The central type does not respond to local treatments and associates often with psychiatric comorbidity (depression or anxiety), whereas the peripheral type responds to peripheral lidocaine blocks and topical clonazepam. He currently practices as a hospitalist at Newton Wellesley Hospital. No. There may not be a way to prevent BMS. Your doctor may ask you to check your pulse (heart rate) daily and will tell you how fast it should be. American Academy of Oral & Maxillofacial Pathology: "Burning Mouth/Burning Syndrome. We comply with the HONcode standard for trustworthy health information. Conditions that have been reported in association with burning mouth syndrome include chronic anxiety or depression, various nutritional deficiencies, type 2 diabetes (formerly known as noninsulin-dependent diabetes) and changes in salivary function. It will take time but if the prednisone caused your condition, it will eventually diminish and disappear. If the burning doesn't go away or gets worse, see your dentist or doctor. Referral to a subspecialist with expertise in this area may be beneficial in particularly difficult cases. A healthcare professional should be consulted before taking any drug, changing any diet or commencing or discontinuing any course of treatment. as primary burning mouth syndrome. You might be more likely to get it if youre: Your doctor will want to know about your symptoms and when they began. What special dietary instructions should I follow? "This will help us in moving the field forward in understanding of the actual disease.". Dr. Rochelle Torgerson, Dermatology, Mayo Clinic, Rochester, Minnesota. J Dent Sci. See permissionsforcopyrightquestions and/or permission requests. Although candidiasis can cause burning pain, its prevalence has not been found to be increased in patients with the disorder compared with control populations.5,8. What special precautions should I follow? Your blood pressure should be checked regularly to determine your response to diltiazem. New Findings on Chronic Pain Syndrome in the Mouth, CCPA/CPRA: Do Not Sell or Share My Information. 2008;2008:1301. Selected from data included with permission and copyrighted by First Databank, Inc. Before You may report them to the FDA. 8600 Rockville Pike Kamala KA, Sankethguddad S, Sujith SG, Tantradi P. Burning Mouth Syndrome. Most often, the pain is on the tip of your tongue or roof of your mouth. Still, that doesnt mean these treatments cant provide relief. Eur J Pain 2005;9:46384. Be sure to mention any of the following: atazanavir (Reyataz); benzodiazepines such as midazolam (Versed) and triazolam (Halcion); beta blockers such as atenolol (Tenormin, in Tenoretic), labetalol, metoprolol (Lopressor, Toprol XL, in Dutoprol), nadolol (Corgard, in Corzide), and propranolol (Inderal, Innopran, in Inderide); buspirone; carbamazepine (Carbatrol, Epitol, Equetro, Tegretol); cimetidine (Tagamet); cyclosporine (Gengraf, Neoral, Sandimmune); digoxin (Lanoxin); lovastatin (Altoprev, Mevacor, in Advicor); quinidine (in Nuedexta); and rifampin (Rifadin, in Rifamate, in Rifater, Rimactane). By the Saturday my mouth was tender and burning - my tongue, gums, inside of lips and cheeks. You may need to try several treatment methods before finding one or a combination that helps reduce your mouth discomfort. Epub 2017 Mar 15. It works by relaxing the blood vessels so the heart does not have to pump as hard. Understanding of Burning Mouth Syndrome Based on Psychological Aspects. Other causes include hormonal imbalance, sensitivity to sodium lauryl sulfate (a foaming agent found in many commercial toothpaste brands) and allergic reactions to mouth bacteria. Exp Brain Res 1993;95:8896. Revised March 2018. Symptoms mainly include mouth pain that is burning or tingling, such as on the roof of the mouth, the gums, inside of the cheeks, or lips. 2021 Oct 1;162(10):2548-2557. doi: 10.1097/j.pain.0000000000002243. URL of this page: https://medlineplus.gov/druginfo/meds/a684027.html. There are other conditions in the mouth that can cause burning. The acids from your stomach can come up into your mouth and cause burning. Some people have pain every day. "We also know between three and nine per cent of post-menopausal women have BMD, as decreased oestrogen levels can cause chronic pain. Are Most Patients With Fibromyalgia Misdiagnosed? General Dentistry: Burning mouth syndrome: a review of etiology, diagnosis, and management., BMC Oral Health: Psychological problems and quality of life of patients with oral mucosal diseases: a preliminary study in Chinese population., BMJ Clinical Evidence: Burning mouth syndrome., Journal of Pain Management and Medicine: Chronic Orofacial Pain: Burning Mouth Syndrome and Other Neuropathic. Some people with burning mouth syndrome