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Thread: Valpoate, Topamax or neurontin for swift diazepam withdrawal

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    Valpoate, Topamax or neurontin for swift diazepam withdrawal 
    #1
    High, I'd appreciate any help you can give me re the title. Basically my benzo tolerance is getting out of hand I'm taking 100mg + every day of diazepam. I'm prescribed 2 ml diazepam tabs to take 3 times per day for anxiety but had a chance to buy more so right now I'm sitting on a lot and I know that if I don't sort this out soon then I'm in for a really really bad time. I also take bupe for opiate addiction- 16 mg.

    Anyway I have reasearched a few case studies in which the benzo abuser was quickly tapered off their benzo over say a week or two while adding an anticonvulsant with great success- the most successful being Topamax and Neurontin.

    I am seriously thinking of doing this or at least trying it. So my question is has anybody used anticonvulsants in benzo withdrawal with success? and how do you think this plan looks? I have diazepam on hand if withdrawal symptoms become too bad etc.

    I also have baclofen- they say that baclofen tolerance does not develop to the thereputic effects- what if I where to switch to that and then taper- sort of like a Benzo Replacement Therapy.

    I'll add that I won't be staying on the anticonvulsants for long and will taper accordingly.

    What do you think guys? Thanks
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    #2
    Here is a case story of what I mean:

    Abstract

    There is an increasing interest in anticonvulsants for the treatment of benzodiazepine withdrawal, and among the newer substances gabapentin seems particularly promising due to its gabaergic and its glutamate-antagonistic activity. We present the case of a rapid benzodiazepine-withdrawal controlled successfully with gabapentin.


    Introduction

    The most often recommended method for benzodiazepine withdrawal is slow tapering (1), which, however, requires a constant motivational management and is therefore often associated with poor treatment retention. This may be particularly true for multidrug users, who usually prefer to withdraw all substances at once and will not stand for long lasting procedures.

    There are different theoretical rationales for using anticonvulsants in substance abuse patients. One important argument is their lack of addiction potential. A further rationale is in part based on evidence supporting the role of kindling in withdrawal syndrome, which has been proposed as a model for understanding withdrawal syndromes (2). Many of the withdrawal phenomena have been linked to modulations of the glutamatergic and/or the gabaergic system. Kindling and learning as well as behavioral sensitization has been described in this context as particular forms of long-term potentiation, which share some neuronal structures and neurophysiological processes. Each of these phenomena has been reported to be established and reinforced during repeated intermittent stimulation, e.g. during application of addictive drugs.

    Some data on carbamazepine show an effect on a number of behavioral effects of benzodiazepine withdrawal (3). Adjunctive carbamazepine reduces iatrogenic benzodiazepine withdrawal severity in placebo-controlled studies (4,5,6). Similarly, two studies found that carbamazepine reduced benzodiazepine withdrawal in benzodiazepine-abusing populations (7, . Despite encouraging case reports of valproate in the treatment of benzodiazepine withdrawal, this could not be confirmed by controlled trials (9, 10). We also have reported recently on the use of topiramate in opiate and in benzodiazepine detoxification(11,12,13).

    Gabapentin, a drug used as adjunctive therapy in the treatment of partial seizures, lacks the shortbacks of benzodiazepines in the treatment of drug dependent patients, such as risk of drug interactions and abuse potential. It has recently been suggested to have some efficacy in the treatment of mild to moderate alcohol withdrawal (14,15,16,17).

    Gabapentin is eliminated via renal mechanisms, which may be of particular utility in patients with hepatic dysfunctions. It furthermore does not interact with liver enzymes thus decreasing the risk of pharmacokinetic interactions. Although it has no direct effect on GABA receptors or transporters, it has been shown to increase GABA turnover in various regions of the brain. It binds to subunits of the L-type calcium channels and increases the synthesis and nonsynaptic release of GABA in the brain (18,19,20). Moreover, it may influence the synthesis of glutamate (20). It has been hypothesized that gabapentin may, through its GABAergic activity, restore the feedback inhibition from the nucleus accumbens after alteration through repeated cocaine use (21).

    Crockford et al. (22) have recently presented a case of benzodiazepine detoxification aided by the use of gabapentin. Their patient, a 49-years old woman with a history of panic disorder and generalized anxiety was dependent on alprazolam and furthermore abused butalbital and diphenhydramine. Gabapentin was given to facilitate clonazepam-based treatment.

    We report the case of a gabapentin-assisted detoxification in a patient who, in addition to benzodiazepine dependence, had a long history of alcohol, opiate and cocaine abuse.

