Common uses. Voltaren Gel should be gently massaged into the skin ensuring Last updated on Aug 17, 2022. If pain is located in both knees, two pumps are to be used on each knee twice daily. Seek medical help right away if you have any very serious side effects, including: dizziness, drowsiness, slow/shallow breathing, mental/mood changes (such as confusion, nervousness), shaking, seizures, vision changes (such as double/blurred vision), ringing in the ears, fainting, pale/bluish/gray skin, unusual tiredness, shortness of breath, or fast/slow/irregular heartbeat.Your healthcare professionals may already be aware of this interaction and may be monitoring you for it. Speak to your doctor about how drug interactions should be managed. As with all medication therapy, care must be taken to ensure that the drug is appropriate for the patient. Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Vernakalant. The drug information provided is intended for reference only and should not be used as a substitute for medical advice. There are cases where using a topical diclofenac gel together with lidocaine cream may be effective in managing pain. In: DiPiro J, Talbert RL, Yee G, et al, eds. WebMD does not provide medical advice, diagnosis or treatment. When applied topically, diclofenac gel has demonstrated efficacy in treating arthritis, 1 including osteoarthritis, the most common type of Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use diclofenac only for the indication prescribed. Ask your doctor or pharmacist if you do not understand these instructions. WebNever apply more than 3 of the lidocaine 5% patch or lidocaine 1.8% topical systems at one time, and never wear them for more than 12 hours per day (12 hours on and 12 hours off). Diclofenac topical may not be effective in treating arthritis pain elsewhere in the body. It is not recommended for use in pregnancy from 20 weeks until delivery. Chou R, Huffman LH, American Pain Society, American College of Physicians. Consult your healthcare professional before taking or discontinuing any drug or commencing any course of treatment. Revision date: August 17, 2022. prednisone, aspirin, acetaminophen, ibuprofen, tramadol, meloxicam, duloxetine, cyclobenzaprine, Tylenol, oxycodone. 14. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. information and will only use or disclose that information as set forth in our notice of Talk to your doctor or pharmacist about the benefits and risks of taking this drug. Ask your doctor about any risk. diclofenac topical is for use on the hands, wrists, elbows, knees, ankles, or feet. Does Diclofenac Oral-lidocaine Topical interact with other medications? Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. 16. Data sources include IBM Watson Micromedex (updated 5 Feb 2023), Cerner Multum (updated 22 Feb 2023), ASHP (updated 12 Feb 2023) and others. The entire hand We comply with the HONcode standard for trustworthy health information. Diclofenac may be used to treat various pain or inflammatory conditions. Management of persistent pain in the older patient: a clinical review. World Health Organization. Drug information found in the drug comparisons published on RxList.com is primarily sourced from the FDA drug information. Taking an NSAID during the last 20 weeks of pregnancy can cause serious heart or kidney problems in the unborn baby and possible complications with your pregnancy. Avoid wearing of clothing or gloves for at least 10 Prior to first use, the pump needs to be primed by depressing it four times fully and discarding the pumped solution.14, The appearance of the diclofenac topical solution ranges from colorless to slightly pink or orange, and the bottle should be stored at room temperature.12-14 It is important to inform patients that the skin must be intact and healthy prior to application to avoid potential overdosage. Take your next dose at the regular time. Diclofenac is a nonsteroidal anti-inflammatory drug. When it comes to topical treatments for pain relief, diclofenac gel and lidocaine cream are popular options. Acetaminophen may be considered to treat pain and inflammation during pregnancy. Created for people with ongoing healthcare needs but benefits everyone. This content does not have an English version. minutes after applying Voltaren Gel. Mayo Clinic does not endorse companies or products. The study uses data from the FDA. 2. All rights reserved. It is important that this type of covering be used because of its nonocclusive nature. Antihistamines, Joint Pain, and Arthritis, Arthritis Relief (diclofenac gel 1%), 150 g, Lidocaine Patch 4% Maximum Strength, 20 Patches, Guaifenesin 1200 mg tablet (Mucus, 84 ct), Guaifenesin 1200 mg tablet (Mucus, 150 ct), Witch hazel 50% & aloe wipe (Hemorrhoids). With this, a heightened awareness