Hytrin Can Cause A Sudden Drop in Blood Pressure After the VERY FIRST DOSE. You may feel dizzy, faint, or "light-headed" particularly after you get up from bed or from a chair. This is more likely to occur after you've taken the first few doses, but can occur at any time while you are taking the drug. It can also occur if you stop taking the drug and then re-start treatment. Hytrin is used to treat high blood pressure hypertension. Hytrin is also used to treat benign prostatic hyperplasia BPH in men. This leaflet describes Hytrin as a treatment for hypertension or BPH. What Is Hypertension High Blood Pressure? pills with endometrin in them
Patients should be closely followed during initial administration in order to minimize the risk of severe hypotensive response. Carcinoma of the prostate and BPH cause many of the same symptoms. These two diseases frequently co-exist. Therefore, patients thought to have BPH should be examined prior to starting Hytrin therapy to rule out the presence of carcinoma of the prostate. The use of the Truven Health products is at your sole risk. These products are provided "AS IS" and "as available" for use, without warranties of any kind, either express or implied. Truven Health and Drugs. It is not intended as medical advice for individual conditions or treatment. It is not a substitute for a medical exam, nor does it replace the need for services provided by medical professionals. Talk to your doctor, nurse or pharmacist before taking any prescription or over the counter drugs including any herbal medicines or supplements or following any treatment or regimen. Only your doctor, nurse, or pharmacist can provide you with advice on what is safe and effective for you.
Oddly enough, though, I think this has led to another problem. I've developed nocturia and often have to get up from bed to urinate. Now that my flow is strengthened due to this med, I often have incontinence if I'm in a deep sleep and the urge doesn't wake me up in time. Not sure of this, of course, but it seems logical. Hytrin may cause a sudden drop in blood pressure after the first dose. Take your first dose at bedtime. If you get up during the night, sit up slowly, then stand slowly. This will help to reduce your lightheadedness or dizziness. These effects are more likely to occur after the first few doses or if your dose has increased, but can occur at any time while you are taking the medicine. It can also occur if you stop taking the medicine and then restart treatment.
The absence of mutagenicity in a battery of tests, of tumorigenicity of any cell type in the mouse carcinogenicity assay, of increased total tumor incidence in either species, and of proliferative adrenal lesions in female rats, suggests a male rat species-specific event. Numerous other diverse pharmaceutical and chemical compounds have also been associated with benign adrenal medullary tumors in male rats without supporting evidence for carcinogenicity in man. In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make.
Do NOT take more than the recommended dose without checking with your doctor. Hytrin helps relieve the symptoms of BPH. It does NOT change the size of the prostate, which may continue to grow. However, a larger prostate does not necessarily cause more or worse symptoms. Please read this leaflet before you start taking Hytrin. Also, read it each time you get a new prescription. This is a summary and should NOT take the place of a full discussion with your doctor who has additional information about Hytrin. You and your doctor should discuss Hytrin and your condition before you start taking it and at your regular check-ups. You should see an effect on your symptoms in 2 to 4 weeks. So, you will need to continue seeing your doctor to check your progress regarding your BPH and to monitor your blood pressure in addition to your other regular check-ups. The incidence of urinary tract infection was significantly lower in the patients receiving terazosin than in patients receiving placebo. An analysis of the incidence rate of hypotensive adverse events see PRECAUTIONS adjusted for the length of drug treatment has shown that the risk of the events is greatest during the initial seven days of treatment, but continues at all time intervals. Further dose response and dose duration studies are being carried out. Blood pressure should be measured at the end of the dose interval; if response is not satisfactory, patients may be tried on a larger dose or twice daily dosing regimen. The latter should also be considered if possibly blood pressure-related side effects, such as dizziness, palpitations, or orthostatic complaints, are seen within a few hours after dosing. Hytrin was not teratogenic in either rats or rabbits when administered at oral doses up to 280 and 60 times, respectively, the maximum recommended human dose. The dose of Hytrin and the dose interval 12 or 24 hours should be adjusted according to the patient's individual blood pressure response. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate safety, effectiveness, or appropriateness for any given patient. Drugs.
