Ursofalk suspension 250mg/5ml 250ml (Dr. Falk)

Compound

The capsules contain the active component ursodeoxycholic acid , as well as inactive components: corn starch, magnesium stearate, colloidal silicon dioxide, sodium lauryl sulfate, gelatin, titanium dioxide, purified water.
ursodeoxycholic acid as an active component , as well as additional components: benzoic acid, xylitol, glycerol, MCC, sodium citrate, propylene glycol, anhydrous citric acid, sodium cyclamate , sodium chloride, flavoring, water.

pharmachologic effect

This drug is a hepaprotector , that is, a medicine that helps dissolve cholesterol gallstones, significantly reducing cholesterol levels in the blood. It has a wide range of effects, in particular, it acts as a hepatoprotective, cholelitholytic, immunomodulatory agent. A hypoglycemic effect is also noted.

Ursodeoxycholic acid , an active substance contained in the drug Ursofalk, is also present in certain quantities in bile. But if certain liver functions are impaired, the synthesis of this substance and its content in the bile decreases. Has a positive effect on immunological reactions in the liver.

The following effects of ursodeoxycholic acid are highlighted:

• has a choleretic effect , reducing the amount of bile acids in bile and increasing their excretion into the intestinal lumen, also reducing the absorption of toxic bile hydrophobic acids;
• a cytoprotective effect is manifested , which consists in the ability of this substance to be incorporated into the lipid layer of the cell membrane, which leads to stabilization of the cell membrane and strengthening of its protective properties;
• there is also an immunomodulatory effect and a decrease in the synthesis of proinflammatory cytokines;
• produces a hypercholesterolemic effect due to a decrease in the absorption of cholesterol in the ileum, a decrease in the synthesis of cholesterol in the liver, and also by activating the process of its excretion with bile.

of bile decreases . As a consequence, the transformation of cholesterol compounds leads to a decrease in the formation of cholesterol and to the dissolution of cholesterol stones.

Under the influence of the drug Ursofalk, gastric and pancreatic secretion increases.

Pharmacokinetics and pharmacodynamics

After taking the medicine in the form of a suspension or capsules orally, the process of absorption of ursodeoxycholic acid occurs in the small intestine. Approximately 60-80% of the dose that was taken is determined in the general bloodstream. Metabolism of the active component occurs in the liver. The active ingredient is partially broken down in the intestines, resulting in the formation of toxic 7-keto-lithocholic acid. This substance is slightly absorbed into the general bloodstream; its detoxification occurs in the liver.

A characteristic feature of this drug is the effect of first passage through the liver. The half-life is 3-5 days. Excretion occurs in feces mainly in the form of metabolites, and a small part is excreted unchanged.

Ursofalk, 100 pcs., 250 mg, capsules

Inside.

Children and adults weighing less than 34 kg are recommended to use Ursofalk in the form of a suspension.

Dissolution of cholesterol gallstones.

The recommended dose is 10 mg/kg/day, which corresponds to:

when taking oral suspension

The drug must be taken daily in the evening, before bed (the capsules are not chewed), with a small amount of liquid.

Duration of treatment is 6–12 months. To prevent recurrent cholelithiasis, it is recommended to take the drug for several months after the stones have dissolved.

Treatment of biliary reflux gastritis

1 caps. (1 measuring cup) Ursofalk daily in the evening, before bedtime (the capsules are not chewed), washed down with a small amount of water.

The course of treatment is from 10–14 days to 6 months, if necessary – up to 2 years.

Symptomatic treatment of primary biliary cirrhosis.

The daily dose depends on body weight and ranges from 3 to 7 caps. or 2–7 measuring cups (from approximately 14 ± 2 mg/kg ursodeoxycholic acid).

In the first 3 months of treatment, the use of the drug Ursofalk (capsules, 250 mg) should be divided into several doses throughout the day. After improvement of liver parameters, the daily dose of the drug can be taken 1 time in the evening.