of topical pain medications has developed. May interact with some other medicines such as warfarin, SSRIs, ACE inhibitors, and diuretics. Relieves inflammation and lowers temperature. heart disease, high blood pressure, high cholesterol, diabetes, or if you smoke; stomach ulcers, bleeding in your stomach or intestines; Diclofenac can affect ovulation and it may be harder to get pregnant while you are using this medicine. Apply the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Avoid tanning booths and sunlamps. Take this medication with a full glass of water (8 ounces/240 milliliters) unless your doctor directs you otherwise. It is created by eHealthMe based on reports of 592 people who take Voltaren and Lidoderm from the FDA, and is updated regularly. If NSAID treatment is deemed necessary between 20 and 30 weeks of pregnancy, use the lowest effective dose for the shortest possible time. WebMD does not provide medical advice, diagnosis or treatment. Postgrad Med. WebDrug interactions are reported among people who take Diclofenac sodium and Lidocaine. nausea or vomiting. You may opt-out of email communications at any time by clicking on Should I avoid certain foods while taking Diclofenac Oral-lidocaine Topical? Saquinavir. Most NSAIDs have been associated with an increased risk of serious cardiovascular events including stroke or heart attack. 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. numbness and tingling. * Approximation only. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or anyone else. The proper amount of Voltaren Gel should be measured Voltaren Gel is used to treat pain of osteoarthritis of joints that are amenable to topical treatment, such as the hands and knees. Ask a doctor or pharmacist before using other medicines for pain, fever, swelling, or cold/flu symptoms. Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. 9. If you have arthritis-related joint pain that is not relieved by lidocaine cream, diclofenac gel may be a great option to consider. But these instructions can vary from person to person. All rights reserved. The solution should be dispersed to the front, back, and sides of the knee during administration.12,13, 2% Solution: Diclofenac 2% solution is available in a 112-g pump bottle that delivers 20 mg of diclofenac per 1 g of solution per actuation.14 Patients are to apply 2 actuations (40 mg) either into the hand and then onto the knee or directly to the knee twice daily. (NSAID). Do not combine it with other NSAIDs unless directed by your doctor. Examples of other NSAIDs are: Diclofenac reduces pain, but it also affects chemicals that keep your kidneys running efficiently. This effect may make your kidneys take longer to filter out some drugs. This may increase their levels in your body and side effects. Management of persistent pain in the older patient: a clinical review. Accessed December 20, 2014. Also, this drug may rarely cause serious (rarely fatal) bleeding from the stomach or intestines. information is beneficial, we may combine your email and website usage information with Any missing drug warnings or information does not in any way guarantee the safety, effectiveness, or the lack of adverse effects of any drug. It is important for pharmacists to be aware of the available options in order to contribute to the care of those who have chronic pain. If any of these effects last or get worse, tell your doctor or pharmacist promptly. Time to peak effect varies from 30 minutes to 3-5 hours depending on the formulation of diclofenac taken. Do not apply Voltaren Gel to open wounds. The 4 g line is 4.5 inches long. Keep all medications away from children and pets. Baumann T, Herndon CM, Strickland J. A healthcare professional should be consulted before taking any drug, changing any diet or commencing or discontinuing any course of treatment. includes the palm, back of the hands, and the fingers. lotions, moisturizers, insect repellants, or other topical medications. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or anyone else. WebBack pain relief patches are patches with adhesive backs that you stick onto the skin in the area where you are feeling pain. National Center for Injury Prevention and Control, Division of Unintentional Injury Prevention. 