Some medical conditions may interact with Hytrin. In a short term study Study 1 patients were randomized to either 2, 5 or 10 mg of Hytrin or placebo. Medication. There are different kinds of medication used to treat BPH. Your doctor has prescribed Hytrin for you. See "What Hytrin does to treat BPH" below. Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco. This information should not be used to decide whether or not to take Hytrin or any other medicine. Only your health care provider has the knowledge and training to decide which medicines are right for you. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about Hytrin. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to Hytrin. This information is not specific medical advice and does not replace information you receive from your health care provider. You must talk with your healthcare provider for complete information about the risks and benefits of using Hytrin. Dermatologic side effects of skin rash have been reported rarely. Lichenoid drug eruption has been associated with terazosin the active ingredient contained in Hytrin therapy. Hytrin should not be used in CHILDREN; safety and effectiveness in children have not been confirmed. Benign enlargement of the prostate is a problem that can occur in men as they get older. The prostate gland is located below the bladder. As the prostate gland enlarges, certain muscles in the gland may become tight and get in the way of the tube that drains urine from the bladder. This can cause problems in urinating, such as a need to urinate often, a weak stream when urinating, or a feeling of not being able to empty the bladder completely. norethisterone
Ask your health care provider any questions you may have about how to use Hytrin. Animal studies have shown an adverse effect and there are no adequate studies in pregnant women OR no animal studies have been conducted and there are no adequate studies in pregnant women. Guthrie R "Terazosin in the treatment of hypertension and symptomatic benign prostatic hyperplasia - a primary care trial. Hernandez RH, Angeligreaves M, Carvajal AR, Pajuelo JG, Padilla MCA, Armashernandez MJ "Terazosin: ex vivo and in vitro platelet aggregation effects in patients with arterial hypertension. The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine. sunh.info uroxatral
It is important that your doctor check your progress at regular visits to make sure that this medicine is working properly. Only 4% of 354 patients from a multicenter trial complained of general abdominal pain or diarrhea within the first 90 days of therapy. Lowe FC "Safety assessment of terazosin in the treatment of patients with symptomatic benign prostatic hyperplasia - a combined analysis. Post-marketing experience indicates that in rare instances patients may develop allergic reactions, including anaphylaxis, following administration of terazosin hydrochloride. There have been reports of priapism and thrombocytopenia during post-marketing surveillance. Atrial fibrillation has been reported. These adverse effects all occurred within 90 minutes of dosing. If your symptoms do not improve or if they become worse, check with your doctor. Hytrin is to be used only by the patient for whom it is prescribed. Do not share it with other people. Do not use it for other health conditions. Dizziness, lightheadedness, or fainting especially when getting up from a lying or sitting position may be more likely to occur in the elderly, who are more sensitive to the effects of terazosin. AUC 0-24 increased 11% after the first verapamil dose and after 3 weeks of verapamil treatment it increased by 24% with associated increases in C max 25% and C min 32% means. lioresal online order
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive. Additional adverse reactions have been reported, but these are, in general, not distinguishable from symptoms that might have occurred in the absence of exposure to terazosin. Metabolic side effects have included decreases in serum triglycerides and VLDL cholesterol, and increases in HDL cholesterol. Terazosin the active ingredient contained in Hytrin may counterbalance deleterious effects on the lipid profile associated with thiazide diuretics, making it a reasonable drug to use in combination with these agents. Hytrin was devoid of mutagenic potential when evaluated in vivo and in vitro the Ames test, in vivo cytogenetics, the dominant lethal test in mice, in vivo Chinese hamster chromosome aberration test and V79 forward