The following mode of application is recommended:

250 mg capsules

when taking oral suspension

Capsules should be taken regularly, without chewing, with a small amount of liquid.

The use of Ursofalk for the treatment of primary biliary cirrhosis can be continued indefinitely.

In patients with primary biliary cirrhosis, in rare cases, clinical symptoms may worsen at the beginning of treatment, for example, itching may become more frequent. In this case, treatment should be continued, taking 1 capsule. daily, then gradually increase the dosage (increasing the daily dose weekly by 1 capsule) until the recommended dosage regimen is achieved again.

Symptomatic treatment of chronic hepatitis of various origins.

Daily dose: 10–15 mg/kg in 2–3 doses. Duration of treatment is 6–12 months or more.

Primary sclerosing cholangitis.

Daily dose - 12–15 mg/kg; if necessary, the dose can be increased to 20–30 mg/kg in 2–3 doses. The duration of therapy ranges from 6 months to several years.

Cystic fibrosis (cystic fibrosis).

Daily dose 12–15 mg/kg; if necessary, the dose can be increased to 20–30 mg/kg in 2–3 doses. The duration of therapy ranges from 6 months to several years.

Non-alcoholic steatohepatitis.

The average daily dose is 10–15 mg/kg in 2–3 doses. The duration of therapy ranges from 6–12 months or more.

Alcoholic liver disease.

The average daily dose is 10–15 mg/kg in 2–3 doses. The duration of therapy is 6–12 months or more.

Biliary dyskinesia.

The average daily dose is 10 mg/kg in 2 divided doses for 2 weeks to 2 months. If necessary, it is recommended to repeat the course of treatment.

Indications for use

Those indications for the use of the drug Ursofalk, which are indicated in the instructions, are associated with use for diseases of the liver and gallbladder, in which cholestasis, an increase in blood cholesterol levels, as well as a decrease in a number of liver functions are noted. The medicine is prescribed for the following diseases:

• primary biliary liver cirrhosis
• primary sclerosing cholangitis;
• hepatitis of various origins (acute and chronic), accompanied by cholestasis ;
• reflux esophagitis and biliary reflux gastritis;
• the presence of cholesterol stones in the gallbladder (provided that the stones are X-ray negative, their diameter is no more than 15 mm, and the person does not have gallbladder dysfunction);
• cystic fibrosis;
• toxic liver damage (including alcohol poisoning);
• atresia of the intrahepatic bile ducts.

Also, tablets and suspension are prescribed to eliminate bile stagnation in people on parenteral nutrition. It is advisable to prescribe them to patients who have undergone liver transplantation in order to prevent liver damage in the case of treatment with drugs with a cholestatic effect and taking hormonal contraceptives. Ursofalk is also prescribed for the prevention of colon cancer in those people who are considered at risk.

Ursofalk

Dissolution of cholesterol gallstones

The recommended dose is 10 mg of ursodeoxycholic acid per 1 kg of body weight per day, which corresponds to:

The drug must be taken daily in the evening, before bedtime.

Duration of treatment is 6-12 months. To prevent recurrent cholelithiasis, it is recommended to take the drug for several months after the stones have dissolved.

Treatment of biliary reflux gastritis

1 measuring cup of Ursofalk daily in the evening before bed.

The course of treatment is from 10-14 days to 6 months, if necessary - up to 2 years.

Treatment of primary biliary cirrhosis

The daily dose depends on body weight and ranges from 2 to 7 measuring cups (approximately 14 mg ± 2 mg ursodeoxycholic acid per 1 kg of body weight). The following mode of application is recommended:

Symptomatic treatment of chronic hepatitis of various origins -

daily dose 10-15 mg/kg in 2-3 doses. Duration of treatment is 6-12 months or more.

Primary sclerosing cholangitis -

daily dose 12-15 mg/kg; if necessary, the dose can be increased to 20 mg/kg in 2-3 doses. The duration of therapy ranges from 6 months to several years (see section: “Special instructions”).

