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1985;76;635-643 PediatricsCommittee on Drugs

"Inactive" Ingredients in Pharmaceutical Products

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PEDIATRICS Vol. 76 No. 4 October 1985 635

AMERICAN ACADEMY OF PEDIATRICS

Committee on Drugs

“Inactive” Ingredients in PharmaceuticalProducts

Pharmaceuticals often contain agents that havea variety of purposes including improvement of theappearance, bioavailabiity, stability, and palatabil-ity of the product. Excipients frequently make up

the majority of the mass or volume of oral andparenteral drug products. These pharmaceutical ad-juvants are usually considered to be inert and donot add to or affect the intended action of the

therapeutically active ingredient.

Some 773 chemical agents have been approvedby the Food and Drug Administration for use asinactive ingredients in drug products.1 Inasmuch as

these compounds are classified as “inactive,” man-

0 ufacturers are not presently required to list themon the product label. These ingredients are used fora variety of different purposes (Table 1). Becauseof the large number of these agents and their fre-quency of use, practicing physicians have recentlybecome concerned about their possible physiologic

effects. The increasing number ofreports of adverse

effects associated with pharmaceutical excipients2has led to professional and consumer organizationsformally requesting the FDA (Food and Drug Ad-

ministration) to require complete disclosure on theproduct label of all substances contained in phar-maceuticals. Problems encountered with “inactive”ingredients, include the following.

ADVERSE EFFECTS OF PHARMACEUTICALEXCIPIENTS

Benzyl Alcohol

This antimicrobial agent is commonly used as a

preservative in many injectable drugs and solutions.A number of neonatal deaths and severe respiratory

and metabolic complications in infants have been

associated with use of this agent.� In a controlledstudy, intraventricular hemorrhage, metabolic aci-

dosis, and increased mortality were positively cor-

related with substantial benzoic acid and benzyl

alcohol levels in neonates.6 Therapeutic doses ofagents other than large-volume fluids do not con-thin the amounts of benzyl alcohol associated withthis syndrome. However, the effects of loweramounts have not been adequately studied (Table2). The American Academy of Pediatrics7 and theCenters for Disease Control8 as well as the FDA9

now recommend that use of products containingthis agent should be avoided in infants and that

intravascular flush solutions containing preserva-

tives should be avoided in newborns.Benzyl alcohol may also cause hypersensitivity

reactions. Contact dermatitis’#{176} as well as more gen-eralized allergic symptoms including nausea, fa-tigue, or angioedema may occur following paren-

teral administration of benzyl alcohol-preserved

products.11”2

Propylene GIycoI

This agent is commonly used as a drug solubilizerin topical, oral, and injectable medications. A num-

ber of cases of localized contact dermatitis from

application of propylene glycol to skin or mucusmembranes have been reported.’3’5 In a series of400 patients with eczematous contact dermatitis,

six (1.5%) were found to be sensitive to propylene

glycol.’6 Absorption from creams applied to burns’7and injection of multivitamin products in infants’8have resulted in serum hyperosmolality. Hyperos-molality related to propylene glycol occurred in nineof 262 hospitalized burn patients.’9 Cardiac ar-

rhythmias, CNS depression, and seizures have oc-

curred in children who have ingested oral liquidmedications containing propylene glycol.�#{176}’2’The

high concentrations of propylene glycol containedin certain parenteral drug products such as pheny-tom, diazepam, and digoxin may induce thrombo-phlebitis when administered intravenously.22 Be-



0

636 PHARMACEUTICAL PRODUCTS

cause propylene glycol is metabolized to lactic acid,

lactic acidosis may be produced.� Hemolysis, CNS

depression, hyperosmolality, and lactic acidosis

have also been reported after intravenoos admfn-istration of propylene glycol.�’ Rapid intravenous

injection of products containing propylene glycolhas also been associated with respiratory depres-sion, dysrhythmias, hypotension, and seizures.�

Lactose

Lactose (milk sugar) is widely used as a filler or

diluent in tablets and capsules and to give bulk topowders. Lactase deficiency, occurring either as a

rare congenital disorder or more commonly as an

acquired lack of intestinal brush border disaccha-

ridase, may lead to diarrhea, abdominal cramping,

TABLE 1. Categories of Pharmaceutical Excipients

Aerating agents and gasesAir displacement agentsColor additivesDenaturing agentsDispersing agentsEmollientsEmulsifiers and emulsifying saltsFlavors and flavoring adjunctsFragrancesHumectantsLevigating agentsOintment basespH control agentsPreservatives

