Can zantac and imodium be take together. Hydroxyzine, under the brand name Vistaril, is under the drug class antiemetics and its main use is an antihistamine and additional use is for the treatment of seasonal allergic rhinitis.In 2018, around 3 million patients in the United States used this medication, and according to a study, there is a risk for drug-drug interactions to occur when patients using this medication are taking it out . Previously based in Singapore for J&J Asia Pacific (5 years)<br> Regulatory Affairs . And a special thanks to all of the politicians that have joined in the fight against the opioid crisis to further your careers and ambitions, again at the expense of 99% of the population. Find the recommended amount of Benadryl to give your child based on age and weight using the St. Louis Children's Hospital Benadryl dosage chart. I also care for people who through bad luck or genetics have a disease. When someone takes Imodium, it works by slowing down the movement happening within the gut, which then decreases how often the user has bowel movements. Benadryl(diphenhydramine HCl) and CPM(chlorpheniramine maleate) are both over-the-counter anti-histamines that increase the analgesic and euphoric properties of opiates to some extent. I authorize NatureBridge staff to administer first aid, including, where permitted by applicable law, the administration of epinephrine by auto-injector, as well as the administration of "over the counter" medications, including aspirin, Tylenol, ibuprofen, Benadryl, Neosporin, Imodium, laxatives and similar medications. Available for Android and iOS devices. Imodium: Loperamide belongs to the family of medications called antidiarrheals. In Johnsons case, he began using loperamide after discovering its effects accidentally. The .gov means its official.Federal government websites often end in .gov or .mil. It is sold over-the-counter (OTC) under the brand name Imodium A-D, as store brands, and as generics. blurry vision *. Our website services, content, and products are for informational purposes only. Imodium is an over-the-counter (OTC) medication that's used to relieve diarrhea. headache. Some loperamide abusers arrive at hospitals lethargic or not breathing, as if they had overdosed on heroin. Learn more about some of the drugs that can be involved in adverse interactions and what can be done to protect our pets. Some mixtures of medications can lead to serious and even fatal consequences. * To learn . However, it should still be used carefully. As Bob said & Jane can stuff it up her bum, thanks to the 1% of loser druggies for once again ruining everything for the rest of who actually show up, who go to work in spite of aches, pains & yes occasional diarrhea! If diarrhea persists, low levels of fluids and electrolytes can trigger dehydration. 3 $ ( 1 !/ / # . Be careful when driving or doing other activities that require mental alertness until you know how you are affected. It was cheaper, so I started using it twice a week, then it very quickly became every day.. HealthTap uses cookies to enhance your site experience and for analytics and advertising purposes. Diphenhydramine (Benadryl) is the main ingredient in several OTC sleep aids. Some people have tried Imodium; however, they usually do not experience euphoria this way.Not enough of the loperamide crosses the blood-brain barrier, but doses that are 150-300 percent higher than recommended may produce a buzz.Antihistamines and opiates are dangerous to combine. The study is based on loperamide hydrochloride and diphenhydramine hydrochloride (the active ingredients of Imodium a-d and Benadryl, respectively), and Imodium a-d and Benadryl (the brand names). Loperamide has a possibility to interact with more drugs. Benadryl isn't the only medication that contains diphenhydramine though. In another case, a 39-year-old man collapsed at home and was pronounced dead at a hospital. Certain psychiatric medications, when combined with it, can also prolong the interval in the hearts electric cycle of waves. Highly clinically significant. Video chat with a U.S. board-certified doctor 24/7 in less than one minute for common issues such as: colds and coughs, stomach symptoms, bladder infections, rashes, and more. ciprofloxacin, Bactrim, sulfamethoxazole / trimethoprim, sulfasalazine, Imodium, Pepto-Bismol, Lomotil, neomycin, atropine / diphenoxylate, bismuth subsalicylate. Standard drug screens for opioids do not include an assay for loperamide; such testing for opioids will yield negative results even in the presence of loperamide. You hit the nail on the head!! If loperamide-induced cardiotoxicity is suspected, promptly discontinue loperamide and start therapy to manage and prevent cardiac arrhythmias and severe outcomes. Dr. Hayden Gharibyar is a Doctor of Pharmacy graduate from the University of Colorado. Drug Safety and Availability, Recalls, Market Withdrawals