Cystic fibrosis (cystic fibrosis) -

daily dose 20 mg/kg/day in 2-3 divided doses, with a further increase to 30 mg/kg/day if necessary.

Body weight more than 10 kg: dosage 20-25 mg ursodeoxycholic acid/kg/day.

Measuring device: measuring cup

* Conversion table:

Children weighing up to 10 kg get sick very rarely. In this case, a commercially available disposable syringe should be used.

Single doses for children weighing up to 10 kg should be measured using a syringe as the measuring cup provided is not designed for volumes less than 1.25 ml. Use a disposable 2 ml syringe in 0.1 ml increments. Please note: disposable syringes are not included in the drug package, but can be purchased at your local pharmacy.

To measure the required dose using a syringe:

1. Shake the bottle before opening it.

2. Pour a small amount of suspension into the measuring cup that is included in the package with the drug.

3. Fill the syringe with a slightly larger volume of the drug than required.

4. Tap the syringe with your fingers to remove air bubbles from the collected suspension.

5. Make sure that the required volume of suspension is in the syringe; if necessary, add or release excess volume.

6. Carefully pour the contents of the syringe directly into the child's mouth.

Do not insert the syringe into the vial. Not

pour unused suspension from the syringe or measuring cup back into the vial.

Body weight up to 10 kg: dosage 20 mg ursodeoxycholic acid/kg/day. Measuring device: disposable syringe

Non-alcoholic steatohepatitis -

the average daily dose is 10-15 mg/kg in 2-3 doses. The duration of therapy ranges from 6-12 months or more.

Alcoholic liver disease -

the average daily dose is 10-15 mg/kg in 2-3 doses. The duration of therapy ranges from 6-12 months or more.

Biliary dyskinesia -

the average daily dose is 10 mg/kg in 2 divided doses for 2 weeks to 2 months. If necessary, it is recommended to repeat the course of treatment.

Contraindications

The instructions indicate the following contraindications to the use of tablets and suspensions:

• X-ray positive gallstones (that is, stones with a high calcium content);
• acute inflammatory diseases of the bile ducts, intestines, gall bladder;
• liver cirrhosis in the decompensation stage;
• non-functioning gallbladder;
• severe disturbances in the functions of the liver, pancreas, kidneys;
• pregnancy and lactation;
• pronounced sensitivity to drug components.

Side effects

During treatment, the following side effects may occur:

• digestive system: diarrhea , manifestation of acute pain in the upper abdomen on the right during the treatment of primary biliary cirrhosis ;
• liver and biliary tract: in rare cases - calcification of stones, decompensation of liver cirrhosis in those undergoing treatment for primary biliary cirrhosis ;
• skin, subcutaneous tissues: in rare cases - urticaria .

If the above side effects worsen or if any other negative symptoms appear during treatment, the patient must inform the specialist.

Instructions for use of Ursofalk (Method and dosage)

Instructions for use of capsules

The drug for dissolving gallstones should be used in a dose of 10 mg per 1 kg of patient weight once a day.

For a patient weighing up to 60 kg, 2 capsules per day is recommended, for a weight from 61 to 80 kg - 3 capsules, for a weight from 81 to 100 kg - 4 capsules, for a weight over 100 kg - 5 capsules. You need to take the tablets in the evening, before going to bed. It is not recommended to chew the capsules.

The duration of taking the drug is from 6 to 12 months. To ensure high-quality prevention of recurrent cholelithiasis , it is recommended to take the drug for several months after the stones have dissolved.

When treating biliary reflux gastritis, 1 Ursofalk capsule should be used every day in the evening for 10 days to 6 months, sometimes up to 2 years.

In the case of symptomatic treatment of primary biliary cirrhosis, the dose of the drug depends on the person’s weight. It can range from 2 to 7 tables. For the first three months of therapy, capsules should be taken several times throughout the day; then, when liver parameters improve, it is enough to drink 1 capsule. Ursofalk in the evening. Treatment of primary biliary cirrhosis can continue for an unlimited period of time. Please note that in rare cases, people with this condition may experience a worsening of symptoms when starting to take the drug. In this situation, you need to reduce the dose to 1 capsule per day, and after the condition improves, you need to gradually increase the dosage.