    Case Report

    A 30 year old patient had been abusing alcohol since the age of 15, opiates and cocaine since 19, and high-dose benzodiazepines since 25. She has a history of recurrent depression, which has been treated during the last year with citalopram 20 mg/d. She had undergone several opiate and cocaine detoxifications between 20 and 25 years, experiencing regularly severe withdrawal symptoms like nausea, vomiting, irritability and insomnia. After 8 years of repeated methadone treatments she succeeded to withdraw from illegal drugs 4 years ago, to attend a therapeutic community during 8 months, and not to consume illegal drugs since then. She, however, reports a subsequent significant increase of alcohol and benzodiazapine consumption. She was therefore hospitalized 4 times for alcohol detoxification during the last 3 years, always exhibiting severe withdrawal symptoms including important tremor, agitation and anxiety, needing high doses of benzodiazepines.

    Whereas infectious hepatitis as well as HIV-infections were excluded prior to the current inpatient detoxification, the hepatic sonography showed signs of a beginning cirrhosis. During the previous 12 months she was hospitalized twice due to acute pancreatitis. As she presented a considerable alcohol consumption of about 15 standard drinks per day, combined with a consumption of oxazepam 240mg per day, she was proposed to be firstly admitted for alcohol detoxification in the alcohol detoxification unit. The alcohol detoxification was performed adapting the oxazepam dose, stabilizing it finally at 15 mg q.i.d. The withdrawal syndrome was characterized by slight tremor, insomnia and fluctuating anxiety and agitation.

    After one week of stable oxazepam dose at 15 mg q.i.d. the patient was transferred to our specific inpatient detoxification program at the Psychiatric University Hospital. The urine screening at admission showed no recent intake of cannabis, cocaine and opiates. As the patient requested a rapid benzodiazepine detoxification, and as she had not tolerated carbamazepine and topiramate during previous hospitalizations, gabapentin was proposed to her. She was informed about the experimental nature of the treatment, as an adjunctive treatment to the benzodiazepine tapering.

    Oxazepam was rapidly tapered out over 4 days. Concomitantly, the patient was administered gabapentin 500mg the first day, 800mg the second day, and 900mg from the third to the ninth day. It was then tapered out until day 12. During his 14-day hospitalization the patient experienced as withdrawal symptoms only transient insomnia, which responded well on zolpidem 10mg and trimipramine 50mg. While she was closely monitored with regard to other benzodiazepine withdrawal symptoms, especially vegetative symptoms, no further withdrawal signs were observed.

    At discharge the patient did receive no more medication beside the antidepressant treatment with citalopram. She has not relapsed with regard to any of the substances during the subsequent month.

    Discussion

    While a slow tapering of benzodiazepines may take several months until complete detoxification, our case confirms a previous report (22) suggesting that gabapentin treatment can be a more rapid alternative, even in patients with a history of multidrug dependence including cocaine and opiate abuse. Besides transient insomnia, all typical withdrawal symptoms were prevented by gabapentin in our case. The course of our case was quite similar to that reported by Crockford et al.. Both patients also described a “benzodiazepine-like” effect even after definitive wash-out of the benzodiazepines. The maximum gabapentin dose given in our patients was 900 mg/d compared to 600 mg/d in Crockford's case, and the dose was well tolerated by the patient, who had previously only poorly tolerated carbamazepine and topiramate.

    Different mechanisms underlying the efficacy of gabapentin in benzodiazepine withdrawal can be considered. Although it has no direct effect on GABA receptors or transporters, it has some GABA-ergic activity, which may be sufficient to compensate the benzodiazepine-related GABA activity. E.g. it has been hypothesized that gabapentin, through its GABAergic activity, may restore the feedback inhibition from the nucleus accumbens after alteration through repeated drug use (21). Furthermore, gabapentin has been reported to influence the synthesis of glutamate (20). Indeed, the role of glutamatergic mechanisms in synaptic plasticity and long-term behavioral adaptation to drugs has repeatedly been emphasized (23).

    In addition to its increasingly corroborated efficacy in the treatment for alcohol detoxification, gabapentin seems to become a promising alternative in benzodiazepine detoxification, for benzodiazepine monodependence as well as for patients with multiple drug abuse.