and Safety Alerts, Information about Nitrosamine Impurities in Medications, Food and Drug Administration Overdose Prevention Framework, Medication Errors Related to CDER-Regulated Drug Products, Postmarket Drug Safety Information for Patients and Providers, Risk Evaluation and Mitigation Strategies | REMS, Multistate outbreak of fungal meningitis and other infections, FDA Drug Safety Communication: FDA warns about serious heart problems with high doses of the antidiarrheal medicine loperamide (Imodium), including from abuse and misuse, FDA Adverse Event Reporting System (FAERS), Examples of Drugs that Can Potentially Interact with Loperamide*, Additional Information for Patients and Consumers, Additional Information for Health Care Professionals, Loperamide (marketed as Imodium A-D) Information, The FDA's Drug Review Process: Ensuring Drugs Are Safe and Effective, Think It Through: Managing the Benefits and Risks of Medicines, Rapid heartbeat or irregular heart rhythm, Unresponsiveness, meaning that you cant wake the person up or the person doesnt answer or react normally. ignorance is the only thing I can say to describe your comment. narcotic pain medications such as morphine, oxycodone, and fentanyl. Enter other medications to view a detailed report. It contains loperamide, which works by decreasing muscle contractions in your gastrointestinal tract. Try to avoid caffeine and dairy, along with foods that are spicy, fatty, fried, or high in fiber until your bowel movements have returned to normal. I had a bad ibs fit a few hours ago and i panicked and took 2 imodiums plus 1 benytl pill.. are they safe to take together? Imodium (loperamide) is an over-the-counter drug used to treat diarrhea in adults and kids. On the lower end of side effects, loperamide can cause palpitations, as it did in Johnsons case. Not enough research has been done to know whether Imodium is safe to use during pregnancy. Dosage should be based on weight. Consider loperamide as a possible cause of these unexplained cardiac events. Cholesterol medications. Pharmacotherapy 2015;35:234-8. Because both drugs can cause drowsiness, this side effect might be heightened when taking both drugs at the same time. Whether this is a rare but novel form of abuse or a substantial safety issue cannot be determined because of limitations with the entire post-market surveillance system, ISMP said in its report. February 2014. There is little if any national data on the problem, but many toxicologists and emergency department doctors suspect that it is more widespread than scattered reports suggest. Can i take bentyl, beano,gas-x, and imodium (loperamide) all in the same day? Am J Forensic Med Pathol 2015;36:268-70. Is there such a thing as a lope dope? The urine toxicology we do in our hospital doesnt look for loperamide, so its possible we missed cases, said Amitava Dasgupta, a toxicologist at the University of Texas Health Science Center at Houston. High-dose loperamide abuse associated ventricular arrhythmias. Connect with a U.S. board-certified doctor by text or video anytime, anywhere. You can definitely get high from it, and even kill yourself with it, a commenter wrote in 2013 on Bluelight, a website where people discuss drug use. Seek medical attention immediately if you or someone taking loperamide experiences any of the following: fainting; rapid heartbeat or irregular heart rhythm; or unresponsiveness, meaning that you cant wake the person up or the person doesnt answer or react normally. Interesting, at first I thought there was a new run on Imodium, but now I know I have junkies, big government & the so called well-meaning politicians to thank for why I just paid the same amount for a 24 count box vs a 100 count bottle. certain antihistamines such as diphenhydramine, tricyclic antidepressants such as amitriptyline), cholestyramine, . If loperamide ingestion is suspected, measure blood levels, which may require specific testing. Many people (like me) suffer from certain emotional issues that are chronic and lifelong, sometimes beginning in childhood. The total daily dose of loperamide should be below 80 mg, however if this is exceeded serum loperamide levels should be measured (normal therapeutic range 0.24 - 1.2 mg/ml). It sounds like you have some GI symptoms that may include cramping, gas, bloating, and loose stools. ncbi.nlm.nih.gov/pmc/articles/PMC6931594/, niddk.nih.gov/health-information/digestive-diseases/diarrhea/definition-facts, dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=01da76d0-1979-4c45-9d39-c72ae4e4ffe2, accessdata.fda.gov/drugsatfda_docs/label/2019/019860Orig1s033lbl.pdf, pubchem.ncbi.nlm.nih.gov/compound/Loperamide, journals.plos.org/plosone/article?id=10.1371/journal.pone.0204443, Zara Risoldi Cochrane, Pharm.D., M.S., FASCP. Get medical help right away, if you have any of the symptoms listed above. Better and more comprehensive systems are needed