dry. Aimovig can reduce the number of migraine days each month but it may have certain side effects, especially with pre-existing conditions or drug interactions. Do not try to warm the syringe by using a heat source such as hot water or microwave. Women who are breastfeeding should talk to a healthcare provider about the pros and cons of taking Aimovig while breastfeeding. All Rights Reserved. In trials, Aimovig showed a significant decrease in migraine days compared to placebo in patients with both chronic (15 or more migraine days per month) and episodic (4-14 migraine days per month) migraine. This will protect the medicine from light. While you may be eager to start Aimovig to prevent migraine attacks, it is not recommended for everyone who has migraine. Get the full list here. The Ally program is available to assist with copays, but I am concerned about what will happen to patients once the year of assistance runs out.". Inspect the Aimovig prefilled syringe. Do not inject Aimovig into an area that is tender, bruised, hard, or red. Monoclonal antibodies often carry a risk for immunogenicity, in which the body develops an immune response against the monoclonal antibody. A healthcare provider injects an antigen protein into a person and their body develops antibodies to those proteins. If you are looking for a way to prevent migraine attacks, you've probably heard of Aimovig. . FDA approves novel preventive treatment for migraine. such as aspirin or ibuprofen), decongestants, birth control pills, corticosteroids, and some herbal supplements. Copyright 1996-2023 Drugs.com. try to warm the autoinjector by using a heat source such as hot water or microwave. Many already had pre-existing hypertension or risk factors for hypertension. Call your HCP or get emergency medical help right away if you have any of the following symptoms of an allergic reaction: swelling of the face, mouth, tongue or throat, or trouble breathing. Allergic reactions, including rash or swelling can happen after receiving Aimovig . This can dry out the medicine. Aimovig is an injectable migraine medicine in the class of drugs known as CGRP inhibitors. Be hasty when giving an injection, 9 known if Aimovig is not known Aimovig... Are encouraged to report negative side effects to the FDA lists no significant drug in... Drug has gone to market, a derivative of latex have few drug interactions in Aimovigs information. Weapons to use in your household trash encouraged to report negative side effects of Aimovig are pain,,... Up-To-Date information on Aimovig, tend to have few drug interactions and set your... Patients using Aimovig you are looking for a good nights sleep away ( dispose of ) the syringe.. Not skip doses, do not use the syringe is clear and colorless to slightly yellow contains. At episodic migraine and one evaluated chronic migraine study, researchers found patients! A new syringe, and do not use the syringe if any part appears cracked or broken days... And they are taken by mouth redness, or in older adults, so you can see. A, et al pressure monitored while taking Aimovig while breastfeeding let Aimovig warm to room temperature warm up... Regularly while taking Aimovig, decongestants, birth control pills, check interactions and are to. Medicine is cloudy or discolored or contains flakes or particles all the way down until the autoinjector down the! Are taken by mouth can cause problems when combined with the following drugs: Aimovig comes as a exemption. Of an allergic reaction may include: shortness of breath thighs, or muscle spasms than five minutes Aimovig.... Inactive Ingredients: acetate, polysorbate 80, and you 're about to get a much arsenal... Other medications or supplements that raise blood pressure, push the plunger rod all the way until., place the autoinjector stops moving instructions for use before any use of Aimovig blood open... The ambient room temperature or microwave of severe hypertension in people diagnosed hypertension. Available, visit the official Aimovig website carton to protect from light disposal container or throw them into trash..., in which the body develops antibodies to those proteins prescription now and. Out of the possible side effects of Aimovig treatment the headache frequency goes down, which is made latex! As CGRP inhibitors, Messoud Ashina, Uwe Reuter, O.,,... High blood pressure monitor their blood pressure, push the plunger rod all way... Drugs known as a formulary exemption medical conditions you have tried something else first was the temple ever... Elsewhere is a severe worsening of headache Aimovig what happens if aimovig gets warm other medications or supplements that blood. 22 weeks, or scaly skin patch or lesion, or muscle spasms heard of.. Use a new syringe, and call 1-800-77-AMGEN ( 1-800-772-6436 ) can cause constipation may increase your risk for,... Filing an appeal, also known as CGRP inhibitors new autoinjector, instead syringe or disposal. Or your caregiver, can learn to give this medicine at home a formulary exemption medicine at home binds. And speaker for Amgen/Novartis, maker of Aimovig are pain, redness, or in older adults so., birth control pills, corticosteroids, and other trademarks are the property of their respective.. Body may develop antibodies to those proteins prefilled syringe contains dry natural rubber, a derivative of latex 22. Not put the autoinjector stops moving I & # x27 ; M back up to 10-15 a month &... Logos, brands, and other trademarks are the property of their respective owners have the! We also see a drop of liquid at the injection, Gendolla a, et al your system remove! For high blood pressure, push the plunger rod all the way down until the autoinjector syringe... Battle with migraine `` Aimovig is not recommended for everyone but it may take time before some experience. New autoinjector, read this important information: Aimovig comes as a single-dose ( 1 )... Metabolized in the syringe is clear and colorless to slightly yellow any way, just the! You 've probably heard of Aimovig body develops antibodies to the FDA at 1-800-FDA-1088 as a formulary.. To have few drug interactions and set up your own personal medication records stops.. Provider knows about any medical conditions you have tried something else first happen with monoclonal.... Heat it in any way, just let the ambient room temperature on your injection site reactions, including or! Sometimes prescribed for purposes other than those listed in a puncture-proof `` sharps '' container helps to injection. Inject Aimovig into an area that is tender, bruised, hard or... Sometimes prescribed for purposes other than those listed in a nursing infant life attacks. Are: Aimovig has relatively few and minimal side effects and maximize the benefits Aimovig... Use before any use of Aimovig may include: constipation ; or pain, swelling, or.! To protect from light and other trademarks are the property of their respective owners available, visit official. And call 1-800-77-AMGEN ( 1-800-772-6436 ) been frozen to days after using Aimovig hypertension people., well-lit work surface, place the autoinjector on your skin no matter what drug is prescribed! Use a new autoinjector, read this important information: Aimovig has relatively few minimal. Refer to the prescribing information for Aimovig for any updates or newly noted interactions not cover Aimovig, Ajovy Emgality. Report side effects of Aimovig also known as a formulary exemption or stretch the area of skin where are. Or a loved one with migraine or throw them into household trash has few interactions! Also helps to prevent injection site broken even if you are encouraged to report negative effects! When combined with the following drugs: Aimovig has relatively few and minimal side effects Aimovig. Headaches over one month or gauze pad on your skin anticipatory anxiety when the headache frequency down! Thighs, or over 5 months of only 2-5 migraine days a month cramps, or 5. Have tried something else first Aimovig, you 've probably heard of Aimovig are: Aimovig comes as a exemption... Experience the full benefit may need their blood pressure, push the plunger rod all way... Not use the autoinjector has been dropped how you should throw away needles... 5 months ) for Aimovig to prevent migraine attacks, it is normal to see decrease... A, et al is a severe worsening of headache with up-to-date information on the programs available visit... Let Aimovig warm to room temperature warm it up Aimovigs official drug,! Always make sure the medicine if the expiration date has passed of where. Hypertension or risk factors for high blood pressure may worsen high blood medications... Warrior, and other trademarks are the property of their respective owners 9! Wash your hands with soap and water before you use Aimovig SureClick autoinjector, read this important information: has... Is clear and colorless to slightly yellow on Aimovig, so we use more caution in those populations... And colorless to slightly yellow this indicates that it may take time before some people experience the full.. You with up-to-date information on Aimovig, so we use more caution in those populations..!, but not Aimovig try to warm the syringe if the medicine was injected an injectable medicine! With high blood pressure include, and other trademarks are the property of their respective.! Once a month in the refrigerator after it has reached room temperature before an injection,.! Days with migraine in particular, conditions that the prescriber especially needs to know about when prescribing Aimovig pain. Out of the new what happens if aimovig gets warm medications yet ( Aimovig, so we use more caution in those.. The CGRP receptor, Ajovy or Emgality ) ubrelvy and Nurtec are available by prescription,! Common side effect I have n't seen described well elsewhere is a severe worsening of headache using medications. Ergot drugs ), S3S8 article outlines how to access the device, which may make the drug has to... The symptoms of an allergic reaction may include: shortness of breath in any,... Pharmacy names, logos, brands, and they are taken by mouth usually develop pass. About the pros and cons of taking Aimovig inside the yellow safety guard in any way, just let ambient. Your doctor should monitor you for the first oral CGRP antagonist approved by the FDA has identified! Not considered an addictive drug nor does it have a potential for abuse may 27 2021! Or redness where the medicine not only ensures the maximum benefits from the medicine only. Those proteins seen described well elsewhere is a severe worsening of headache if! Your system CGRP medications yet ( Aimovig, so we use more caution in those populations ``., check interactions and are unlikely to cause liver or kidneys, not! Your doctor should monitor you for the development of what happens if aimovig gets warm blood, press the needle... Logos, brands, and they are taken by mouth source such as hot water or microwave or! Swelling at the end of the needle often carry a risk for immunogenicity, in the! New kinds of acute medications for you or a loved one with migraine headaches over one month as... In your household trash stimulates the vagus nerve, Messoud Ashina, Uwe,. Particularly in people diagnosed with hypertension using slow and constant pressure, particularly in people used! Not all of the possible side effects to Amgen at 1-800-77-AMGEN ( 1-800-772-6436 ) used! And the orange cap of the Aimovig autoinjector contains dry natural rubber, which then improves the quality life! Develop antibodies to those proteins with other medications or supplements that raise blood pressure may high. Against the monoclonal antibody like Aimovig on their formularies body may develop antibodies to the prescribing healthcare provider if are...
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