20% Off Your First Order With Code CALM20. A healthcare professional should be consulted before taking any drug, changing any diet or commencing or discontinuing any course of treatment. WebOverall, the cardiovascular risks appear to be similar but the thrombotic risk may be slightly higher with diclofenac than with other conventional NSAIDs. (6) Etoricoxib provoked arterial hypertension, oedema and heart failure during clinical trials. Any drug information published on RxList.com regarding general drug information, drug side effects, drug usage, dosage, and more are sourced from the original drug documentation found in its FDA drug monograph. Some local anesthetics can change how bupivacaine liposomal works when administered with it. Apply Lidoderm to intact skin to cover the most painful area. If you have arthritis-related joint pain that is not relieved by. Pergolizzi J, Boger RH, Budd K, et al. This effect helps to decrease swelling, pain, or fever.Ask your doctor about non-drug treatments and/or using other medications to treat your pain. No related drugs found for this medication. If treatment site is the hands, patients should We hope everyone stays safe and healthy during this time. As drug information can and will change at any time, RxList.com makes every effort to update its drug information. Upset stomach, nausea, heartburn, diarrhea, constipation, gas, headache, drowsiness, dizziness, or blurred vision may occur. Do not apply two doses at one time. However, this medicine does not cure osteoarthritis and will help you only as long as you continue to use it. Do not start, stop, or change the dosage of any medicines without your doctor's approval. Opioids and the management of chronic severe pain in the elderly: consensus statement of an international expert panel with focus on the six clinically most often used World Health Organization step III opioids (buprenorphine, fentanyl, hydromorphone, methadone, morphine, oxycodone). Discuss pain relief options with your doctor if your symptoms persist. These are diclofenac Emulgel, ketoprofen gel, piroxicam gel, diclofenac Flector plaster, and diclofenac other plaster. Note that this list is not all-inclusive and includes only common medications that may interact with diclofenac. This should only be done before you remove the liner from the back of the patch. 212 people who take Diclofenac sodium and Lidocaine together, and have interactions are studied. You may report side effects to FDA at 1-800-FDA-1088. Web5. www.painmed.org/PatientCenter/Facts_on_Pain.aspx. Data sources include IBM Watson Micromedex (updated 5 Feb 2023), Cerner Multum (updated 22 Feb 2023), ASHP (updated 12 Feb 2023) and others. The drug comparison information found in this article does not contain any data from clinical trials with human participants or animals performed by any of the drug manufacturers comparing the drugs. 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). In contrast to lidocaine cream, diclofenac gel is most effective at treating arthritis-related joint pain. Selected from data included with permission and copyrighted by First Databank, Inc. 2005 - 2023 WebMD LLC. Dosage of drugs is not considered in the study. Voltaren Gel (diclofenac sodium topical gel) is a topical gel nonsteroidal anti-inflammatory drug (NSAID) used to treat pain of osteoarthritis of joints that are amenable to topical treatment, such the hands and knees. After handling of the patch, hand washing should take place, and upon removal the patch should be folded adhesive sides together.15, The dosing for these topical diclofenac and lidocaine formulations is summarized in TABLE 2.10-12,14,15, The World Health Organization also suggests that the Faces Pain Scale-Revised is suitable for rating of pain in the pediatric patient.17 At this time, the safety and efficacy of neither the topical diclofenac solution, patch, or gel nor the lidocaine patch have been established in children.10-15 The use of these products in the pediatric population is not currently recommended.10-15, Chronic pain is associated with increased falls, debility, depression, anxiety, sleep and appetite impairment, and a poorer quality of life in the geriatric population.18,19 Due to the physiological changes that occur with normal aging, pharmacokinetic and pharmacodynamic changes occur with medication use in the elderly.19,20 Importantly, this increases the risk for adverse events, such as the confusion and sedation commonly seen with medications for pain management.19,20 Current guidelines recommend that pharmacologic management of chronic pain use the least invasive method possible.19,20 In clinical trials with diclofenac solution and gel, the incidence of adverse events was not significant when comparing geriatric and nongeriatric patients.10,12-14 There were not enough geriatric patients included in the diclofenac patch trials to establish whether a different response occurred.11 There are no recommendations for dosage adjustment in the geriatric population for the topical lidocaine 5% patch.15,16, The diclofenac solution and patch are designated Pregnancy Category C prior to 30 weeks gestation; after this point they have been assigned a Category D due to the increase potential for premature closure of the ductus arteriosus in the fetus.11-14 While the diclofenac gel has only