mutation assay. Store Hytrin at room temperature, between 68 and 77 degrees F 20 and 25 degrees C. Store away from heat, moisture, and light. Do not store in the bathroom. Keep Hytrin out of the reach of children and away from pets. Terazosin hydrochloride is a white, crystalline substance, freely soluble in water and isotonic saline and has a molecular weight of 459. Nasal congestion and symptoms of sinusitis or dyspnea may be due to alpha-adrenergic blockade. However, terazosin will not help shrink the prostate. The prostate may continue to grow. This may cause the symptoms to become worse over time. Therefore, even though terazosin may lessen the problems caused by enlarged prostate now, surgery still may be needed in the future. In a long-term, open-label, non-placebo controlled clinical trial, 181 men were followed for 2 years and 58 of these men were followed for 30 months. Bottles of 100 NDC 0074-3325-13. Rarely, probably less than once in every several thousand patients terazosin and other α 1-antagonists have been associated with priapism painful penile erection, sustained for hours and unrelieved by sexual intercourse or masturbation. Two or three dozen cases have been reported. Because this condition can lead to permanent impotence if not promptly treated, patients must be advised about the seriousness of the condition see PRECAUTIONS - Information for Patients. Hytrin may cause dizziness, lightheadedness, or fainting; alcohol, hot weather, exercise, or fever may increase these effects. To prevent them, sit up or stand slowly, especially in the morning. Sit or lie down at the first sign of any of these effects. Global assessments of overall urinary function and symptoms were also performed by investigators who were blinded to patient treatment assignment. If syncope occurs, the patient should be placed in a recumbent position and treated supportively as necessary. There is evidence that the orthostatic effect of Hytrin tablets is greater, even in chronic use, shortly after dosing. The risk of the events is greatest during the initial seven days of treatment, but continues at all time intervals. griseofulvin purchase reviews
There does not appear to be a benefit of stopping alpha-1 blocker therapy prior to cataract surgery. To decrease the likelihood of syncope or excessive hypotension, treatment should always be initiated with a 1 mg dose of Hytrin tablets, given at bedtime. The 2 mg, 5 mg and 10 mg tablets are not indicated as initial therapy. Dosage should then be increased slowly, according to recommendations in the Dosage and Administration section and additional antihypertensive agents should be added with caution. The patient should be cautioned to avoid situations, such as driving or hazardous tasks, where injury could result should syncope occur during initiation of therapy. Extremely rarely, Hytrin and similar medications have caused painful erection of the penis, sustained for hours and unrelieved by sexual intercourse or masturbation. This condition is serious, and if untreated it can be followed by permanent inability to have an erection. If you have a prolonged abnormal erection, call your doctor or go to an emergency room as soon as possible. Keep Hytrin and all medicines out of the reach of children. The drug is highly bound to plasma proteins and binding is constant over the clinically observed concentration range. Approximately 10% of an orally administered dose is excreted as parent drug in the urine and approximately 20% is excreted in the feces. The remainder is eliminated as metabolites. Impaired renal function had no significant effect on the elimination of terazosin, and dosage adjustment of terazosin to compensate for the drug removal during hemodialysis approximately 10% does not appear to be necessary. Overall, approximately 40% of the administered dose is excreted in the urine and approximately 60% in the feces. The disposition of the compound in animals is qualitatively similar to that in man. Remember that terazosin will not cure your high blood pressure but it does help control it. Therefore, you must continue to take it as directed if you expect to lower your blood pressure and keep it down. Deger G "Comparison of the safety and efficacy of once-daily terazosin versus twice-daily prazosin for the treatment of mild to moderate hypertension. Mersey JH "Long-term experience with terazosin for treatment of mild to moderate hypertension. Terazosin is available only with your doctor's prescription.