Propellants

Solvents and vehiclesStiffening agentsSuppository basisSurface-active agentsSuspending agentsTablet and capsule diluentsTablet basesTablet bindersTablet-coating agents

bloating, and flatulence following ingestion of milkproducts or lactose. These effects are produced

either by lactic acid formed in the intestine by

bacteria from undigested lactose or by a high intes-

tinal osmotic load caused by unabsorbed carbohy-di�ate with production of carbon dioxide and hydro-gen gas by bacterial fermentation.� Lactose intol-erance in infants and young children may be asso-ciated with severe, prolonged diarrhea complicated

by bacterial proliferation in the small bowel, dehy-dration, and metabolic acidosis.27 Lactose may be

detrimental to the galactose-intolerant infant.Late-onset lactase deficiency (adult hypolacta-

sia) is a common disorder. Approximately 90% of

adult American blacks and 60% to 80% of Mexican-Americans, native American Indians, Asians, and

most Middle-Eastern and Mediterranean popula-tions have abnormal findings on lactose tolerancetests.�� About 10% of the white population with

Scandinavian or European ancestry is affected.�Lactase deficiency may develop sporadically inotherwise tolerant individuals during intestinal dis-eases such as tropical sprue or acute gastroenteri-

tis.34 Sensitivity to lactose varies widely in severity,although some individuals (adults and children)may experience diarrhea, gaseousness, or cramping

after ingestion of as little as 3 g of lactose andpossibly less.�’� Such symptoms can occur in sen-

sitive individuals following ingestion of drugs con-

taming lactose.37

Coloring Agents

Numerous dyes are used in pharmaceutical man-

ufacturing. These agents give products a distinctive,identifiable appearance, and they impart a uniformand attractive color to products that might other-

wise be drab, unappealing, or exhibit color variationfrom batch to batch.

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TABLE 2. Parenteral Medications That Contain Benzyl Alcohol

Drug Benzyl AlcoholContent (%)

Estimated AverageDaily Intake of

Benzyl Alcohol inInfants

Aminophylline 2.0 2-4 mg/kgAquamephyton neonatal injection 0.9 4.5 mgBacteriostatic saline 1.5 99-234 mg/kgBacteriostatic water 1.5 99-234 mg/kgDexamethasone injection 1.0 2.5 mgFolate sodium 1.5 0.6-0.9 mgHeparin injection 1000 �ag/mL 1.0 1.2 mgMultivitamin infusion 0.9 45 mgPavulon injection 1.0 2-3 mg/kgPhenobarbital injection 1.5 1.15-2.3 mg/kgSolu-Cortef injection 0.905 0.18 mg/kgTrace elements 0.9 9 mgValium injection 1.5 4.5-10.5 mg/kgVitamin E injection 2.0 2-20 mg/kg 0



TABLE 3. Reactions Associated with Pharmaceutical Coloring Agents

Dye Effect ReferenceNo.

Angioedema, urticaria, pruritus 47Urticaria, unspecified subjective symptoms 48Bronchoconstriction (combined with ponceau, Sunset Yellow) 49

Bronchoconstriction (combined with Brillant Blue, Indigo Car- 49mine)

Sequential vascular response, unspecified symptoms 50Elevation of protein-bound iodide 51

Bronchoconstriction (combined with amaranth, Sunset Yellow) 49Anaphylactoid reaction (combined with Sunset Yellow) 52Chest heaviness 53

Urticaria, unspecified subjective symptoms 48Purpura 54

Sunset Yellow (FD & C Yellow No.6)

D & C Yellow No.11

Quinoline Yellow

Brillant Blue (FD & C Blue No. 1)

Indigo Carmine (FD & C Blue No.2)

0 New coccine

0

484952

535457

58,59

sine)

AMERICAN ACADEMY OF PEDIATRICS 637

Several groups of dyes have been associated with

serious adverse effects. The azo dye tartrazine (FD

& C Yellow No. 5) is well known as a potentialdanger in aspirin-intolerant individuals. Approxi-