For the symptomatic treatment of chronic hepatitis of various origins, the dose of the drug per day is 10-15 mg per 1 kg of weight, it should be taken in 2-3 doses. Reception lasts from 6 to 12 months.

In patients with primary sclerosing cholangitis and cystic fibrosis , the dose is 12-15 mg of the drug per 1 kg of weight. If necessary, the dosage is increased to 20-30 mg per 1 kg of weight. Treatment lasts from 6 months to several years.

In people with non-alcoholic steatohepatitis , as well as with alcoholic liver disease, a dose of 10-15 mg per 1 kg of weight is used. Treatment lasts 6-12 months or longer.

Patients with biliary dyskinesia are prescribed 10 mg of the drug per 1 kg of weight per day, the medicine must be taken for 2 weeks. up to 2 months Treatment can be repeated if necessary.

Ursofalk suspension, instructions for use

For newborns, children and adults whose weight does not exceed 47 kg, the drug is prescribed in the form of a suspension. To dissolve cholesterol stones , you need to take a suspension at a dose of 10 mg per 1 kg of weight once a day. Children weighing 5-7 kg receive 0.25 scoop; 8-12 kg – half a measuring spoon; 13-18 kg - 0.75 spoons; 19-25 kg – 1 spoon; 26-35 kg – 1.5 spoons; 36-50 kg – 2 spoons; 51-65 kg - 2.5 spoons; 66-80 kg – 3 spoons; 81-100 kg – 4 spoons; more than 100 kg – 4 spoons.

When treating other diseases, it should be taken into account that the content of 1 measuring spoon corresponds to the content of the active substance in one capsule. How to take it - before or after meals - does not matter significantly.

Ursofalk suspension 250mg/5ml 250ml (Dr. Falk)

Dissolution of cholesterol gallstones

The recommended dose is 10 mg of ursodeoxycholic acid per 1 kg of body weight per day, which corresponds to:

The drug must be taken daily in the evening, before bedtime.

Duration of treatment is 6-12 months. To prevent recurrent cholelithiasis, it is recommended to take the drug for several months after the stones have dissolved.

Treatment of biliary reflux gastritis

1 measuring cup of Ursofalk daily in the evening before bed.

The course of treatment is from 10-14 days to 6 months, if necessary - up to 2 years.

Treatment of primary biliary cirrhosis

The daily dose depends on body weight and ranges from 2 to 7 measuring cups (approximately 14 mg ± 2 mg ursodeoxycholic acid per 1 kg of body weight). The following mode of application is recommended:

Symptomatic treatment of chronic hepatitis of various origins -

daily dose 10-15 mg/kg in 2-3 doses. Duration of treatment is 6-12 months or more.

Primary sclerosing cholangitis -

daily dose 12-15 mg/kg; if necessary, the dose can be increased to 20 mg/kg in 2-3 doses. The duration of therapy ranges from 6 months to several years (see section: “Special instructions”).

Cystic fibrosis (cystic fibrosis) -

daily dose 20 mg/kg/day in 2-3 divided doses, with a further increase to 30 mg/kg/day if necessary.

Body weight more than 10 kg: dosage 20-25 mg ursodeoxycholic acid/kg/day.

Measuring device: measuring cup

* Conversion table:

Children weighing up to 10 kg get sick very rarely. In this case, a commercially available disposable syringe should be used.

Single doses for children weighing up to 10 kg should be measured using a syringe as the measuring cup provided is not designed for volumes less than 1.25 ml. Use a disposable 2 ml syringe in 0.1 ml increments. Please note: disposable syringes are not included in the drug package, but can be purchased at your local pharmacy.