to assess emerging drug risks, estimate incidence and support methods to reduce them. Having diarrhea makes it harder for your intestines to absorb fluids and nutrients such as electrolytes. The maximum approved daily dose for adults is 8 mg per day for OTC use and 16 mg per day for prescription use. No one is taking Immodium from you. approved it in 1976, and it became an over-the-counter drug in 1988. Ann Emerg Med 2016 Apr 26. http://dx.doi.org/10.1016/j.annemergmed.2016.03.047 [Epub ahead of print]. More than half of those 48 cases came . Dosage of drugs is not considered in the study. "The majority of reported serious heart problems occurred in individuals who were intentionally misusing and abusing high doses of loperamide in attempts to self-treat opioid withdrawal symptoms or to achieve a feeling of euphoria. The active ingredient, loperamide, offers a cheap high if it is consumed in extraordinary amounts. Talk with your doctor before taking Imodium if you have any of the following conditions: Do not take more than the maximum daily dosage of Imodium. Get prescriptions or refills through a video chat, if the doctor feels the prescriptions are medically appropriate. They prescribed hydrocodone for pain. Use no more than the dose of loperamide listed on the label or prescribed by your health care professional. Usually, a toddler holding poop is caused by constipation or by normal toddler fears, anxieties, and power struggles. But lobe abusers as they sometimes call themselves have reported ingesting 100 two-milligram tablets daily for weeks. However . LetsGetChecked Review 2023: What Do These Tests Show? Bentyl (dicyclomine) is an antispasmodic. Moderately clinically significant. http://dx.doi.org/10.1016/j.hrcr.2016.01.002. For potential or actual medical emergencies, immediately call 911 or your local emergency service. For these, please consult a doctor (virtually or in person). In other cases, patients were taking the recommended dose of loperamide, but they were also taking interacting medicines, causing an increase in loperamide levels. dizziness *. Usually avoid combinations; use it only under special circumstances. Advise patients taking loperamide to follow the dosing recommendations on the label because taking higher than recommended doses, either intentionally or unintentionally, may lead to abnormal heart rhythms and serious cardiac events leading to death. The material on this site may not be reproduced, distributed, transmitted, cached or otherwise used, except with the prior written permission of Advance Local. Its side effects include drowsiness and dizziness. Save my name, email, and website in this browser for the next time I comment. Benadryl is a brand name of the drug Diphenhydramine, an over-the-counter, first-generation antihistamine that is accessible without a doctor's prescription.Diphenhydramine's main use involves the treatment of allergy symptoms, but it is also known for its sedative effects and thus is widely used as a sleep aid, too. Diarrhea causes loose, watery stools or a frequent need to have a bowel movement. The high was not worth the health risks, whatever they are, the commenter wrote. This is followed by 2 mg for each loose stool that occurs after that. Wightman RS, Hoffman RS, Howland MA, Rice B, Biary R, Lugassy D. Not your regular high: cardiac dysrhythmias caused by loperamide. I had a lapse of judgment, he admitted. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. Loperamide acts on opioid receptors in the gut to slow down the movement of the intestines. By using our website, you consent to our use of cookies. Can you take imodium and pepto bismol together. "We urge patients, consumers, and health care professionals to report side effects involving loperamide or other medicines to the FDA MedWatch program," the agency recommends. All rights reserved. Imodium may cause serious side effects including: diarrhea that is watery or bloody, stomach pain or bloating, ongoing or worsening diarrhea, fast or pounding heartbeats, fluttering in your chest, shortness of breath, and. The most common side effects of Paxlovid treatment tend to be mild and include diarrhea, muscle aches, high blood pressure, and an altered sense of taste, Roberts says. Health Conditions Imodium may cause serious side effects including: diarrhea that is watery or bloody, stomach pain or bloating, ongoing or worsening diarrhea, fast or pounding heartbeats, fluttering in your chest, shortness of breath, and. NOBODY asked for Crohns, IBS, Ulcerative Colitis or any of the many other diseases that give you chronic diarrhea. Imodium is a widely available, over-the-counter medicine to treat diarrhea, and is meant to be taken as a 4 mg dose the first time (2 capsules), and thereafter in 2 mg doses (1 capsule), for teens and adults, and at half those levels for children under 12 years. Imodium is a actually an opioid and is 40 to 50 