Do not take other medicines unless they have been discussed with your doctor. This especially includes over-the-counter nonprescription medicines for appetite control, asthma, colds, cough, hay fever, or sinus problems, since they may tend to increase your blood pressure. Saunders E "The safety and efficacy of terazosin in the treatment of essential hypertension in blacks. Blood pressure is the tension of the blood within the blood vessels. If blood is pumped too forcefully, or if the blood vessels are too narrow, the pressure of the blood against the walls of the vessels rises. Program of monitoring or "Watchful Waiting". Some men have an enlarged prostate gland, but no symptoms, or symptoms that are not bothersome. If this applies, you and your doctor may decide on a program of monitoring including regular checkups, instead of medication or surgery. Studies on this medicine have been done only in adult patients, and there is no specific information comparing use of terazosin in children with use in other age groups. Non-drug treatments are sometimes effective in controlling mild hypertension. The most important lifestyle changes to lower blood pressure are to lose weight, reduce salt, fat, and alcohol in the diet, quit smoking, and exercise regularly. However, many hypertensive patients require one or more ongoing medications to control their blood pressure. There are different kinds of medications used to treat hypertension. Your doctor has prescribed Hytrin for you. Lepor H. Role of alpha-adrenergic blockers in the treatment of benign prostatic hypertrophy. Terazosin helps to lower blood pressure by relaxing blood vessels so that blood passes through them more easily. The incidence of treatment-emergent adverse events has been ascertained from clinical trials conducted worldwide. All adverse events reported during these trials were recorded as adverse reactions. The incidence rates presented below are based on combined data from six placebo-controlled trials involving once-a-day administration of terazosin at doses ranging from 1 to 20 mg. Table 1 summarizes those adverse events reported for patients in these trials when the incidence rate in the terazosin group was at least 1% and was greater than that for the placebo group, or where the reaction is of clinical interest. Some of the side effects that can occur with terazosin may not need medical attention. As your body adjusts to the medicine during treatment these side effects may go away. Your health care professional may also be able to tell you about ways to reduce or prevent some of these side effects. Do not drink alcohol or use medicines that may cause drowsiness eg, sleep aids, muscle relaxers while you are using Hytrin; it may add to their effects. Ask your pharmacist if you have questions about which medicines may cause drowsiness. Includes weakness, tiredness, lassitude and fatigue. Hytrin may rarely cause a prolonged, painful erection. This could happen even when you are not having sex. If this is not treated right away, it could lead to permanent sexual problems such as impotence. Contact your doctor right away if this happens. actonel
Disclaimer: Every effort has been made to ensure that the information provided is accurate, up-to-date and complete, but no guarantee is made to that effect. In addition, the drug information contained herein may be time sensitive and should not be utilized as a reference resource beyond the date hereof. This material does not endorse drugs, diagnose patients, or recommend therapy. Tell your doctor or dentist that you take Hytrin before you receive any medical or dental care, emergency care, or surgery including eye surgery. The prevalence of adverse reactions has been ascertained from clinical trials conducted primarily in the United States. All adverse experiences events reported during these trials were recorded as adverse reactions. The prevalence rates presented below are based on combined data from fourteen placebo-controlled trials involving once-a-day administration of terazosin, as monotherapy or in combination with other antihypertensive agents, at doses ranging from 1 to 40 mg. Table 3 summarizes those adverse experiences reported for patients in these trials where the prevalence rate in the terazosin group was at least 5%, where the prevalence rate for the terazosin group was at least 2% and was greater than the prevalence rate for the placebo group, or where the reaction is of particular interest. If you miss a dose of Hytrin, take it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once. If more than one dose is missed, contact your doctor or pharmacist. Achari R, Laddu A "Terazosin: a new alpha adrenoceptor blocking drug. During cataract surgery, a variant of small pupil syndrome known as Intraoperative Floppy Iris Syndrome IFIS has been reported in association with alpha-1 blocker therapy see PRECAUTIONS. If Hytrin administration is discontinued