0 mately 2% to 20% of patients with asthma aresensitive to aspirin; of these, approximately 10%are also sensitive to tartrazine.�’39 Unlike aspirin,tartrazine does not alter prostaglandin synthesis

and does not, therefore, exert anti-inflammatoryactions. Nonetheless, reactions to tartrazine aresimilar to those produced by aspirin and include

acute bronchospasm or increased bronchial reactiv-ity as well as urticaria and angioedema.3� Rarely,

anaphylaxis occurs.”t� Because of the seriousnessof these reactions and because of the widespread

Amaranth (FD & C Red No.2)

Erythrosine (FD & C Red No.3)

Ponceau (FD & C Red No. 4)

Neutral Red

Evans Blue (C.!. Direct Blue 53)

Patent Blue

Methyl Blue (C.!. Acid Blue 93)

Gentian Violet (C.I. Basic Violet 3)

Contact dermatitis

use of tartrazine in foods and over-the-counter and

prescription drugs, the FDA� in 1980 required all

products containing tartrazine to be labeled so asto provide a means to avoid this substance. No

other dye or pharmaceutical excipient is currently

subject to similar labeling requirements.In addition to tartrazine, many other dyes have

caused unwanted effects. Examples of these effects

are listed in Table 3.Dyes and other food additives have also been

suggested as a cause or aggravating factor in somecases of hyperactivity in children47; carefully con-

trolled trials�’69 and current opinion7#{176}72 generally

refute a possible association.Hypersensitive individuals should avoid dyes; liq-

Urticaria, rhinitis, nasal congestionBronchoconstriction (combined with amaranth, ponceau)Anaphylactoid reaction (combined with ponceau)Eosinophilotactic responsePurpuraAbdominal pain, vomiting, indigestion, distaste for food

Contact dermatitis

55,56

Contact dermatitis 59

Bronchoconstriction (combined with erythrosine, Indigo Car- 49mine)

Eosinophilotactic response 53

Bronchoconstriction (combined with Brillant Blue, erythro- 49

Dermatitis

Unspecified subjective symptomsPurpuraDermatitis

Wheezing, dyspnea

Contact dermatitis

60-62

485463

64

65,66



TABLE 4. Examples of Dye-Free Orally Administered Liquid Medications


C1as�ification and Product (Manufacturer)

AnalgesicsDemerol* (Winthrop-Breon)

AnalepticsCoramine* (Ciba)

Antibiotic/antiinfectiveAntepar (Burroughs-Wellcome)

Antiminth (Pfizer)Chloromycetin (Parke-Davis)Coco-Quinine (Lilly)Coly-Mycin S (Parke-Davis)Furoxone (Norwich-Eaton)Gantrisin syrup (Roche)Gantrisin pediatric suspension (Roche)Mandelamine-250 (Parke-Davis)

Minocin (Lederle)Mintezol (Merck Sharp & Dohme)Pediazolet (Ross)Vancocint (Lilly)

Antihistamine/decongestant/antitussive

Chlorafed (Hauck)Codiclear (Central)

Deconamine syrup (Berlex)Elixir terpin hydrate/codeine (Lilly)Pseudoephedrine and triprolidine syrup (Roxane)Pseudoephedrine syrup (Roxane)SK-terpin hydrate/codeine (Smith Kline)Tussionex (Pennwalt)Thss-Ornade (Smith Kline)

Cardiovascular agents

Aldomet (Merck Sharp & Dohme)Colestidt (Upjohn)

GastrointestinalAlternagel (Stuart)Aromatic cascara sagrada fluidextract (Roxane)

Camalox (Rorer)

Citrocarbonatet (Upjohn)Doxinate (Hoechst)

Effersylliu.mt (Stuart)Ipecac syrup USPt (Roxane)Kaopectate (Upjohn)Maalox Plus (Rorer)

Maalox TC (Rorer)

Milk of magnesia USP (Roxane)Mylanta II (Stuart)

Neutralox (Lemmon)

Parapectolin (Rorer)Paregoric (Lilly)Paregoric (Roxane)Perdiemt (Rorer)

Hormonal agentsDexamethasone solution (Roxane)

Intensol* (Roxane)Maxibolin (Organon)Proglycem (Schering)

Active Ingredients

(per 5 mL unless indicated otherwise)