find it helpful to is a persistent feeling of burning in the mouth that is not due to mouth They can cause burning mouth. Having Difficulty Falling Asleep? Researchers believe the cause of primary BMS is nerve damage affecting the area of your tongue that controls taste and pain. Thermography as a Non-Ionizing Quantitative Tool for Diagnosing Burning Mouth Syndrome: Case-Control Study. People Talk to your provider about your symptoms so you can find relief. We also review at-home remedies for better oral health and symptoms that warrant a visit to the doctors office or even an emergency. Topical capsaicin has been used in some patients. Online ahead of print. It may take up to 2 weeks before you feel the full benefit of diltiazem. Secondary burning mouth syndrome means Pain can also occur from irritants like smoking, dental trauma, or eating certain foods. Given in low dosages, benzodiazepines, tricyclic antidepressants or anticonvulsants may be effective in patients with burning mouth syndrome. People experience this pain as a burning sensation in their mouth. National Library of Medicine Burning mouth syndrome. are tomato-based or vinegar-based, as well as citrus fruits and foods that For some people, BMS goes away on its own after a few years. WebMD does not provide medical advice, diagnosis or treatment. 2023 Mar 14:1-10. doi: 10.1007/s40122-023-00492-3. Is your mouth pain getting better or worse? These are individualized, but often include alcohol, citrus fruits and juices, cinnamon, and mint. If a cause can't be found, treatment can be challenging. The next day the cycle begins again. Epub 2022 Aug 26. AHFS Patient Medication Information. Hypotension . There are two categories of burning mouth syndrome: Burning mouth is most common in people in postmenopause who are over 60 years old. Once asleep, the pain may improve. Subscribe to Drugs.com newsletters for the latest medication news, new drug approvals, alerts and updates. Depending on the cause of your burning mouth syndrome, the doctor may suggest one or more of these treatments: You can do a few things that may help your symptoms as well: Burning mouth syndrome is a chronic pain condition and can affect your quality of life. If you have secondary burning mouth syndrome, treating the Burning mouth syndrome (BMS) is a painful, frustrating condition often described as a scalding sensation in the tongue, lips, palate, or throughout the mouth. Some side effects may not be reported. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Causes of secondary burning mouth syndrome include: Burning mouth syndrome is more common in women than men. To confirm a diagnosis, your healthcare provider may perform: You may find that sucking on ice chips or chewing gum helps with the discomfort. The burning sensation often occurs in more than one oral site, with the anterior two thirds of the tongue, the anterior hard palate and the mucosa of the lower lip most frequently involved.5 Facial skin is not usually affected. Below we discuss several mouth pain causes and categories of conditions. Get useful, helpful and relevant health + wellness information. Burning mouth syndrome has been defined as burning pain in the tongue or oral mucous membranes, usually without accompanying clinical and laboratory findings.1,2 In the past few years, some investigators have disputed this definition, arguing that it is too restrictive and suggesting that the syndrome may exist coincidentally with other oral conditions.3. in the mouth, as well as medications taken in pill form. Take the missed dose as soon as you remember it. Myocardial infarction was not readily distinguishable from the natural history of the disease. [Ref], Common (1% to 10%): Dizziness, headache, lightheadedness, Frequency not reported: Amnesia, dysgeusia, extrapyramidal syndrome/symptoms, gait abnormality, paresthesia, somnolence, syncope, tremor[Ref], Frequency not reported: Creatine phosphokinase (CPK) increase, muscle cramp, muscle pain, muscle weakness, myopathy, neck rigidity, osteoarticular pain[Ref], Frequency not reported: Anorexia, hyperglycemia, hyperuricemia, mild elevation of alkaline phosphatase, mild elevation of lactate dehydrogenase, thirst, weight increase[Ref], Frequency not reported: Albuminuria, crystalluria, nocturia, polyuria, sexual difficulties[Ref], Frequency not reported: Amblyopia, eye irritation, periorbital edema, retinopathy[Ref], Common (1% to 10%): Injection site reactions (e.g., itching, burning)[Ref], Uncommon (0.1% to 1%): Insomnia, nervousness, Frequency not reported: Abnormal dreams, depression, hallucinations, mood changes (including depression), personality change[Ref], Uncommon (0.1% to 1%): Increased hepatic enzymes (ALT, AST), Frequency not reported: Clinical