METOLAZONE: CONTRAINDICATION AND SIDE EFFECTS

What is this medicine - Metolazone?

METOLAZONE (me TOLE a zone) is a diuretic. It increases the amount of urine passed, which causes the body to lose salt and water. This medicine is used to treat high blood pressure. It is also reduces the swelling and water retention caused by heart or kidney disease.

This medicine may be used for other purposes; ask your health care provider or pharmacist if you have questions.


What should I tell my health care provider before I take this medicine?

They need to know if you have any of these conditions:

• diabetes
• gout
• immune system problems, like lupus
• kidney disease
• liver disease
• pancreatitis
• small amount of urine or difficulty passing urine
• an unusual or allergic reaction to metolazone, sulfa drugs, other medicines, foods, dyes, or preservatives
• pregnant or trying to get pregnant
• breast-feeding

How should I use this medicine?


Take this medicine by mouth with a glass of water. Follow the directions on the prescription label. Remember that you will need to pass urine frequently after taking this medicine. Do not take your doses at a time of day that will cause you problems. Do not take at bedtime. Take your medicine at regular intervals. Do not take your medicine more often than directed. Do not stop taking except on your doctor's advice.

Talk to your pediatrician regarding the use of this medicine in children. Special care may be needed.

Overdosage: If you think you have taken too much of this medicine contact a poison control center or emergency room at once.

NOTE: This medicine is only for you. Do not share this medicine with others.

What if I miss a dose?

If you miss a dose, take it as soon as you can. If it is almost time for your next dose, take only that dose. Do not take double or extra doses.

What may interact with this medicine?

• alcohol
• antiinflammatory drugs for pain or swelling
• barbiturates for sleep or seizure control
• digoxin
• dofetilide
• lithium
• medicines for blood sugar
• medicines for high blood pressure
• medicines that relax muscles for surgery
• methenamine
• other diuretics
• some medicines for pain
• steroid hormones like cortisone, hydrocortisone, and prednisone
• warfarin

This list may not describe all possible interactions. Give your health care provider a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use. Also tell them if you smoke, drink alcohol, or use illegal drugs. Some items may interact with your medicine.


What should I watch for while using this medicine?
Visit your doctor or health care professional for regular checks on your progress. Check your blood pressure as directed. Ask your doctor or health care professional what your blood pressure should be and when you should contact him or her.

You may need to be on a special diet while taking this medicine. Ask your doctor.

Check with your doctor or health care professional if you get an attack of severe diarrhea, nausea and vomiting, or if you sweat a lot. The loss of too much body fluid can make it dangerous for you to take this medicine.

You may get drowsy or dizzy. Do not drive, use machinery, or do anything that needs mental alertness until you know how this medicine affects you. Do not stand or sit up quickly, especially if you are an older patient. This reduces the risk of dizzy or fainting spells. Alcohol may interfere with the effect of this medicine. Avoid alcoholic drinks.

This medicine may affect your blood sugar level. If you have diabetes, check with your doctor or health care professional before changing the dose of your diabetic medicine.

This medicine can make you more sensitive to the sun. Keep out of the sun. If you cannot avoid being in the sun, wear protective clothing and use sunscreen. Do not use sun lamps or tanning beds/booths.

What side effects may I notice from receiving this medicine?

Side effects that you should report to your doctor or health care professional as soon as possible:

• allergic reactions such as skin rash or itching, hives, swelling of the lips, mouth, tongue, or throat
• fast or irregular heartbeat, chest pain
• feeling faint
• fever, chills
• gout pain
• hot red lump on leg
• muscle pain, cramps
• nausea, vomiting
• numbness or tingling in hands, feet
• pain or difficulty when passing urine
• redness, blistering, peeling or loosening of the skin, including inside the mouth
• unusual bleeding or bruising
• unusually weak or tired
• yellowing of the eyes, skin

Side effects that usually do not require medical attention (report to your doctor or health care professional if they continue or are bothersome):

• abdominal pain
• blurred vision
• constipation or diarrhea
• dry mouth
• headache

CREATINE: DIETARY SUPPLEMENT

Creatine is a dietary supplement that is often used to improve athletic performance. Excessive use of creatine can strain the kidneys and cause kidney damage. Individuals should follow proper dosing recommendations for creatine and consult a physician prior to taking supplements. Individuals who currently take creatine and have kidney problems should discontinue use of creatine to prevent further kidney damage.