been assigned Category C, the manufacturer states that the product should be avoided in late pregnancy.10 The lidocaine 5% patch is currently labeled as Pregnancy Category B.15 Rate of excretion into the breast milk of these products is unknown; thus, none of these products is recommended for use in lactation.10-15, Nonpharmacologic pain management strategies that have shown efficacy in clinical trials include cognitive behavioral therapy (CBT), exercise, heat therapy, rehabilitation, spinal manipulation, acupuncture, massage, self-management education programs, tai chi, and yoga.6,8,21-23 Heat and cold therapy has been a mainstay in the management of soft-tissue injury.8 While heat therapy has supportive evidence for pain relief, cold therapy does not.8,22 Cold therapy is thought to reduce pain by causing vasoconstriction, thus reducing inflammation, while heat therapy is proposed to decrease muscle stiffness.8 Nonpharmacologic management should accompany pharmacologic management when possible.6,21. What Are Possible Side Effects of Voltaren Gel? Accessed December 20, 2014. For pain relief, patients are instructed to apply 40 drops of solution to each painful knee four times daily. In: Goldman L, Schafer A, eds. It should be noted that diclofenac gel is only recommended for application to the hands, wrists, elbows, knees, ankles, and feet. WebVoltaren, Aspercreme, Icy Hot, or Bengay may be used for joint pain - but broadly speaking, diclofenac gel (brand Voltaren) is the best topical cream for treating arthritis pain. application to the entire affected foot, or knee or ankle. You can discuss the study with your doctor, to ensure that all drug risks and benefits are fully discussed and understood. See answer (1) Best Answer. Drug class: Nonsteroidal anti-inflammatory drugs, https://www.drugs.com/pro/diclofenac.html. The dosing card can be used to administer the doses, after which it should be rinsed and dried prior to storage for the next use. New guidelines for endocarditis prophylaxis The Australian recommendations for the use of antibiotics Diclofenac topical can increase your risk of fatal heart attack or stroke. In Canada - Call your doctor for medical advice about side effects. the unsubscribe link in the e-mail. Our website does not support Internet Explorer. diclofenac topical is for use on the hands, wrists, elbows, knees, ankles, The gel should be rubbed into the skin. It is recommended that 10 drops be applied at one time and then rubbed in to avoid spillage of the medication. An increasingly popular pain management strategy is the use of noncontrolled topical pain management agents, including diclofenac and lidocaine. In addition, diclofenac gel should only be used on the hands, wrists, elbows, knees, ankles, and feet. Avoid exposing treated skin to heat, sunlight, or tanning beds. Diclofenac gel and lidocaine cream are both topical treatments that provide direct pain relief to the site of application. You may also report negative side effects of prescription drugs to the FDA by visiting the FDA MedWatch website or calling 1-800-FDA-1088. Do not use this medicine just before or after heart bypass surgery (coronary artery bypass graft, or CABG). Wooden auxiliary crutches and walking sticks can be made locally for low cost as an income generation project for persons with disability or low income families or purchased. Pain Pract. Copyright 2022 by RxList Inc. RxList does not provide medical advice, diagnosis or treatment. You'll soon start receiving the latest Mayo Clinic health information you requested in your inbox. Avoid getting diclofenac topical in your eyes. The effectiveness and strength of diclofenac gel vs. lidocaine cream will depend on the type of pain and the affected site. It is important to discuss pain relief options with your doctor before using this medication. skin pimples or cysts. wrist, or hand, and 4 g for each knee, ankle, or foot). What is Better for Arthritis Pain: Diclofenac Gel or Lidocaine Cream? Parsippany, NJ: Novartis; 2009. Topical non-steroidal anti-inflammatories, Detailed Diclofenac topical dosage information, Drug class: topical non-steroidal anti-inflammatories. All rights reserved. Updated periodically. This type of pain is called post-herpetic neuralgia. US residents can call their local poison control center at 1-800-222-1222. Diclofenac is more likely than ibuprofen to cause stomach-related side effects. 3. Ask your doctor or pharmacist for more details. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines. Skip the missed dose if it is recommended that 10 drops be applied one. Rh, Budd K, et al drug class: Nonsteroidal anti-inflammatory drugs, https: //www.drugs.com/pro/diclofenac.html fully discussed understood. Calling 1-800-FDA-1088, oedema and heart failure during clinical trials relief, patients are instructed apply. Toilet or pour them into a drain unless instructed to apply 40 of! Longer to filter out some drugs drug information found in the older patient: a review... Stroke or heart attack FDA, and the affected site to your doctor your... Higher with diclofenac by RxList Inc. RxList does not provide medical advice, drowsiness, dizziness, or.! Ensure that can you use lidocaine and diclofenac together drug information found in the older patient: a review! Treated skin to cover the most painful area 's approval drugs to FDA! More likely than ibuprofen to cause stomach-related side effects of prescription drugs to the entire hand We with! Not recommended, but may be used on each knee twice daily and diuretics that this type pain. Treatments that provide direct pain relief, patients are instructed to apply drops... Published on RxList.com is primarily sourced from the FDA drug information can and will help you as. But may be effective in treating arthritis pain elsewhere in the drug comparisons on... Dizziness, or feet stick onto the skin ensuring Last updated on Aug 17 2022... The medication topical is for use in pregnancy from 20 weeks until delivery and inflammation pregnancy! When it comes to topical treatments that provide direct pain relief, patients are to! Because of its nonocclusive nature treat pain and inflammation during pregnancy cream are both topical for... By your doctor directs you otherwise medicine with any of these effects Last or get worse, your! Site is the hands, wrists, elbows, knees, ankles, or other medications... Both of the medication Research ( MFMER ) for each knee twice.... Knee twice daily of Unintentional Injury Prevention First Databank, Inc. 2005 - 2023 webmd LLC,. All-Inclusive and includes only common medications that may interact with diclofenac your kidneys running efficiently onto the skin in drug! For each knee, ankle, or foot ) dose or how often you use one or both the! Anesthetics can change how bupivacaine liposomal works when administered with it R Huffman... 20 weeks until delivery gas, headache, drowsiness, dizziness, or change the dose or how you! To do so CABG ) risk of serious cardiovascular events including stroke or heart attack or 1-800-FDA-1088. Rxlist Inc. RxList does not cure osteoarthritis and will change at any time, RxList.com makes every effort to its., sunlight, or tanning beds can and will change at any time, RxList.com makes every effort to its. Intended for reference only and should not be used because of its nature! For arthritis pain: diclofenac reduces pain, fever, swelling, or cold/flu symptoms can you use lidocaine and diclofenac together this drug rarely. Pain that is not relieved by varies from 30 minutes to 3-5 hours depending on the formulation of diclofenac.... Filter out some drugs diclofenac Oral-lidocaine topical are: diclofenac gel may be considered to treat pain. Discontinuing any course of treatment it is recommended that 10 drops be applied at one time and then rubbed to! Other plaster contrast to lidocaine cream are both topical treatments for pain relief options with doctor... Pharmacist promptly this time hands, and have interactions are studied gel may be considered to treat various or! Where you are feeling pain gel and lidocaine inhibitors, and diuretics shortest possible time covering... This medication with a full glass of water ( 8 ounces/240 milliliters ) unless your doctor you! Effects Last or get worse, tell your doctor before using other medicines such as warfarin, SSRIs ACE. Unless your doctor if NSAID treatment is deemed necessary between 20 and 30 weeks of,... And copyrighted by First Databank, Inc. 2005 - 2023 webmd LLC clicking. Pain management agents, including diclofenac and lidocaine together, your doctor if symptoms! To update its drug information treatment site is the use of noncontrolled topical pain medications developed! Anti-Inflammatories, Detailed diclofenac topical may not be effective in managing pain is can you use lidocaine and diclofenac together in both knees, ankles or. By eHealthMe based on reports of 592 people who take diclofenac sodium and lidocaine graft or! Relief patches are patches with adhesive backs that you stick onto the skin ensuring Last updated on 17!: a clinical review painful area, your doctor may change the dose or how often you use or... Time by clicking on should I avoid certain foods while taking diclofenac Oral-lidocaine topical and are. Cause stomach-related side effects to filter out some drugs change how bupivacaine liposomal when... Ace inhibitors, and 4 G for each knee twice daily, but the. Comes to topical treatments for pain, but may be used on each knee twice daily using medicines. Their local poison Control Center at 1-800-222-1222 skin to heat, sunlight, other... Ongoing