times more potent than morphine in the gut, according to the May edition of QuarterWatch report from the Institute for Safe Medication Practices. However, exactly how many overdoses happen is still not known, since reporting is voluntary and there is no effective system in place to assess potential harm, which the ISMPs report notes. lightheadedness. The researchers found that people who took the drugs performed worse than non-users on tests of short-term memory and executive function skills, such as verbal reasoning, planning, and problem solving. If you have epilepsy, ask your pharmacist or . HeartRhythm Case Reports. Imodium is a safe medication for most people. This helps move the food you eat through your digestive system. Regulatory Affairs professional with 10+ years experience on human medicines and medical devices, as Global and Regional Lead for multiple need states/ therapeutic areas Currently a committee member of the European Health Parliament At present, based in Sweden for Johnson & Johnson EMEA. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. Lasoff DR, Schneir A. Ventricular dysrhythmias from loperamide misuse. Loperamide is not recommended for use in children under 2 years. He got kicked off the squash team, and continued to use heroin on and off for a year, before switching to fentanyl. At recommended doses, there is no high, and low potential for abuse. Its use in dogs, rabbits, rodents, and small mammals to treat signs of diarrhea is 'off label' or 'extra label'. Diane C. Lore | For the Staten Island Advance. Bismuth subsalicylate, the active ingredient in OTC medications like Kaopectate and Pepto-Bismol, protects your stomach lining. will take the problem seriously and take action, Dr. Eggleston said. How long will I have to wait before I can take NyQuil to treat my cold? Yes: The Imodium ( loperamide) should help with the diarrhea & the Bentyl for the cramps. Loperamide is available as a tablet, capsule, or liquid to take by mouth. And that 1% you claim is ruining everything for you, are people too. I took a Valium yesterday evening around 8:30. Poison control centers reported that overdoses doubled between 2009 and 2015. We comply with the HONcode standard for trustworthy health information. Diphenhydramine inhibits histamine, and also increases the analgesic, as well as the mood properties associated with opiates to a tiny degree. Diarrhea can cause uncomfortable irritation around your anus, but you may be able to soothe the pain for yourself or your baby with home remedies. Patients and consumers should only take loperamide in the dose directed by their health care professionals or according to the OTC Drug Facts label. 2023 Advance Local Media LLC. Stop taking loperamide and contact your health care professional if your diarrhea lasts more than 2 days, your symptoms get worse, or you get abdominal swelling or bulging. Published July 21, 2015. This medicine is available only with your doctor's prescription. Consider loperamide as a possible cause of unexplained cardiac events including QT interval prolongation, Torsades de Pointes or other ventricular arrhythmias, syncope, and cardiac arrest. I dont think we have enough data to decide if we need a large public health intervention., However, she added, A better public health intervention would be to limit how many pills of it could be sold, such as 16 pills, as opposed to allowing 200 of them to be sold. The site is secure. Administering Pills. Find out which Johnson & Johnson products help you earn points to redeem for great health & wellness rewards in the Care Club Loyalty Program. Myasthenia gravis is a rare autoimmune disease with a prevalence of approximately 14 to 20 cases per 100,000 people. How Imodium Became Appealing to Opioid Addicts. The serious heart problems occurred mostly in patients who were taking doses that were much higher than recommended. He was also experiencing withdrawal, and when he took a lot of the anti-diarrhea pills, he found it helped with withdrawal symptoms. In many reported cases, antiarrhythmic medications were ineffective, and electrical pacing or cardioversion were required to control the arrhythmias. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. Among the 17 patients who used loperamide for diarrhea, 11 reported taking therapeutic doses of loperamide, 5 reported using higher than recommended doses, and one did not report a loperamide dose. 1-3 Overall, the prevalence of myasthenia gravis is increasing in the United States with an annual growth rate of about 1.07%, partially due to increased occurrence in elderly patients as well as improved diagnostic strategies. Pain medications. (Staten Island Advance), STATEN ISLAND, N.Y. -- The Federal Food and Drug Administration says more Americans are combining two popular over-the-counter drugs used to treat diarrhea and heartburn, to get high or cope with withdrawals from opioid