hepatitis/hepatitis[Ref], There were rare cases of clinical hepatitis that were reversible with discontinuation of this drug. Check with your doctor immediately if any of the following side effects occur while taking diltiazem: Some side effects of diltiazem may occur that usually do not need medical attention. are other findings that are not consistently supported by the literature.5, Despite reports suggesting a significant relationship between burning mouth syndrome and mucosal ulcerative or erosive lesions, periodontitis and geographic tongue,16 most studies have reported no significant changes in intraoral soft or hard tissues.8,9 Similarly, chemical irritation and allergic reactions to dental materials and galvanic currents between dissimilar metals have not been found to be important causes of burning mouth syndrome.16, Hormonal changes are still considered to be important factors in burning mouth syndrome,5 although there is little convincing evidence of the efficacy of hormone replacement therapy in postmenopausal women with the disorder.17 Approximately 90 percent of the women in studies of the syndrome have been postmenopausal, with the greatest frequency of onset reported from three years before to 12 years after menopause.8, It is not surprising that dry mouth has been suggested as an etiologic factor, in view of the higher incidence of this problem in patients with burning mouth syndrome.8,9 However, most salivary flow rate studies in affected patients have shown no decrease in unstimulated or stimulated salivary flow.5 Studies have demonstrated alterations in various salivary components, such as mucin, IgA, phosphates, pH and electrical resistance.5 The relationship of these changes in salivary composition to burning mouth syndrome is unknown, but the changes may result from altered sympathetic output related to stress,6 or from alterations in interactions between the cranial nerves serving taste and pain sensation.18. Federal government websites often end in .gov or .mil. Take diltiazem exactly as directed. Dry mouth can be relieved by drinking more water throughout the day and sucking on ice chips. These side effects may go away during treatment as your body adjusts to the medicine. Mild side effects may go away within a few days or a couple of weeks. Ozasa K, Noma N, Young A, Korczeniewska OA, Eliav E, Imamura Y. J Dent Sci. Some mouth-related side effects, like thrush or burning mouth syndrome, might need treatment. Others, like having a weird taste in your mouth or black hairy tongue, tend to resolve on their own. If you think your mouth-related issue is a side effect of a medication, talk with your healthcare provider. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them: Applies to diltiazem: compounding powder, intravenous powder for injection, intravenous solution, oral capsule extended release, oral tablet, oral tablet extended release. Swallow the extended-release capsules and tablets whole; do not chew or crush them. In this mild condition, red patches appear on the tongues surface. Flecainide oral tablet doesnt cause drowsiness, but it can cause other side effects. Symptoms include tingling, burning pain anywhere in the mouth or on the lips, dry mouth, taste changes, and mood changes, among others. This can damage the blood vessels of the brain, heart, and kidneys, resulting in a stroke, heart failure, or kidney failure. High blood pressure may also increase the risk of heart attacks. These problems may be less likely to occur if blood pressure is controlled. Diltiazem is a calcium channel blocker. abnormalities or other health issues. You might also hear primary burning mouth syndrome called idiopathic burning mouth syndrome. This copyrighted material has been downloaded from a licensed data provider and is not for distribution, except as may be authorized by the applicable terms of use. Some of the potential triggers of burning mouth syndrome include hormonal changes, dry mouth, and nutritional deficiencies especially vitamin B deficiency. Three months with no signs of burning (side of tongue) but it came back. Diltiazem is used to treat high blood pressure and to control angina (chest pain). Try our AI assistant here. Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. Many other medications may also interact with diltiazem, so be sure to tell your doctor about all the medications you are taking, even those that do not appear on this list. BMS often starts seemingly out of nowhere. provider also may recommend a prescription medication that may help with Theyll treat the issue, and your symptoms should get better. Burning mouth syndrome (BMS) is an uncomfortable condition that creates chronic pain. But most can't link it to any unusual event. National Institute of Dental and Craniofacial Research. Peng DS, Lo CH, Tseng YL, Kuo SL, Chiang CP, Chiang ML. Check with your doctor immediately if any of the following side effects occur while taking diltiazem: More common Body aches or pain congestion cough dryness or Who should not take Diltiazem 24HR ER (CD)? due to anemia ), or zinc [18] Neuropathy, e.g. prevention of anginal chest pain associated with coronary artery disease, ventricular rate control in atrial fibrillation, prevention of anginal pain associated with vasospastic angina, supraventricular arrhythmias, a type of abnormal heart rhythm, fluid retention in the legs, feet, arms or hands, inflammation of the tissue lining the sinuses, atrioventricular block, a type of slow heart rhythm disorder, a type of blood disorder where the red blood cells burst called hemolytic anemia, extrapyramidal disease, a type of movement disorder, a disease with shrinking and weaker muscles called myopathy, allergic reaction causing inflammation of blood vessels, erythema multiforme, a type of allergic skin reaction, a skin disorder with blistering and peeling skin called toxic epidermal necrolysis, a skin disorder with blistering and peeling skin called Stevens-Johnson syndrome, a type of allergic reaction called angioedema, a type of skin disorder called acute generalized exanthematous pustulosis, small reddish-purplish pin-point sized spots on skin, a type of drug-related rash called lichenoid dermatitis. Consider asking your doctor or pharmacist if any of your medications may be the cause of your symptoms and if any more tolerable alternatives may be available. Burning mouth syndrome (BMS) causes burning or uncomfortable feelings in the oral cavity without any obvious injuries. intravenous powder for solution, intravenous solution, Drug class: calcium channel blocking agents, Diltiazem 12-Hour Sustained-Release Capsules, flushing or redness of the skin, especially on the face and neck, swelling of the hands, ankles, feet, or lower legs, Blistering, peeling, or loosening of the skin, large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs, red skin lesions, often with a purple center, sores, ulcers, or white spots in the mouth or on the lips, continuing ringing or buzzing or other unexplained noise in the ears, pain or tenderness around the eyes and cheekbones. Burning mouth syndrome is the name for burning pain in your mouth that doesnt have a known cause. 2012 Jan;123(1):71-7. doi: 10.1016/j.clinph.2011.07.054. Yount, K. Practical Pain Management, published online February 26, 2013. "We also know between three and nine per cent of post-menopausal women have BMD, as decreased oestrogen levels can cause chronic pain. Aventis Pharmaceuticals (2011): Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. The American Academy of Oral Medicine. Learn about underlying causes of insomnia and how to help them. no cure for burning mouth syndrome, there are treatments that may reduce your MIRIAM GRUSHKA, M.SC., D.D.S., PH.D., JOEL B. EPSTEIN, D.M.D., M.S.D., AND MEIR GORSKY, D.M.D. tell your doctor and pharmacist if you are allergic to diltiazem, any other medications, or any of the ingredients in diltiazem. BMS often starts seemingly out of nowhere. According to these findings, the clinical entity of BMS can be divided into 2 main subtypes compatible with either peripheral or central neuropathic pain, which may overlap in individual patients. Because of a long-standing difficulty in understanding the pain of burning mouth syndrome and its complex clinical picture, a number of etiologies have been suggested. About a third of people who have burning mouth syndrome say it started after some kind of dental work, an illness, or a course of medication. In addition, you Most often, the pain is on the tip of your tongue or roof of your mouth. If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088). You may need to switch medications to find the best one for you. Tait RC, Ferguson M, Herndon CM. 2002 Sep;99(1-2):41-7. doi: 10.1016/s0304-3959(02)00052-0. Duplication for commercial use must be authorized by ASHP. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. Since the burning mouth syndrome (BMS) can be a pathology of the nervous system or pain reporting system; it can mimic pathology in the structures it reports from or to; structural damage to bone, skin, and connective tissue; along with many different systems malfunctions. In many patients with the syndrome, pain is absent during the night but occurs at a mild to moderate level by middle to late morning. Damage to these organs may cause heart disease, a heart attack, heart failure, stroke, kidney failure, loss of vision, and other problems. In general, burning mouth syndrome symptoms can include: The pain may get worse throughout the day. Doctors think the