Creatine

Creatine is an amino acid that is synthesized in the kidneys and liver and supports muscle growth and contraction, according to Peace Health. Creatine is naturally available in fish and meat and is also marketed to athletes as a performance-enhancing supplement. According to the Mayo Clinic, the most popular creatine supplement is creatine monohydrate. Prolonged use or high doses of creatine may contribute to kidney damage.

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Kidneys and Creatinine

Kidneys remove waste from the body, help form red blood cells and help regulate blood pressure. Creatinine is a chemical waste product of creatine. It is usually filtered out through the kidneys and excreted in the urine. High levels of creatinine in the blood can be caused by high doses of creatine and may be a sign of kidney damage and the inability of the kidneys to filter out creatinine.

MedlinePlus says kidney problems that are associated with high creatinine levels include acute tubular necrosis, diabetic nephropathy, glomerulonephritis or pyelonephritis, all of which can lead to chronic kidney disease (CKD) or kidney failure. CKD and kidney failure can result in seizures, coma and, ultimately, death. Individuals with either condition may need dialysis, a regular treatment that cleans the blood, or a kidney transplant.

Lab Values

According to the Mayo Clinic, normal blood creatinine is 0.6 to 1.2 mg/dL. Men usually have higher creatinine levels than women because creatinine increases with muscle mass. High creatinine can be caused by dehydration, certain medications and creatine supplements.

Dosing

The University of Maryland Medical Center says the risk of kidney damage is greater when high doses of creatine supplements are taken. The Mayo Clinic does not advise taking more creatine than is recommended by manufacturers. A normal loading dose for an athlete prior to an athletic event is 5g, four times a day for a week. A maintenance dose for athletes is 2 to 5g per day.

Warnings and Considerations

According to MedlinePlus, possible side effects of creatine supplements include upset stomach, loss of appetite, diarrhea, nausea, muscle cramps, heat intolerance, fever, dehydration, reduced blood volume, electrolyte imbalances, increased thirst, headache, anxiety, irritability, aggression, nervousness, sleepiness, depression, abnormal heart rhythm, fainting or dizziness, blood clots in the legs, seizure and swollen limbs.

Creatine supplements are not regulated by the Food and Drug Administration. Many of the health and performance claims for creatine have not been scientifically substantiated. Peace Health advises that creatine should only be taken after consultation with a doctor or pharmacist. Creatine may not be appropriate for pregnant or breastfeeding women and children. It should not be taken by people with kidney or liver disease due to the risk of further kidney damage and altered liver function.

Creatine and Growth Hormone

• Creatine, a naturally occurring protein, plays an essential role in muscle development, conversion of fat to energy and possibly brain function and maintenance of the immune system. Importantly for athletes, creatine is reported to enhance physical performance by stimulating the production of human growth hormone (HGH).

  The pituitary gland, a small organ at the base of the brain, produces HGH along with other hormones. HGH regulates muscle development, organ growth and bone length, or height. The pituitary gland continues to produce HGH throughout life, but it releases HGH at slower rates as we age.

  Almost all creatine in the body is concentrated in the muscles, and the remaining 5 percent is found largely in organs with high-energy needs such as the heart, brain and testes. Reduced HGH levels gradually result in typical signs of aging: muscle loss, higher fat-to-muscle ratio and bone loss. Skin sags as it loses elasticity and tone. Illnesses increase as the immune system loses potency.

  HGH supplementation can reverse these signs of aging. However, expense and tight regulation make HGH treatments impractical. Anaerobic exercise, such as weightlifting, or intense, sustained aerobic exercise, such as long-distance running, can boost HGH production. Creatine, obtained either naturally in the diet or through supplements, can also increase HGH.

Effects of Creatine

• Creatine supplementation stimulates release of HGH from the pituitary, mimicking HGH replacement therapy. Effects of continued creatine supplementation include improved mood, regeneration of bone and muscle mass, reduced body fat and enhanced stamina.

  Because it improves muscle mass and endurance, creatine supplementation is popular among athletes. Other uses of creatine are being explored, such as a treatment for heart disease, muscular dystrophy, Alzheimer's disease and Lou Gehrig's disease.