    Corresponding author

    Daniele Zullino
    Service d'abus de substances
    Hôpitaux Universitaires de Genève
    Rue verte 2
    CH – 1205 – Genève
    Tel.: + 41 22 372 55 60
    Fax: + 41 22 328 17 60
    e - mail: [Daniele.Zullino@hcuge.ch]
    Last edited by DJ25; 20-11-2009 at 15:49.
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    #3
    Greenlighter
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    The problem with Diazipam is that you build a tolerance very quick,I get 100 10mg a month and I have two wait a few days after I take some until I take them again,or I don't feel them.As far as neurontin I would not even take that it could throw you into withdraw immediately,I would just try and taper down a bit until your down to 10mg a day then 5,then stop.
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    #4
    How would neurontin put you in withdrawal??? and are your diazepam prescribed?

    Anyway I am completely useless at tapering (hence the suboxone for Pod/morphine/codeine/tramadol and dihidrocodeine addiction), (heroin also) and have other drug problems- cocaine mostly.

    I just find this interesting, A case study of a lady who was hopelessly addicted to alprazolam and was successfully treated using Topamax is available online. There is increasing interest in the psych /drug community in anticonvulsants.
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    #5
    Bluelighter HighonLife's Avatar
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    i guess if you can then go for it but i would be very careful

    the words swift and benzo WD seems like a bit of a contradiction though
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    #6
    Bluelighter DopaMan's Avatar
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    Neurontin will not "throw you into withdrawal, " as previously stated. It's a relatively minor anticonvulsant which is NEVER used by itself for the treatment of seizure disorder BUT this doesn't mean it can't be used during benzo withdrawal....although this is a time in which a person will be at risk for seizures. Either way until I read the aforementioned studies I have no idea just how effective gabapentin will be for WD's, although I can only guess it will be beneficial in either benzo WD or even EtOH WD.
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    #7
    Well Dopaman that was my thinking- sort of giving it a shot- I havent tried neurontin yet so I'm about to get some in. There are also as mentioned a few studies re topamax in which they state the properties of the drug (I can't remember the exact science mechanisms) can reverse addictive behaviour such as compulsive gambling, sex addicion, alcoholism etc etc (only while one takes the drug of course!)

    Although Topamax used in addictions are nothing new. It occurred to me that if they are so beneficial in alcohol and other addictions then why not benzos right?

    Although I haven't seen a dosing regime for a topamax all of this will be trial and error as I have benzo's on hand of things get out of hand and my aunt who is a nurse said she would help me out.
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    #8
    Bluelighter
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    Can you give your vallies to a friend/family member to give to you on a shedule?

    I'm sure if you where to take a 2mg a few times a day - when the WD started to get truely unbearable, then after a few days you would be well on track to just taking what you are prescribed.
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    #9
    when i withdrew from benzo's i tried depakote and neurontin both helped not completely but what made a horrific experience a little more manageable, i tend to think for me the depakote helped more because neurontin wears of fast and tolerance grows to fast also with it , dont know much about topamax,
    i know you asked about anticonvulsants but if you could try to get your hands on clonidine that helped me alot,
    i tend to also agree with above poster get someone a family member or someone you trust to help you wean down, i tried cold turkey didnt work, goodluck and wish you success i hate benzo's now couldnt pay me to take them but when i was on them wow what a hate love relationship, i have been a heroin methadone bupe addict for almost eighteen yrs and benzo's are what seriously kicked my ass not something i would wish on anyone
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    #10
    I have clonidine asha, thanks for that. Can I ask what sort of dose you took re Valproate as I have the 200 mg pills (UK). I find 200-400 mg quite good for anxiety/mood etc.

    Btw- what are people's oppinions on swapping to Baclofen and then tapering?

    THanks
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    #11
    hmmm sorry i dont exactly remember dosage it was like a greyish blue pill if that makes any sense to you ,maybe you know what dose that is in depakote, i only took it for a week because i was pregnant so i tried to stop almost all my medications, sorry i dont know anything about baclofen but i remember when i was ready to quit the benzo"s i searched everywhere on line for a magic cure, it sucks honestly but i knew and always known that i would have to pay for my usage and i couldnt get out of some withdrawal but depakote clonidine doxepin for sleep, and neurontin kept it from getting out of hand, sorry your going through this wish you the best oh side note beware of so called herbal cures i am embarrased to think of all the money i spent on them, and none really helped whatsoever
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    #12
    Yeah thanks ash, I don't get on with valerian lol. I haven't tried theanine which is supposed to help. The only other thing I can think of would be Phenibut, but that has it's own addiction potential. I also have access to Soma. So there are a few things I could juggle about I suppose. Thanks for the concern.