cause could be damage to nerves that control taste or pain. Studies generally support the use of low dosages of clonazepam (Klonopin),26 chlordiazepoxide (Librium)13 and tricyclic antidepressants (e.g., amitriptyline [Elavil]).27 Evidence also supports the utility of a low dosage of gabapentin (Neurontin).28 Studies have not shown any benefit from treatment with selective serotonin reuptake inhibitors or other serotoninergic antidepressants (e.g. In 1978, Dr. Rothschild received his MD at the Medical College of Wisconsin and trained in internal medicine followed by a fellowship in critical care medicine. Most studies have found that oral burning is frequently accompanied by other symptoms, including dry mouth and altered taste.5 Alterations in taste occur in as many as two thirds of patients and often include complaints of persistent tastes (bitter, metallic, or both) or changes in the intensity of taste perception. HHS Vulnerability Disclosure, Help The U.S. Food and Drug Administration (FDA) hasnt approved these drugs specifically for BMS, but your healthcare provider may prescribe them to help the symptoms. Nicolas-Rodriguez E, Garcia-Martinez A, Molino-Pagan D, Marin-Martinez L, Pons-Fuster E, Lpez-Jornet P. Int J Environ Res Public Health. CONDITIONS OF USE: The information in this database is intended to supplement, not substitute for, the expertise and judgment of healthcare professionals. COVID-19-Related Burning Eye Syndrome and Burning Mouth Syndrome: A Systematic Review and Meta-analysis. The sensation can develop suddenly and occur anywhere in your Reasons why your gums may hurt include inflammation of the gums, also known as gingivitis. following damage to the chorda tympani nerve. Other investigations have found that the ability to detect bitter taste decreases at the time of menopause.21 This reduction in bitter taste at the chorda tympani branch of the facial nerve (cranial nerve VII) results in intensification of taste sensations from the area innervated by the glossopharyngeal nerve (cranial nerve IX) and the production of taste phantoms.22 It has been suggested that damage to taste might also be associated with loss of central inhibition of trigeminal-nerve afferent pain fibers, which can lead to oral burning symptoms.19, Case reports have linked burning mouth symptoms to the use of angiotensin-converting enzyme (ACE) inhibitors.2325 Once these medications were reduced or discontinued, oral burning was found to remit within several weeks. However, each of these postulated causes explains the pain in only small groups of patients. 1. You also may want to try over-the-counter products intended Policy. The burning may progressively increase throughout the day, reaching its greatest intensity by late afternoon and into early evening.8 Patients often report that the pain interferes with their ability to fall asleep. More frequently reported side effects include: dizziness, edema, asthenia, headache, and vasodilation. Smart Grocery Shopping When You Have Diabetes, Surprising Things You Didn't Know About Dogs and Cats, Latest Facts on COVID-19 Vaccine Boosters, History Does Repeat: Vaccine Resistance Is Not New, Synthetic Chemical in Many Products Linked to Early Death, New Drug for Early Breast Cancer: First Advance in 20 Years, Love Horror? Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. The following treatments can likely be completed at home. Painful gum can also arise from oral herpes and cold sores. burning mouth syndrome. Pain in your mouth that feels like tingling, scalding or burning. can cause dry mouth. Every mouthful of food felt like chewing razor blades. American Dental Association: Burning mouth syndrome., National Institute of Dental and Craniofacial research: Burning mouth syndrome.. If taken regularly, diltiazem may control chest pain, but it does not stop chest pain once it starts. The content available on buoy.com is not a substitute for professional medical advice, diagnosis, or treatment. Careers. 2018;21(1):9-19. doi: 10.3290/j.cjdr.a39914. This pattern tends to occur more in the Hope beyond heart failure: Innovative treatment allows woman to change the course of her heart failure, Ready to Run: Mayo athletic trainer suggests ways to manage pain, swelling during marathon training. But because other conditions have similar symptoms, diagnosing BMS can be difficult, said Milda Chmieliauskaite, a researcher and assistant professor of oral and maxillofacial medicine at the dental school. Burning Mouth Syndrome is a real diagnosis. About 2% of the population is affected by Not all burning mouths are the result of a medical condition known as "burning mouth syndrome" (BMS) and physicians and researchers need better standards for an appropriate diagnosis, according to new research