  Meat, poultry and fish are natural sources of creatine. The liver and kidneys also manufacture creatine using specific amino acids. Additionally, creatine supplements are available in powder or tablet form. Most people receive an average of 2 g of creatine per day in their diet.

Cautions

• Although creatine is a naturally occurring protein, supplementation is associated with side effects. Creatine supplements are associated with water retention, weight gain, diarrhea, nausea, vomiting, cramping, gastrointestinal problems, muscle pain and high blood pressure.

  Creatine is considered a dietary supplement, not a drug, and is not regulated by the Food and Drug Administration. Quality varies among products, and harmful additives or contaminants are not monitored or controlled.

  Consistent improvement in physical performance has not been proven in scientific research. Some studies have shown creatine supplements slightly boost performance in sports such as weightlifting and sprinting that require short energy bursts. Results vary, however, and not everyone experiences the same level of benefit. Some people don't respond to creatine at all.

  As an untested treatment, creatine supplementation has no standard dose and the long-term risks are unknown. Creatine supplements are not recommended for people with diabetes or kidney or liver disease.

Creatine Monohydrate Side Effects

As far as what we've experienced, the best part about creatine is that there are no adverse side effects of creatine. As far as what has been reported in studies, creatine is completely safe and works as a very effective supplement. Yet although there are no risks of taking creatine, we don't know about its long-term effects as the record of research is relatively recent.

Just like every supplement it is not recommended to overuse creatine once your muscles have achieved the saturation value. That is, you should only take the dosage recommended by your doctor or as written on the bottle. A conservative approach is to plan to use creatine only for limited periods before taking a substantial break from it so the body can re-set to normal functioning.

Many experiments performed on creatine have shown that creatine does not cause any adverse side effects as such, but the only effect of taking creatine is that after taking the creatine supplement you will experience an increase in body mass. But, that is the thing I think that all bodybuilders and athletes would love to have.

Creatine Side Effects

In a three-year study designed to find out whether these creatine side effects really do exist, creatine was determined to have no effect on the incidence of injury or cramping in a group of American footballers. Although no negative side effects have ever been noted in the research, some effects that you may physically experience are:

• Some of the people claim that creatine users are susceptible to cramps, muscle spasms, and some may even be prone to pulled muscles.
• Persons taking creatine may also show allergic reactions like itching or hives.
• Sometimes, there may be swelling in your face or hands.
• Some persons taking creatine said that they had some tingling sensation in their throat.
• Consumption of creatine may sometimes cause diarrhea or stomach problems.
• You may sometimes experience trouble in breathing.
• Creatine in some rare cases may also cause kidney stones.

Other Side Effects of Creatine may be:

• You may experience chest tightness.
• You may experience weight gain. But, that from my point of view is not a bad effect; it is a good result as all weight lifters love to have more and more mass.
• Water Retention.
• You may notice some gas problems and bloating.
• Heat Intolerance.

If you are experiencing a lot of adverse side effects you should stop taking creatine right away and talk to your doctor.

10 WAYS TO LIVE NORMALLY WITH A LEAKY BLADDER

Do you plan your day to make sure bathroom stops will be available at short notice and scope out buildings so you always know where the nearest bathroom is? Do you tell yourself to wait an hour for that glass of iced tea so you won't have to dash for the ladies'? If so, it's likely you have a condition called overactive bladder, or OAB. And if you're between 40 and 55, you may be one of the many women for whom OAB is a menopause- and age-related problem.

10 Ways to Live Normally With a Leaky Bladder

One comfort: You're in good company. Studies show overactive bladder affects at least -- and probably more than -- 17 percent of women in the U.S. Why more? Because this problem is vastly underreported, due to the embarrassment factor. (It's not the easiest thing to talk to your doctor about.) But help is available. In the meantime, here's what you should know about the connection between OAB and menopause -- along with available treatments.


What's the connection between menopause and OAB?

During perimenopause, the period leading up to menopause, and menopause itself, the level of estrogen -- which helps to keep the tissues of your bladder and urethra healthy -- begins to drop significantly. If you've begun to notice dryness and sensitivity during sex, it's likely you're at risk for bladder problems as well. The reason: Just as the tissues of the vaginal wall begin to thin and dry out, so does the tissue that lines the bladder. When that happens, your bladder becomes more sensitive to irritants and more susceptible to "hair-trigger" releases.