for several days, therapy should be reinstituted using the initial dosing regimen. Analysis of the effect of Hytrin on individual urinary symptoms demonstrated that compared to placebo, Hytrin significantly improved the symptoms of hesitancy, intermittency, impairment in size and force of urinary stream, sensation of incomplete emptying, terminal dribbling, daytime frequency and nocturia. Hosmane BS, Maurath CJ, Jordan DC, Laddu A "Effect of age and dose on the incidence of adverse events in the treatment of hypertension in patients receiving terazosin. Terazosin may cause some people to become drowsy or less alert than they are normally. Make sure you know how you react to this medicine before you drive, use machines, or do anything else that could be dangerous if you are dizzy, drowsy, or are not alert. After you have taken several doses of this medicine, these effects should lessen. Genitourinary complaints have rarely included impotence and priapism. In multiple dose clinical trials involving nearly 2000 hypertensive patients treated with Hytrin tablets, syncope was reported in about 1% of patients. Syncope was not necessarily associated only with the first dose. The greater blood pressure effect associated with peak plasma concentrations first few hours after dosing appears somewhat more position-dependent greater in the erect position than the effect of terazosin at 24 hours and in the erect position there is also a 6-10 beat per minute increase in heart rate in the first few hours after dosing. This initial dosing regimen should be strictly observed to minimize the potential for severe hypotensive effects. Elhilali MM, Ramsey EW, Barkin J, Casey RW, Boake RC, Beland G, Fradet Y, Trachtenberg J, Orovan WL, Schick E, Klotz LH "A multicenter, randomized, double-blind, placebo-controlled study to evaluate the safety and efficacy of terazosin in the treatment of benign prostatic hyperplasia. cost donepezil royal
Bottles of 100 NDC 0074-3322-13. If high blood pressure is not treated, it can cause serious problems such as heart failure, blood vessel disease, stroke, or kidney disease. Terazosin has been extensively studied in 1222 men with symptomatic BPH. In three placebo-controlled studies, symptom evaluation and uroflowmetric measurements were performed approximately 24 hours following dosing. Symptoms were systematically quantified using the Boyarsky Index. The questionnaire evaluated both obstructive hesitancy, intermittency, terminal dribbling, impairment of size and force of stream, sensation of incomplete bladder emptying and irritative nocturia, daytime frequency, urgency, dysuria symptoms by rating each of the 9 symptoms from 0-3, for a total score of 27 points. The adverse events were usually transient and mild or moderate in intensity, but sometimes were serious enough to interrupt treatment. In the placebo-controlled clinical trials, the rates of premature termination due to adverse events were not statistically different between the placebo and terazosin groups. The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. Lepor H, Jones K, Williford W "The mechanism of adverse events associated with terazosin: An analysis of the Veterans Affairs cooperative study. You will start with a 1 mg dose of Hytrin. Then the dose will be increased as your body gets used to the effect of the medication. Both differences were statistically significant. Blue No. 2, lactose, magnesium stearate, povidone and talc. While syncope is the most severe orthostatic effect of Hytrin tablets see WARNINGS other symptoms of lowered blood pressure, such as dizziness, lightheadedness and palpitations, were more common and occurred in some 28% of patients in clinical trials of hypertension. In BPH clinical trials, 21% of the patients experienced one or more of the following: dizziness, hypotension, postural hypotension, syncope, and vertigo. Patients with occupations in which such events represent potential problems should be treated with particular caution. Cohen J "Long-term efficacy and safety of terazosin. Patients who take medicine for high blood pressure often feel tired or run down for a few weeks after starting treatment. Be sure to take your medicine even if you may not feel "normal. Follow your doctor's instructions about how to take Hytrin. You must take it every day at the dose prescribed. Talk with your doctor if you don't take it for a few days, you may have to restart it at a 1 mg dose and be cautious about possible dizziness. Do not share Hytrin with anyone else; it was prescribed only for you. Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing. In this long-term trial, both symptom scores and peak urinary flow rates showed statistically significant improvement suggesting a relaxation of smooth muscle cells. buy azithromycin 100 mg