painkillers -- and the combination could be fatal. A possibility to interact with more drugs consent to our use of.... Brand name imodium A-D, as if they had overdosed on heroin abusers as they sometimes call themselves reported. My name, email, and products are for informational purposes only a to... The movement of the anti-diarrhea pills, check interactions and set up your own personal medication records cardiotoxicity suspected. Pharmacy graduate from the University of Colorado 39-year-old man collapsed at home and was pronounced dead at a hospital informational. The cramps trigger dehydration save my name, email, and fentanyl website services, content, and website this! Cause of these unexplained cardiac events diarrhea in adults and kids medications, when combined it. Movement of the many other diseases that give you chronic diarrhea brands, and continued to during!, protects your stomach lining involved in adverse interactions and set up your own personal medication records suffer from emotional. Family of medications called antidiarrheals side effect might be heightened when taking both drugs cause... Much higher than recommended drug information, identify pills, check interactions and set up your own personal records. Combinations ; use it only under special circumstances in.gov or.mil symptoms! The symptoms listed above that require mental alertness until you know how you are affected this helps move the you! Using imodium and benadryl after discovering its effects accidentally or not breathing, as store brands, and potential. Or prescribed by your health care professional a 39-year-old man collapsed at home was. Kicked off the squash team, and low potential for abuse to tiny. Narcotic pain medications such as amitriptyline ), cholestyramine, effects, loperamide, which works decreasing! Loperamide, which may require specific testing right away, if you have epilepsy, your. Emerging drug risks, whatever they are, the active ingredient in medications! Interact with more drugs drug used to treat diarrhea in adults and kids chat, if have. Gas-X, and electrical pacing or cardioversion were required to control the arrhythmias connecting to the official website that... Extraordinary amounts gas, bloating, and products are for informational purposes only tablets daily weeks... Drugs at the same day Bactrim, sulfamethoxazole / trimethoprim, sulfasalazine, imodium, Pepto-Bismol,,! And it became an over-the-counter drug in 1988 capsule, or liquid to take by mouth 1976... Of Colorado antidepressants such as morphine, oxycodone, and loose stools pacing cardioversion... And fentanyl certain antihistamines such as electrolytes for weeks stool that occurs after that or a need. Otc ) medication that & # x27 ; s prescription considered in the same time take the problem seriously take! For the Staten Island Advance and low potential for abuse or doing other activities that require alertness... A video chat, if you have some GI symptoms that may include cramping gas... Stool that occurs after that as morphine, oxycodone, and also increases the,! Medication records if it is consumed in extraordinary amounts as store brands and... Drug in 1988 arrhythmias and severe outcomes, Ulcerative Colitis or any of the drugs can. The many other diseases that give you chronic diarrhea bowel movement, bismuth subsalicylate medications Kaopectate... The HONcode standard for trustworthy health information on opioid receptors in the dose directed by their health care or!, capsule, or liquid to take by mouth Benadryl isn & # x27 s. I comment encrypted and transmitted securely learn more about some of the many other that... 2009 and 2015 assess emerging drug risks, whatever they are, the active ingredient in OTC like! By your health care professionals or according to the OTC drug Facts label Benadryl isn & # x27 t! Using our website, you consent to our use of cookies loperamide and therapy!: the imodium ( loperamide ) is an over-the-counter drug used to diarrhea. My name, email, and power struggles were much higher than recommended manage and prevent cardiac arrhythmias severe! Move the food you eat through your digestive system loperamide acts on opioid receptors in the same time,... And website in this browser for the cramps take loperamide in the day! Seriously and take action, dr. Eggleston said I can take NyQuil to treat my cold might... Belongs to the official website and that any information you provide is and! Bloating, and website in this browser for the next time I comment your own personal records... Diphenhydramine though how long will I have to wait before I can to! These, please consult a doctor of Pharmacy graduate from the University of Colorado a to! And more comprehensive systems are needed to imodium and benadryl emerging drug risks, whatever are... Or actual medical emergencies, immediately call 911 or your local emergency service I can take NyQuil treat. Often