What's more, lack of estrogen can cause the pelvic muscles, which are responsible for maintaining bladder control, to weaken, eventually resulting in incontinence.

What kinds of bladder control problems can happen with menopause?

Overactive bladder problems take several forms:

Urgency: When you have to go, you have to go now.

Frequency: You have to go all the time, defined as a problem if you need to go more than eight times in a 24-hour period. And yes, this problem is a doozy for sleep disruption.

Urge incontinence: The need to go now comes on suddenly, and if life conspires to keep you from a bathroom, you're likely to have an accident.

How is overactive bladder diagnosed?

To diagnose a bladder control problem, your doctor will perform a physical exam, including a pelvic exam, and order lab tests to look for signs of a urinary tract infection or other problems. The doctor will likely ask you to keep a "voiding diary" in which you write down when you go, note any associated symptoms, and describe accidents or other problems. Keeping a diary can also help you reconstruct the circumstances prior to an accident (what you ate and drank beforehand, for example) or any overwhelming urges you can recall.

What treatments are available for menopause-related overactive bladder?

There are treatments for overactive bladder that help you control urges, treatments that strengthen muscles or improve muscle control, and treatments aimed to reduce irritation. Your primary care physician or a specialist can work with you to analyze the type of bladder problems you're having and devise the best treatment plan. Doctors are likely to suggest lifestyle changes, muscle-strengthening exercises, and bladder retraining before they start considering medications -- which might have side effects -- or surgery. What follows are the most common treatment strategies for bladder problems associated with menopause, in the approximate order a doctor might suggest them.

Treatments for menopause-related OAB

Dietary changes

Many women are surprised to learn how dramatically what they eat and drink can affect bladder function. With that in mind, try eliminating these foods and beverages -- all known to irritate the bladder, triggering urges -- one at a time:

coffee and black tea

citrus fruits and juices

chocolate

regular and diet sodas

alcohol

spicy foods

tomatoes and tomato-based foods and sauces

artificial sweeteners

vinegar and vinegar-based salad dressings

To protect your bladder from irritation and urges:

Drink eight glasses of water, spaced throughout the day.

Drink milk, almond milk, or soy milk to see if this soothes the bladder.

Take a probiotic supplement, which helps control yeast growth and promotes a healthy bladder.

Strengthening bladder muscles with Kegel exercises

With menopause and age, the pelvic floor muscles known as Kegels that control the bladder's ability to hold in urine can weaken. Strengthening these muscles is one of the best ways to control leakage. To do Kegel exercises, squeeze and hold the pelvic muscles and then relax them. You can locate these muscles by stopping the flow of urine midstream. Although it's possible to strengthen Kegels on your own, it's most effective to work with a nurse or physical therapist (PT) who specializes in pelvic floor strengthening.

Bladder retraining for OAB

Your bladder muscles have been conditioned over time to influence the sudden need to urinate -- probably in ways you're not even aware of. Bladder retraining is a therapeutic approach to relearning the ability to resist or inhibit the feeling of urgency. Working with a physical therapy nurse, you retrain your bladder by timing visits to the bathroom according to a strict schedule, gradually extending the intervals between bathroom visits. In addition, the therapist will teach you ways to distract yourself between bathroom visits. A bladder retraining program usually takes at least six to eight weeks to produce results.

Estrogen therapy

If your bladder symptoms first appeared during perimenopause or if you're experiencing other menopause-related symptoms, working with your ob/gyn to control these symptoms with hormone therapy may be the best solution. Many women find that vaginal estrogen, applied as a ring or cream, is extremely effective in treating overactive bladder. This is different from systemic hormone therapy, which uses oral hormones distributed throughout the body, and has fewer risks.

Weight loss

Weight gain -- often associated with menopause -- puts pressure on the bladder, urethra, and pelvic floor muscles. Many women have found that when they lose weight, their overactive bladder problems are gone along with the extra pounds. If you're overweight, try using your frustration with overactive bladder problems as a motivator to embark on a diet and exercise regime.

Other medications

A number of medications can help with OAB, but they're not usually the first treatments of choice, since they can have side effects. Known as anticholinergic agents, they block the action of acetylcholine, a neurotransmitter that stimulates the bladder to contract. By reducing contractions, they control sudden urges to go. Common brand names include Ditropan, Detrol, Oxytrol, Enablex, Sanctura, and Vesicare. The problem with anticholinergics is that they can block other bodily functions as well, causing side effects such as dry eyes, dry mouth, and constipation. Some women also report memory and cognitive problems from these medications.