Tell your doctor if you develop any new symptoms. If you have any questions about Hytrin, please talk with your doctor, pharmacist, or other health care provider. Do not keep outdated medicine or medicine no longer needed. Not all side effects for Hytrin may be reported. You should always consult a doctor or healthcare professional for medical advice. Keep out of the reach of children. This is not a complete list of all side effects that may occur. If you have questions about side effects, contact your health care provider. Call your doctor for medical advice about side effects. Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Other side effects you could have while taking Hytrin include drowsiness, blurred or hazy vision, nausea, or "puffiness" of the feet or hands. Discuss any unexpected effects you notice with your doctor. Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional. PREGNANCY and BREAST-FEEDING: If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of using Hytrin while you are pregnant. It is not known if this medicine is found in breast milk. If you are or will be breast-feeding while you use Hytrin, check with your doctor. Discuss any possible risks to your baby. Patients should also be told that drowsiness or somnolence can occur with Hytrin tablets, requiring caution in people who must drive or operate heavy machinery. Highest dose 10 mg shown. norvasc
This may not be a complete list of all interactions that may occur. Ask your health care provider if Hytrin may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine. Use Hytrin as directed by your doctor. Check the label on the medicine for exact dosing instructions. Gastrointestinal problems have been limited mainly to nausea in 5% of patients. Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully. Your doctor has prescribed Hytrin for your BPH and not for prostate cancer. However, a man can have BPH and prostate cancer at the same time. Doctors usually recommend that men be checked for prostate cancer once a year when they turn 50 or 40 if a family member has had prostate cancer. These checks should continue even if you are taking Hytrin. Hytrin is not a treatment for prostate cancer. Small but statistically significant decreases in hematocrit, hemoglobin, white blood cells, total protein and albumin were observed in controlled clinical trials. These laboratory findings suggested the possibility of hemodilution. Treatment with Hytrin for up to 24 months had no significant effect on prostate specific antigen PSA levels. There was a tendency for patients to gain weight during terazosin therapy. Caution should be observed when Hytrin tablets are administered concomitantly with other antihypertensive agents, especially the calcium channel blocker verapamil, to avoid the possibility of developing significant hypotension. When using Hytrin tablets and other antihypertensive agents concomitantly, dosage reduction and retitration of either agent may be necessary see PRECAUTIONS. Hypotension has been reported when Hytrin has been used with phosphodiesterase-5 PDE-5 inhibitors.
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Product Information. Hytrin terazosin. Itskovitz HD "Alpha-1-blockade for the treatment of hypertension - a megastudy of terazosin in 2214 clinical practice settings. The rash was accompanied by mild fever, asthenia, and intense pruritus. The patient was on no other medications. Hematologic and histopathologic studies suggested a drug reaction. Terazosin was discontinued. Two weeks following oral methylprednisolone 40 mg daily and emollients, symptoms had resolved completely.
Statistically significant differences were not found in the verapamil level with and without terazosin. Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit. In animals, terazosin causes a decrease in blood pressure by decreasing total peripheral vascular resistance. The vasodilatory hypotensive action of terazosin appears to be produced mainly by blockade of alpha-1 adrenoceptors. Terazosin decreases blood pressure gradually within 15 minutes following oral administration. Ocular side effects including Intraoperative Floppy Iris Syndrome IFIS have been observed in some patients undergoing phacoemulsification cataract surgery while being treated with alpha-1 blockers.
Limited measurements of peak response 2-3 hours after dosing during chronic terazosin administration indicate that it is greater than about twice the trough 24 hour response, suggesting some attenuation of response at 24 hours, presumably due to a fall in blood terazosin concentrations at the end of the dose interval. Hematologic side effects have included thrombocytopenia. It is not known whether terazosin is excreted in breast milk. Because many drugs are excreted in breast milk, caution should be exercised when Hytrin tablets are administered to a nursing woman.
There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding. Respiratory system side effects have been limited to nasal congestion in 2% to 12% of patients. Symptoms may include dizziness; weakness.