    The thing that get's a hold on me in withdrawal is the hypersomnia/depression and irritability. I don't seem to get the anxiety that bad- I read a book (accessed online) that we derease our REM sleep so that basically when we cease use of benzo's we are in for some catching up of our natural sleep cycle's. This for me was worse than opiate withdrawals. I also get hot and cold flashes, extreme sensitivity to stimuli etc etc.

    Actually the story of why I obtained the benzo's is quite paradoxical to the above I obtained them in order to do a slow taper as in the past I'd done cold turkey's and I believed I had messed my GABA functioning up and believed I could fix this by doing a slow taper but before that 'why not have some fun before' ha, that came back to bite me on the ass.
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    #13
    yeah i get yah i honestly could never taper any drugs really, i mean i know that you are supposed to quit benzo's by tapering but i just cant do it , i tried the taper method with every drug i ever did but lol it just isnt in me to be able to save drugs,
    i did like theanine i forgot and magnesium helped a bit, the somas and clonidine should really help you along with the depakote or neurontin , also since your sleep schedule is of wack maybe try a little melatonin, i know what you mean about valerian not to good for me does opposite effect actually,
    i agree also i think benzo withdrawal was way worst than opiate addiction , im not bragging whatsoever but i have been shooting drugs for almost twenty yrs and was addicted to almost every drug that is out there but barbs and i will tell you i would quit heroin over benzo's anyday, it feels like life is so big, everything is louder, brighter, stronger, but i will tell you it gets better i am so happy i dont take them anymore, since when i finally quit them i think i used valium three times, once to come down from speed and two other times when me and my ex broke up and i didnt like them like i used to, actually i think my mind was trying to remind me how fucked up the withdrawal was,
    hey if you need a friend to talk to or just some support msg me i will mail you back goodluck
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    #14
    Bluelighter morphonorconic's Avatar
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    I can't say with any certainty what effects Depakote or Topamax would have. Depakote has acts on GABA receptor sites, and might be useful. Neurontin can definitely be helpful for Benzodiazepine withdrawl, as I have learned from experience. The only problem that comes to mind is the fact that Gabapentin lowers the seizure threshold, and so does having a deficit of Diazepam in your system. Those two factors together will increase the likelyhood of having a seizure.

    I believe Baclofen would provide some level of relief without any adverse effects to worry about, though I do not know much about this drug either, other than the fact it too acts at GABA receptors sites.

    Between the four drugs you have mentioned, plus whatever remaining Diazepam you have left, you should be able to ween down/off without any danger, and probably without too much discomfort either. If I were you, I do some thorough research on Depakote, Topamax, Neurontin, and Baclofen to gather all the knowledge you can in regards to each one, and any possible adverse effects or contraindications between any of the four, as well as pertaining to your situation and your intended use, and make an informed decision as to which drugs you will use, and how much of them you will need.

    Taking the least amount necessary is always a good idea in situations like these, due to the fact that the substitutes you plan to use are pharmacologically similar to Valium, and going overboard with them will only make your situation worse in the long run.

    Good luck; Benzo w/d is about as bad as it gets. Hopefully you will learn from this experience, so you can avoid situations like these in the future.
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    #15
    I vote for giving a few to someone to hold onto and dispense to you, if you can't control how many you take. If you have the benzos to taper with, nothing is going to be better or smoother than a gradual decline. Plus, diazepam is pretty much the benzo you're supposed to switch to when you're tapering, so you're really a step ahead of everyone else; you can start cutting back right away.
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    #16
    Bluelighter Colmes's Avatar
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    none of the medications you named will do shit in the midst of serious valium withdrawl.

    The words swift, diazapam, and withdraw shouldnt be used in the same sentence.

    You have to taper really, if you care about your sanity, plus withdraws can cause seizures and can be potentially life threatening.
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    #17
    Quote Originally Posted by Colmes View Post
    The words swift, diazapam, and withdraw shouldnt be used in the same sentence.
    100% truth.
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    #18
    Quote Originally Posted by BollWeevil View Post
    100% truth.
    Well it seemed to work in the above mentioned study and there are other case studies in which it's seemed to work obviously aided by other drugs. I know where your coming from though. I've been reading a bit about topamax and believe it actually works in reducing addictive behaviour in general- sex addiction, cocaine addiction.

    I'm not saying getting of a benzo swiftly would be the best way foreward but with increasing levels of interest by the medical proffession in treating alcohol withdrawal etc with anticonvulsants, I'm saying they are on to something and it's about time they found substitutes.