Meperidine 50 mg

Nikethamide 1.25 g

Piperazine citrate 500 mgPyrantel pamoate 250 mgChloramphemcol 150 mgQuinine 110 mgColistin 25 mgFurazolidone 50 mgSulfisoxazole 500 mgSulfisoxazole 500 mgMethenamine mandelate 250 mgMincoycline 50 mgThiabendazole 500 mgErythromycin 200 mg, sulfisoxazole 600 mgVancomycin 417 mg

Chlorpheniramine 2 mg, pseudoephedrine 30 mgHydrocodone 5 mg, potassium gualacolsulfonate

300 mgPseudoephedrine 30 mg, chlorpheniramine 2 mgTerpin hydrate 85 mg, codeine 10 mgPseudoephedrine 30 mg, triprolidine 1.25 mgPseudoephedrine 30 mgTerpin hydrate 85 mg, codeine 10 mgHydrocodone 5 mg, phenyltoloxamine 10 mgPhenyipropanolamine 12.5 mg, caramiphen 6.7

mg

Methyldopa 250 mgColestipol 5 g/packet

Aluminum hydroxide 600 mgHydroxymethylanthraquinones equivalent to

cascara sagrada extract 1 g/mLAluminum hydroxide 225 mg, magnesium hy-

droxide 200 mg, calcium carbonate 250 mgSodium citrate 1.82 g, sodium bicarbonate 0.78 gDocusate 50 mgPsyllium hydrocolloid 3 gIpecac alkaloids 20 mg/15 mLKaolin 975 mg, pectin 22 mgAluminum hydroxide 225 mg, magnesium hy-

droxide 200 mg, simethicone 25 mgAluminum hydroxide 600 mg, magnesium by-

drOxide 665 mgMagnesium hydroxide 400 mgAluminum hydroxide 400 mg, magnesium by-

drOxide 400 mg, simetbicone 30 mgAluminum hydroxide 300 mg, magnesium by-

droxide 150 mgOpium 2.5 mg, kaolin 916 mg, pectin 27 mgMorphine (equivalent) 2 mgMorphine (equivalent) 2 mgPsyllium (82% w/v), senna (18% w/v)

Dexamethasone 0.5 mgDexametbasone 5 mgEtbylestrenol 2 mgDiazoxide 250 mg

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TABLE 4. Continued

Classification and Product (Manufacturer)

O PsychotropicsCibalith-S (Ciba)Haldol* (McNeill)Navane (Roerig)Permitil (Schering)Sinequan (Roerig)

Thorazine syrup (Smith Kline)Trilafon (Schering)

Sedatives/hypnotics

Chloral hydrate syrup (Roxane)Spasmolytics/bronchodilators

Alupent inhalent solution* (boehringer Ingelheim)Aquaphyllin (Ferdale)Elixicon (Berlex)Marax DF (Roerig)

Neothylline (Lemmon)Slo-Phyllin GG (Rorer)Somophyllin-DF (Fisons)Theoclear (Central)

MiscellaneousGlyoxide (Marion)

Glycerin oral solution USP (Roxane)* Flavoring-free.

t Preservative-free.

Active Ingredients(per 5 mL unless indicated otherwise)

Lithium 8 mEq (= lithium carbonate 300 mg)Haloperidol 10 mgThiotbixene 25 mgFlupbenazine 25 mgDoxepin 50 mgChlorpromazine 10 mgPerphenazine 16 mg

Chloral hydrate 250 mg

Metaproterenol 50 mg/mLTheophylline 5.33 mgTheophylline 100 mgEphedrine 6.25 mg, theophylline 32.5 mg, hy-

droxyzine 2.5 mgDypbylline 53.3 mgTheophyffine 50 mg, Guaifenesin 30 mgTbeophylline 90 mgTheophylline 5.33 mg

Carbamide peroxide 100 mg/mL, anhydrous gly-cerol qs

Glycerin 50% v/v (0.6 g/mL)

uid medications that do not contain dyes are listed

in Table 4. Examples of nutritional supplements/

0 vitamins that do not contain dyes are presented inTable 5. These listings were compiled from volun-tary responses to personal communications re-ceived from 56 US drug manufacturers (out of 96

contacted) between June 1983 and March 1984.Until complete ingredient labeling is mandated,these lists will provide a tool to prevent reactionsthrough avoidance in sensitive children using liquiddosage forms. Because inactive ingredients maychange without changes in labeling, information inTables 4 and 5 should be verified.

Sulfites

Sulfiting agents are widely used as antioxidants.