To measure the required dose using a syringe:

1. Shake the bottle before opening it.

2. Pour a small amount of suspension into the measuring cup that is included in the package with the drug.

3. Fill the syringe with a slightly larger volume of the drug than required.

4. Tap the syringe with your fingers to remove air bubbles from the collected suspension.

5. Make sure that the required volume of suspension is in the syringe; if necessary, add or release excess volume.

6. Carefully pour the contents of the syringe directly into the child's mouth.

Do not insert the syringe into the vial. Do not pour unused suspension from the syringe or measuring cup back into the vial.

Body weight up to 10 kg: dosage 20 mg ursodeoxycholic acid/kg/day. Measuring device: disposable syringe

Non-alcoholic steatohepatitis -

the average daily dose is 10-15 mg/kg in 2-3 doses. The duration of therapy ranges from 6-12 months or more.

Alcoholic liver disease -

the average daily dose is 10-15 mg/kg in 2-3 doses. The duration of therapy ranges from 6-12 months or more.

Biliary dyskinesia -

the average daily dose is 10 mg/kg in 2 divided doses for 2 weeks to 2 months. If necessary, it is recommended to repeat the course of treatment.

Interaction

The absorption of ursodeoxycholic acid in the intestine and, accordingly, the effectiveness of the drug is reduced when taking colestipol, cholestyramine, as well as antacids that contain aluminum hydroxide or aluminum oxide. If it is necessary to use these medications, they should be taken at least two hours before taking Ursofalk.

Under the influence of ursodeoxycholic acid, the absorption of cyclosporine from the intestine is enhanced. That is, if it is necessary to take cyclosporine, you need to control the concentration of cyclosporine in the blood and adjust the dose of the drug.

There is a possibility that when taking Ursofalk, the absorption of Ciprofloxacin .

It should be borne in mind that when taking lipid-lowering drugs (especially clofibrate), neomycin, estrogens, progestins, the saturation of bile with cholesterol increases, so the ability of the active substance to dissolve cholesterol gallstones may decrease.

special instructions

Ursofalk should be taken under the supervision of a specialist.

In the first 3 months of use, it is very important to monitor liver function indicators, first every 4 weeks, then once every three months. It is important to identify liver dysfunction at the earliest stages. It is also important to determine as quickly as possible whether people with primary biliary cirrhosis .

To determine whether there is any progress in the treatment of calcification of stones, it is necessary to conduct an oral cholecystography with examination in a standing position, as well as in a supine position, 6-10 months after the start of therapy.

Ursofalk should not be prescribed if it is not possible to visualize the gallbladder using an x-ray, if there is calcification of stones, or attacks of colic.

In very rare cases, cases of decompensation of liver cirrhosis have been reported.

People suffering from diarrhea need to reduce the dose of drugs. Patients with persistent diarrhea should stop therapy.

URSOFALC

Directions for use and doses

Children and adults weighing less than 47 kg are recommended to use Ursofalk in suspension.
Dissolution of cholesterol gallstones

The recommended dose is 10 mg of ursodeoxycholic acid per 1 kg of body weight per day, which corresponds to:

The drug must be taken daily in the evening, before bed (the capsules are not chewed), with a small amount of liquid. Duration of treatment is 6-12 months. To prevent recurrent cholelithiasis

It is recommended to take the drug for several months after the stones have dissolved.

Treatment of biliary reflux gastritis

1 capsule of Ursofalk daily in the evening before bed, without chewing and with a small amount of water.

The course of treatment is from 10-14 days to 6 months, if necessary - up to 2 years.

Symptomatic treatment
of primary biliary cirrhosis
The daily dose depends on body weight and ranges from 3 to 7 capsules (approximately 14 ± 2 mg ursodeoxycholic acid per 1 kg of body weight).

In the first 3 months of treatment, taking Ursofalk 250 mg capsules should be divided into several doses throughout the day. After improving liver parameters, the daily dose of the drug can be taken once, in the evening.

The following mode of application is recommended:

250 mg capsules

Capsules should be taken regularly, without chewing, with a small amount of liquid.

The use of Ursofalk for the treatment of primary biliary cirrhosis can be continued indefinitely.