    I mean depakote and I think Topamax work on the Gaba-a receptor. And although neurontin/pregabalin don't thy have other features that help withdrawal, for example glutamate antagonism (I think), something to do with calcium channels/NMDA antagonism which increases Gaba synthesis in the brain.

    In fact I've just got my doctor to script me Lyrica- but I'm only at a starting dose of 100 mg per day, and need much less valium, sometimes more than half the amount taken previously. I find high dose pregabalin to ease valium withdrawal massively. Once I'm scripted a higher dose I think I will give the vals to my mother and try using the lyrica (although I know Lyrica has it's downsides, like amnesia etc and it's not that easy to come off but much easier than benzo's in my experience.
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    #19
    I was first given neurontin in the er when i went for opiate withdrawals. I was given 600mg in the er and the dr offered to write me a script, i was pissed and said no thanks. I went outside and sat on the curb for about an hour waiting for my ride, when all of the sudden i realized my back wasnt hurting anymore, and my legs werent cramping so bad, and i seemed kinda calm....so i swallowed my pride, went back inside, found the doc and asked for the script....it made the withdrawals much easier.
    Now I take neurontin for a different reason. I am prescribed 300mg 3x a day. I take all 3 at once, and I get high. It is not the same as an opiate high, but i love it. It actually varies in the ways it makes me feel...sometimes i feel like i just smoked weed, sometimes light and spacey, it always makes me motor-mouth, sometimes energetic where i clean all day, yet i sleep great if i take it at night. It's really wierd to me all the different effects this drug has on me. BUT, if i take too much, i hate it....it feels like when you smoke too much weed and get too high, you know where you cant wait for it to wear off.
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    #20
    Greenlighter
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    Quote Originally Posted by lunashahla View Post
    I was first given neurontin in the er when i went for opiate withdrawals. I was given 600mg in the er and the dr offered to write me a script, i was pissed and said no thanks. I went outside and sat on the curb for about an hour waiting for my ride, when all of the sudden i realized my back wasnt hurting anymore, and my legs werent cramping so bad, and i seemed kinda calm....so i swallowed my pride, went back inside, found the doc and asked for the script....it made the withdrawals much easier.
    Now I take neurontin for a different reason. I am prescribed 300mg 3x a day. I take all 3 at once, and I get high. It is not the same as an opiate high, but i love it. It actually varies in the ways it makes me feel...sometimes i feel like i just smoked weed, sometimes light and spacey, it always makes me motor-mouth, sometimes energetic where i clean all day, yet i sleep great if i take it at night. It's really wierd to me all the different effects this drug has on me. BUT, if i take too much, i hate it....it feels like when you smoke too much weed and get too high, you know where you cant wait for it to wear off.
    Yeah neurontin at a high enough dose does give a "high" if you will. Like he said, if you take toooooo much, you will be regretting it. Its IMO like a drunken/sloppy "high", that is if you dont fall asleep.
    It does help ease my benzo w/d when i run out, it basically just helps mellow the w/d out.
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    HOW TO GET OFF BENZO'S. THIS WILL SAVE YOUR LIFE. Dr. Ashton leading benzo withdrawal 
    #21
    [SIZE="3"]expert. This link will take you directly to her withdrawal schedule.
    Print the one that applies to you, find a really GOOD DOCTOR show him or her this site and get on this withdrawal schedule A.S.A.P.

    THIS WILL SAVE YOUR LIFE. PASS ON THE INFORMATION TO ANYONE WHO NEEDS IT PLEASE.

    SITE WITH WITHDRAWAL SCHEDULE BELOW.

    SCROLL DOWN TO SEE WHICH ONE IS RIGHT FOR YOU. THIS IS A FREE SERVICE!

    http://benzo.org.uk/manual/index.htm
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    #22
    TRUTH. www.benzo.org.uk look at the leading beno withdrawal expert in the world's schedule. Saved my life and many others. But there is nothing "swift" about it! TRUTH!
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    #23
    truth!
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    try this ok it has saved so many people's lives and good luck you can do it! 
    #24
    www.benzo.org.uk look for Professor Ashton's withdrawal schedule see what you are on and follow it if you have a great doctor who can help even better.

    I did it. You can do it too! Prayers to all getting off Benzo's and you guys are amazing helping each other lots of interesting info. Thanks!
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    #25
    hello
    i am new to this site so please bare with me.
    i think m son is addicted to diazipam- they are not scripted.
    How can I help him to get off them as i have read it can cause seizures etc if you just stop- which he obvously can't......... thanks
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