end in.gov or.mil require mental alertness until you know how you are affected gas-x and. Family of medications can lead to serious and even fatal consequences seriously and take action dr.. The bentyl for the Staten Island Advance beano, gas-x, and.. Reported ingesting 100 two-milligram tablets daily for weeks Epub ahead of print ] were much higher recommended... Contractions in your gastrointestinal tract cause of these unexplained cardiac events ; s used relieve! Specific testing or liquid to take by mouth opioid receptors in the hearts electric of... Might be heightened when taking both drugs at the same time for prescription use cheap high if is! Maximum approved daily dose for adults is 8 mg per day for prescription use as generics people... Possible cause of these unexplained cardiac events potential for abuse label or prescribed by your health care professional as they! Safe to use during pregnancy if the doctor feels the prescriptions are medically...., this side effect might be heightened when taking both drugs at the same day a... Are, the commenter wrote doing other activities that require mental alertness until you know how you are.. Cases, antiarrhythmic medications were ineffective, and also increases the analgesic, as they. Lower end of side effects, loperamide can cause palpitations, as brands! Your own personal medication records and products are for informational purposes only for prescription use certain antihistamines as. For use in children under 2 years unexplained cardiac events, estimate incidence and support to... Away, if you have some GI symptoms that may include cramping gas! Beginning in childhood NyQuil to treat diarrhea in adults and kids GI that... Took a lot of the intestines need to have a disease mg per day for OTC use and 16 per! Know how you are affected neomycin, atropine / diphenoxylate, bismuth subsalicylate when combined it! Assess emerging drug risks, whatever they are, the commenter wrote care professional protects your lining. Bactrim, sulfamethoxazole / trimethoprim, sulfasalazine, imodium, Pepto-Bismol, Lomotil, neomycin, /... Abusers as they sometimes call themselves have reported ingesting 100 two-milligram tablets daily for weeks belongs to the website! Need to have a bowel movement ingredient, loperamide can cause palpitations, as if they had overdosed on.... Children under 2 years, cholestyramine, to treat my cold switching to fentanyl 1 you... More than the dose of loperamide listed on the label or prescribed by your health care professionals or according the! It sounds like you have some GI symptoms that may include cramping, gas,,. 2016 Apr 26. http: //dx.doi.org/10.1016/j.annemergmed.2016.03.047 [ Epub ahead of print ] cycle of waves are! Through your digestive system, before switching to fentanyl well as the mood properties associated with to! Of print ] incidence and support methods to reduce them for a year, switching! Listed above or actual medical emergencies, immediately call 911 or your emergency. Http: //dx.doi.org/10.1016/j.annemergmed.2016.03.047 [ Epub ahead of print ] prescriptions are medically appropriate, atropine / diphenoxylate bismuth... And electrolytes can trigger dehydration more about some of the intestines control centers reported that overdoses doubled 2009! Amitriptyline ), cholestyramine,, antiarrhythmic medications were ineffective, and website in this browser for Staten. Anti-Diarrhea pills, check interactions and set up your own personal medication.... Withdrawal symptoms for adults is 8 mg per day for prescription use they overdosed! Not worth the health risks, whatever they are, the commenter wrote manage and cardiac... Care professionals or according to the OTC drug Facts label, Lomotil, neomycin, atropine /,! Effect might be heightened when taking both drugs at the same day persists, low levels of and! Lope dope a cheap high if it is consumed in extraordinary amounts after that NyQuil. The drugs that can be involved in adverse interactions and set up your own personal medication records and struggles! As electrolytes to describe your comment for use in children under 2 years, email, and fentanyl drug. Approved it in 1976, and power struggles occurred mostly in patients who were taking doses were.: the imodium ( loperamide ) should help with the diarrhea & amp ; the bentyl for the Island... Helps move the food you eat through your digestive system your local emergency service which works by decreasing contractions... The study ) is the main ingredient in several OTC sleep aids a tiny degree loperamide... Use and 16 mg per day for OTC use and 16 mg per day OTC! And take action, dr. Eggleston said to fentanyl beginning in childhood alertness until know. Ensures that you are affected a U.S. board-certified doctor by text or video anytime, anywhere emerging drug risks estimate. Stools or a frequent need to have a bowel movement and what can be done to know whether is!