Six sulfite compounds (sulfur dioxide, sodium sul-fite, sodium and potassium bisulfite, and sodiumand potassium metabisulfite) have been categorized

as “Generally Recognized as Safe” (GRAS) for usein foods and drugs. Their GRAS status is currentlyunder reconsideration, however, as the FDA hasreceived reports of approximately 250 cases of ad-

verse reactions, including six deaths associated withingestion of sulfites in foods.73 Serious reactionshave also occurred following oral or inhalationaladministration of certain drugs. Symptoms most

0 frequently include wheezing, dyspnea, chest tight-ness (particularly in patients with a history of

asthma), urticaria, angioedema, flushing, weakness,

or nausea.7478 Anaphylaxis has occurred.76’77’79’�#{176}Metabisulfite hypersensitivity has been demon-

strated in 19 of 29 (66%) children with a history of

chronic asthma.8’Of particular concern is the presence of sulfites

in many medications used by asthmatics. Althoughmany nebulizer solutions contain sulfites, metered-

dose aerosol bronchodilators do not contain sulfitesand, thus, may be recommended for sulfite-sensi-tive asthmatics. Parenteral drugs such as cortico-steroids and antibiotics as well as intravenous so-lutions may contain sulfites (Table 6). A total of 47nonoral prescription bronchodilator products are

known to contain sulfites.82 Nonsulfite-containingproducts used for treatment of asthma are pre-

sented in Table 7.Diagnosis of sulfite sensitivity is made by history

and through challenge testing.76 Avoidance of foodscontaining sulfites through careful reading of thelabel and inquiry at restaurants as to use of sulfiting

agents may prevent reactions. Drug manufacturersare not currently required to include sulfites in thelabeling of oral products.

Saccharin

Many oral drugs, including both solid and liquiddosage forms, contain saccharin as a sweeteningagent. Saccharin is not included in drug labeling.



Product (Manufacturer) Active Ingredients (5 mL unless indicated otherwise)

Vitamin Vitamin Vitamin Vitamin Vitamin OtherB, (mg) B2 (mg) B3 (mg) B5 (mg) B� (mg)

Aquasol A (USV) Vitamin A 5,000 U/0.1 mLAquasol E (USV)Betalin complex (Lilly) 2.7 1.4 6.8 2.7 0.6

Vitamin E 50 U/mLVitamin B12 3 �ig

Drisdolt (Winthrop-Breon) Ergocalcifero 8,000 U/mLFeostat suspension (O’Neal) Iron 100 mgFerrous sulfate liquid (Roxane)Homicebrin (Lilly) 1 1.2 10 3 0.5

Iron 300 mgVitamin B,2 3 ig

Hytakerol (Winthrop-BreonIncremin with iron (Lederle) 6 3

Dihydrotacbysterol 0.25 mg/mLVitamin B,2 �g

Lederplex (Lederle) 1.1 1.3 15 7.5 1.5Lipomul (Upjohn)Livitimin (Beecham) 1 1 2 0.7 1

Corn oil 3.3 gVitamin B,2 1 �ig

Theragran (Squibb) 10 10 100 21 4.1 Vitamin B,2 5 gig, Vitamin C 200

mg, Vitamin A 10,000 U, VitaminD400U

Zentron (Lilly) 1 1 3 1 1 Vitamin B,2 3 gig, Vitamin C 100mg, iron 12 mg

Zymalixir (Upjohn) 1 1 8 2 Liver concentrate 65 mg, iron 15 mg

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TABLE 6. Some Bisulfite-Containing Medications Used by Asthmatics

Brand Name Manufacturer

TABLE 5. Examples of Dye-Free Nutritional Supplements/Vitamins*


* List excludes infant vitamin drops; none contain dyes.

t Flavoring-free and preservative-free.