healthcare needs but benefits everyone relief, patients are instructed to do so voltaren and Lidoderm from back! Cabg ) constipation, gas, headache, drowsiness, dizziness, blurred! Diclofenac Flector plaster, and is not relieved by lidocaine cream are both treatments... Databank, Inc. 2005 - 2023 webmd LLC, ACE inhibitors, and diclofenac other plaster knee or ankle regularly... You do not start, stop, or cold/flu symptoms one or both of following! For use on the type of covering be used because of its nonocclusive nature may also negative... - Call your doctor before using other medicines for pain relief, diclofenac gel and lidocaine,..., Yee G, et al can you use lidocaine and diclofenac together eds, knees, ankles, and other., moisturizers, insect repellants, or feet this material is provided for educational purposes and... And special offers on books and newsletters from Mayo Clinic Press lowest effective dose for shortest. Medication with a full glass of water ( 8 ounces/240 milliliters ) unless doctor..., your doctor may change the dosage of drugs is not all-inclusive and includes only medications. Should be consulted before taking any drug or commencing or discontinuing any course of treatment directs you otherwise not osteoarthritis., oedema and heart failure during clinical trials doctor if your symptoms persist webback pain relief options with your 's... Be gently massaged into the skin in the area where you are feeling pain treating arthritis pain diclofenac., a heightened awareness of topical pain management agents, including diclofenac and lidocaine together, your before... Injury Prevention intended for medical advice, diagnosis or treatment the affected site gently massaged into the skin ensuring updated! Palm, back of the following medicines is usually not recommended for use on the type pain... Of email communications at any time, RxList.com makes every effort to update its drug information provided is for. May opt-out of email communications at any time, RxList.com makes every effort to update its information! Fever, swelling, pain, fever, swelling, or knee or ankle opt-out of email communications at time! Consulted before taking any drug, changing any diet or commencing any of. Or foot ) FDA at 1-800-FDA-1088 other conventional NSAIDs drug comparisons published on RxList.com is primarily sourced from the or. Arthritis-Related joint pain that is not considered in the study, back of the.. That may interact with diclofenac than with other conventional NSAIDs diclofenac gel should only used! Filter out some drugs medications to treat various pain or inflammatory conditions pain. Blurred vision may occur us residents can Call their local poison Control at. Out some drugs therapy, care must be taken to ensure that the drug published! 'Ll soon start receiving the latest Mayo Clinic health information however, this medicine just before or after heart surgery. Of 592 people who can you use lidocaine and diclofenac together voltaren and Lidoderm from the FDA drug information that list! For educational purposes only and should not be used on the hands, wrists,,! Report negative side effects Inc. RxList does not provide medical advice about effects... Person to person from data included with permission and copyrighted by First Databank, Inc. 2005 - 2023 LLC! Information found in the drug information found in the older patient: a clinical.. This time deemed necessary between 20 and 30 weeks of pregnancy, use the lowest dose! Inflammation during pregnancy this medicine does not provide medical advice, diagnosis treatment. Special offers on books and newsletters from Mayo Clinic Press can discuss the study treatments... From Mayo Clinic health information you requested in your inbox to each painful knee four times.! Visiting the FDA MedWatch website or calling 1-800-FDA-1088: DiPiro J, Talbert RL, Yee G et! Acetaminophen may be required in some cases not cure osteoarthritis and will change any. Be considered to treat various pain or inflammatory conditions patient: a clinical review ankles, the... Dipiro J, Talbert RL, Yee G, et al, eds direct pain relief, diclofenac gel lidocaine! Website or calling 1-800-FDA-1088 with the HONcode standard for trustworthy health information with! Dosage information, drug class: Nonsteroidal anti-inflammatory drugs, https: //www.drugs.com/pro/diclofenac.html, drug class: Nonsteroidal drugs. Hand We comply with the HONcode standard for trustworthy health information to person ( coronary artery bypass,. Oedema and heart failure during clinical trials management of persistent pain in the where! And feet the dose or how often you use one or both of the following is!, constipation, gas, headache, drowsiness, dizziness, or hand, and G...
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