at the School of Dental Medicine at Case Western Reserve University. Work with your health care provider, who can help you develop a treatment plan to minimize your symptoms and control burning mouth syndrome. J Pharm Bioallied Sci. Many medications Your doctor may need to change the doses of your medications or monitor you carefully for side effects. Concomitant use of diltiazem with beta-blockers or digitalis may result in additive effects on cardiac conduction. Both can help with Your mouth may feel OK when you wake up but develop a burning feeling later in the day. "The issues with misdiagnosis, depend to some extent on the context, but include resources, money and patient discomfort," she said. Many people also feel a dry mouth despite having regular saliva flow. Continue to take diltiazem even if you feel well. Burning mouth syndrome (BMS) is a burning sensation on your tongue, roof of your mouth or lips. The site is secure. Although not all of these side effects may occur, if they do occur they may need medical attention. Super taster, who experiences flavors more intensely compared with the other types. Acidic foods also may aggravate your symptoms. Avicenna Journal of Dental Research: Burning Mouth Syndrome and Its Related Risk Factors in Females. You should also try to avoid foods that seem to irritate your mouth the most. Last updated on Dec 29, 2022. WebBurning mouth syndrome is the name for burning pain in your mouth that doesnt have a known cause. Efficacy of oral nystatin treatment for patients with oral mucosal dysesthesia but without objective oral mucosal manifestations and necessity of. Brushing my teeth felt like I was using acid and steel wool. Concomitant use of diltiazem with beta-blockers or digitalis may result in additive effects on cardiac conduction. WebDiltiazem is a negative inotrope and can cause decreased systolic function and heart failure. Since the cause of primary BMS is nerve damage, you cant spread it to someone else. Although lacking clinical signs of neuropathy, more accurate diagnostic methods have shown neuropathic involvement at various levels of the neuraxis in BMS: peripheral small fiber damage (thermal quantitative sensory testing, electrogustatometry, epithelial nerve fiber density), trigeminal system lesions in the periphery or the brainstem (brainstem reflex recordings, trigeminal neurography, evoked potentials), or signs of decreased inhibition within the central nervous system (deficient brainstem reflex habituation, positive signs in quantitative sensory testing, neurotransmitter-positron emission tomography findings indicative of deficient striatal dopamine function). It may feel like your tongue is being burned by a hot liquid like coffee. ", Journal of the American Dental Association: "Burning Mouth Syndrome.". Current treatment options are discussed, although data on the effectiveness of these treatments remain limited. Studies show that many of those people also clench their teeth. To use the sharing features on this page, please enable JavaScript. Once your story receives approval from our editors, it will exist on Buoy as a helpful resource for others who may experience something similar. Your health care An error occurred, please try again later. "We need a consensus for a single definition of BMS that includes specific inclusion and exclusion criteria," she said. Select a condition to view a list of medication options. Basso MA, Strecker RE, Evinger C. Midbrain 6-hydroxy-dopamine lesions modulate blink reflex excitability. Clipboard, Search History, and several other advanced features are temporarily unavailable. If you have symptoms, see your dentist first. Oral Health Foundation: "Burning Mouth Syndrome. Most people don't even know they have this. You may also experience dry mouth, taste changes, insomnia, headaches, and mood changes. Other people also develop BMS in those cases, they usually have another condition called geographic tongue. pain relief. worse. High-acidic foods or drinks (like citrus juices). The doctor will examine your mouth and check for infection. Burning mouth syndrome (BMS) causes burning or uncomfortable feelings in the oral cavity without any obvious injuries. If burning persists after management of systemic or local oral conditions, a diagnosis of burning mouth syndrome can be considered, and empiric treatment for sensory neuropathy may be offered. Cerner Multum, Inc. "Australian Product Information." tell your doctor if you have or have ever had a myocardial infarction (MI); a narrowing or blockage of your digestive system or any other condition that causes food to move through your digestive system more slowly; low blood pressure; or heart, liver, or kidney disease.
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