Adrenalin Chloride 1:100

Adrenalin injection 1:1000Alupent solution 5%Alupent syrup

Amikin injectionApogen injectionBristagen injectionBronkosol inhalant 1.0%Bronkosol solution 0.25%Bronkosol unit dose 0.25%Celestone injection4-Way nasal sprayGaramycin injection (all but intravenous piggy-

back and intratbecal)Hexadrol phosphate injectionIsoetharine HCL 0.25%, 1%Isoetbarine HC1 Dispos-a-Med 0.5%Isoetharine HC1, 1%Isoproterenol Dispose-a-MedIsuprel injection

Isuprel solution 0.5%, 1%Metaprel solution 5%Micronefrin solution 2.25%Minocin syrup

Nebcin injectionNetromycin injectionReglan injectionVaponefrmn solution 2.25%Vapo-Iso solution 0.5%

Parke-Davis

Parke-DavisBoehringer Ingetheim

Boehringer IngetheimBristolBeecbamBristolBreon

BreonBreon

ScberingBristol-Meyers

Scbering

OrganonPhilips RoxaneParke-Davis

Philips RoxaneParke-Davis

Breon

BreonDorsey

BirdLederleDistaSeberingRobinsFisonsFisons

Artificially sweetened foods (such as low-caloriesoft drinks) that contain saccharin are labeled with

the caution, “use of this product may be hazardousto your health. . .contains saccharin which has been

determined to cause cancer in laboratory animals.”

Saccharin may be present in drugs in substantialamounts. Ingestion of the recommended daily dos-age of chewable aspirin or acetaminophen tabletsin a school-aged child would provide approximatelythe same amount of saccharin contained in one can 0



0

0 of a diet soft drink. Relative to the body weight ofa child less than 9 or 10 years of age, this amount

used chronically would fall into the category of“heavy use” as defined in a major large-scale FDA!NCI (National Cancer Institute) epidemiologicstudy.� In this study, heavy use of artificial sweet-eners was associated with a significantly increasedrisk for development of bladder cancer. Severalother case-control studies have failed to document

an association of saccharin use and cancer in hu-mans,� although the magnitude or risk of carci-

nogenesis is still not fully resolved. Saccharin inges-tion has occasionally been associated with devel-opment of episodic urticarial reactions.87.ss

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REFERENCES

1. Brown JL: Incomplete labeling of pharmaceuticals: A list of“inactive” ingredients. N Engi J Med 1983;309:439-441

2. Smith JM, Dodd DRP: Adverse reactions to pharmaceutical

TABLE 7. Some Medications Used by Asthmatics That Do Not Contain Bisulfites


Brand Name

Accurbron elixirAerolone solution 0.25%Alupent aerosolAlupent tabletsAminopbylline injection

Bretbine injection 0.1%Brethine tabletsBronitin Mist aerosol

Bronkaid Mist aerosolBronkometer aerosolDuo-Medihaler aerosolElixopbyllin elixir

Intal capsulesIntal solution 1%Medibaler-Epi aerosolMedihaler-Iso aerosolMetaprel aerosolNorisodrine aerosolNorisodrine sulfate powderPrimatene mist suspension aerosolPrimatene mist solution aerosolProventil aerosolQuibron capsuleQuibron liquid

Sus-Phrine injectionTheo-Dur sprinkleTheo-Dur tabletsVanceril inhalerVentolin aerosolVentolin inhalerVentolin tablets

Manufacturer

Merrell DowLillyBoehringer IngetheimBoehringer IngetheimElkins-Sinn

Geigy

GeigyWhitehallWinthropBreon

Riker

BerlexFisons

FisonsRiker

Riker

Dorsey

Abbott

AbbottWhitehallWhitehallScheringMead JohnsonMead JohnsonBerlexKeyKeyScheringGlaxoGlaxo

Glaxo

RECOMMENDATIONS

Labeling ofpharmaceutical agents should includequalitative listings of inactive ingredients so that

adverse reactions or complications can be avoidedin susceptible persons. Provision of such informa-

tion should be a mandatory part of the manufac-

turer’s labeling for all prescription and over-the-

counter products.

COMMITFEE ON DRUGS, 1984-1985

Albert W. PrUitt, MD, Chairman

Ralph E. Kauffman, MD

Howard C. Mofenson, MD

Robert J. Roberts, MDBarry H. Rumack, MDHarvey S. Singer, MDStephen P. Spielberg, MD, PhD

Liaison RepresentativesDonald R. Bennett, MD, PhD

Sumner J. Yaffe, MDLouis Farchione, MDMartha M. Freeman, MD

Melvin V. Gerbie, MD

Sam A. Licata, MD

Mary Lund Mortensen, MD

AAP Section LiaisonSanford N. Cohen, MD

ConsultantsLarry K. Golightly, PharmDSusan C. Smolinske, BS, RPhRocky Mountain Drug Consultation Center

Advisor

Jeffrey Lee Brown, MD



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