Biofeedback

Many experts now recommend using biofeedback to aid in the process of retraining the bladder and strengthening pelvic floor muscles. Biofeedback uses electrodes to measure your heart rate, skin temperature, and breathing. It's designed to help you become more aware of your bladder and the muscles you use when you urinate, so you can develop more control.

Sacral nerve stimulation surgery

Electrically stimulating the nerves that control the bladder can greatly reduce or prevent incontinence. Sacral nerve stimulation uses a small neurotransmitter that's implanted under the skin and sends mild electrical impulses to a nerve located in the lower back (the sacral nerve) to influence the bladder and the pelvic floor muscles. The surgery doesn't have a permanent effect on nerves; it only works as long as the neurotransmitter is operational. This means it's a symptom treatment rather than a cure, but it also means it can be discontinued at any time.

ALZHEIMER'S DISEASE: BEST MEDICINE AND TREATMENT

A progressive disease of brain is Alzheimer’s Disease (AD). The characteristics of this disease include memory impairment and disturbance in thinking functionality. According to scientists, the cause of the disease is either accumulation or increased production of specific protein that leads to death of nerve cells.

Treatment for Alzheimer’s Disease

Prescription drugs or medications are helpful in treating AD. Medication is useful for treating behavioral, physical and psychological changes that occur due to this degenerative disease.

US Food and Drug Administration approves five drugs for treating AD. These drugs include: Exelon, Cognex, Razadyne, Aricept and Namenda. These drugs can have side effects and research is going on to test its effectiveness. These drugs do not give positive results to some people while on some others it gives significant effects.

Working of Prescription Drugs

Cholinesterase Inhibitors drugs include Exelon, Cognex, Razadyne and Aricept. In the brain, they delay the breakdown of acetylcholine. For communication between nerve cells, acetylcholine is helpful and is important for memory.

Pharmaceutical Effects

In early stages of AD Exelon, Razadyne and Aricept are effective. For slowing down the degeneration of cognitive symptoms, these prescription drugs are effective. People exhibiting behavioral problems due to AD get relief from these drugs. The use of these drugs improves the quality of life.

Namenda (mematine)

Namenda is N-methyl D-aspartate, which acts on another nerve message transmitter known as glutamate. This drug protects brain from glutamate as it contributes in the death of brain’s nerve cells in people suffering from Alzheimer’s disease. The use of this drug is effective in severe and moderate forms of AD. The improvement of the life of people suffering from AD is visible within few weeks by the use of this drug.

Side Effects of Drugs

Namenda – Headache, dizziness, skin rash, confusion and constipation are the major side effects. Some lesscommon side effects include back pain, insomnia, vomiting, fatigue, hallucinations, high blood pressure and shortness of breath.

Exelon Upset stomach, vomiting, fatigue, nausea and weight loss are some side effects. Dizziness, abdominal pain, tremor, sweating, psychiatric disturbance, diarrhea are some of the less common effects. Gastro intestinal bleeding may occur due to the drug.

Razadyne – If you are taking the drug for the first time you may commonly feel weight loss, nausea, appetite loss, vomiting. Headaches, urinary tract infections, tremor, dizziness, runny nose, blood in urine are some less common effects.

Aricept – Nausea, fatigue, muscle cramps are common effects. Rarely gastric or duodenal ulcers, liver damage, bladder overflow obstruction etc occurs.

Cognex – This is less commonly used as it can cause liver damage. Seizures, heart problems are serious side effects.

Make sure that you consult your doctor and do a lot of research before starting these medicines.

CONSUMER'S MEDICINE INFORMATION

Consumer Medicine Information (CMI) is designed to inform consumers about prescription and pharmacist-only medicines. It provides information about a medicine and is written by the pharmaceutical manufacturer.

A CMI gives you important facts to know before, during and after taking your medicine.

The content of a CMI is defined by legislation and includes headings such as how to take your medicines, side effects and a description of the product. The legislation ensures the leaflet is accurate, unbiased and easy to use.

How do you use it?

Be sure to check that the brand name (usually in largest text) on your medicine exactly matches with the leaflet, to ensure you've chosen the right one.

Read the entire CMI before taking a new medicine, or to learn more about a medicine you're already taking, to ensure you get the best and safest use of the medicine.

Take it with you to your doctor or pharmacist to discuss any questions about medicines.

Keep it handy so you can refer to it later.

Don't use it to try and diagnose, treat, cure or prevent illness yourself.

Where else can you get a copy?

Ask your pharmacist or doctor and they will print it from their computer.

Contact the Medical Information Department of the pharmaceutical manufacturer of your medicine. Find their number in the phone book.

Sometimes you get the Consumer Medicine Information leaflet inside the medicine packet or box.

Sometimes you can find the CMI inside the packet or box. If not, you can:

• search the name of your medicine above and download it from this website
• call Medicines Line on 1300 633 424 for the cost of a local call. You can ring Mon – Fri, 9am – 5pm, Eastern Standard Time
• ask your pharmacist or doctor and they will print it from their computer
• contact the Medical Information Department of the pharmaceutical company that made your medicine. Find their number in the phone book.

MEDICINE UPDATES

Medicine Update issues

Medicine Update lets you know about new medicines and new PBS listings. Each issue provides an independent assessment of current information and research about a different medicine.

Title	Date	Why read this
Denosumab (Prolia) for postmenopausal osteoporosis.	December 2010	Information on denosumab, a medicine used for treatment of postmenopausal osteoporosis.
Exenatide (Byetta) for type 2 diabetes	December 2010	This issue provides information on exenatide (Byetta) for the treatment of type 2 diabetes.
Panadol Extra (paracetamol and caffeine) for pain	December 2010	This Medicine Update is for people who are taking, or thinking about taking, Panadol Extra.
Sitagliptin (Januvia) for type 2 diabetes	August 2010	This Medicine Update is for people who are taking, or thinking about taking, sitagliptin for type 2 diabetes.
Vildagliptin (Galvus) for type 2 diabetes	August 2010	This Medicine Update is for people who are taking, or thinking about taking, vildagliptin for type 2 diabetes.
Pramipexole (Sifrol and Sifrol ER) for Parkinson’s disease	August 2010	A new, long-acting form of pramipexole (Sifrol ER) is available for Parkinson’s disease. This revised Medicine Update describes the potential benefits, side effects and issues to be aware of with pramipexole (Sifrol) or the long-acting form (Sifrol ER).
Dabigatran (Pradaxa) for preventing blood clots after hip or knee replacement surgery	April 2010	Dabigatran is a new medicine to prevent blood clots forming after hip or knee replacement surgery. It works by thinning the blood.
Rivaroxaban (Xarelto) for preventing blood clots after hip or knee replacement surgery	April 2010	Rivaroxaban is a new medicine to prevent blood clots forming after hip or knee replacement surgery. It works by thinning the blood.
Zoledronic acid (Aclasta) for osteoporosis	April 2009	Information for consumers about zoledronic acid (Aclasta), a new treatment for osteoporosis. This treatment is used only once a year, and is given through a drip into a vein.
Tramadol for pain	December 2008	Information for consumers about tramadol, a painkiller prescribed by your doctor.
Duloxetine (Cymbalta) for major depression	August 2008	Information for consumers about duloxetine (Cymbalta), a new antidepressant for major depression.
Strontium ranelate (Protos) for osteoporosis in postmenopausal women	April 2008	Information for consumers about strontium ranelate (Protos) for osteoporosis in postmenopausal women.
Alendronate (Fosamax) for osteoporosis - preventing fractures in people with very fragile bones (low bone mineral density)	January 2008	Information for consumers about the drug Alendronate for preventing fractures in people with very fragile bones (low bone mineral density) and osteoporosis.
Fluticasone with salmeterol (Seretide) for chronic obstructive pulmonary disease	January 2008	Information for consumers about the drug Seretide, for chronic obstructive pulmonary disease.
Varenicline (Champix) for quitting smoking	January 2008	An updated version of this article is coming soon. You can read this original version, but note that the information about PBS listings is now out of date.
Lumiracoxib (Prexige) for osteoarthritis	April 2007	Since this issue of Medicine Update was published, lumiracoxib (Prexige) has been withdrawn by the Therapeutic Goods Administration.