In patients with primary biliary cirrhosis, in rare cases, clinical symptoms may worsen at the beginning of treatment, for example, itching may become more frequent. In this case, treatment should be continued, taking one capsule daily, then the dosage should be gradually increased, increasing the daily dose by one capsule weekly, until the recommended dosage regimen is achieved again.

Symptomatic treatment of chronic hepatitis of various origins -

daily dose 10-15 mg/kg in 2-3 doses. Duration of treatment is 6-12 months or more.

Primary sclerosing cholangitis

— daily dose 12-15 mg/kg; if necessary, the dose can be increased to 20 mg/kg in 2-3 doses. The duration of therapy ranges from 6 months to several years (see section: “Special instructions”).

Cystic fibrosis (cystic fibrosis)

— daily dose 12-15 mg/kg; if necessary, the dose can be increased to 20-30 mg/kg in 2-3 doses. The duration of therapy ranges from 6 months to several years.

Non-alcoholic steatohepatitis

- average daily dose 10-15 mg/kg in 2-3 doses. The duration of therapy ranges from 6-12 months or more.

Alcoholic liver disease

- average daily dose 10-15 mg/kg in 2-3 doses. The duration of therapy ranges from 6-12 months or more.

Biliary dyskinesia

- average daily dose of 10 mg/kg in 2 divided doses for 2 weeks to 2 months. If necessary, it is recommended to repeat the course of treatment.

Analogues of Ursofalk

Level 4 ATC code matches:
Ursodex

Henofalk

Ursoliv

Choludexan

Ursohol

Ursodez

Urdoxa

Ursosan

Livodex

Analogues of this medicine are Ursolit , Ursobil , Ursolvan , Holacid , Ursohol , Ursosan , Delursan , etc.

The price of Ursofalk analogues depends on the manufacturer and packaging. The most optimal drug is prescribed by the attending physician individually.

Which is better: Ursofalk or Ursoliv?

The medicine Ursoliv contains, like Ursofalk, ursodeoxycholic acid as an active component. Therefore, their effect on the human body is similar. However, sometimes these medications can act differently depending on your individual body. Therefore, the choice of drug should be made by a doctor after careful research.

Ursofalk capsules: instructions for use

The dosage, course duration and frequency of administration are determined by the doctor depending on the age, body weight and condition of the patient:

1. If your weight is less than 60 kg, you can take 2 capsules per day.
2. With a weight ranging from 61 to 80 kg, you can take 3 pieces.
3. If the weight is from 81 to 100 kg - 4 pcs.
4. For body weight over 100 kg – 5 pcs.

The tablets are taken once a day, an hour before bedtime, and the capsules must be swallowed whole, without chewing. They are washed down with a small amount of water. The total duration of therapy ranges from 6 months to 1 year. To prevent the secondary development of cholelithiasis, it is necessary to take the medication for 3-4 months after the complete dissolution of cholesterol stones is confirmed.

Admission rules also depend on the diagnosis:

1. For the treatment of reflux gastritis (biliary type), take 1 capsule in the evening, the course lasts up to 6 months.
2. In the presence of chronic hepatitis, take the number of capsules that corresponds to the ratio: 10 mg per 1 kg of body weight. The course can last up to 12 months.
3. Cholangitis, cystic fibrosis - up to 15 mg per 1 kg of body weight.
4. Dyskinesia of the bile ducts – 10 mg per 1 kg, duration up to 2 months.
5. For the treatment of biliary cirrhosis, take 2-7 capsules per day, the course lasts up to several months.

Reviews about Ursofalk

Those reviews about Ursofalk treatment that users leave on forums are very different, but mostly positive opinions are written about the medicine. Many patients write that after a course of treatment, gallstones were not detected by ultrasound, which means the drug turned out to be effective. Reviews from doctors are less common, but experts also write about this medicine in a positive way.

Parents also leave favorable reviews of the suspension for children, noting that the medicine tastes good for children and is also effective. Also, according to users, Ursofalk quickly helps with jaundice in newborns.

Indications for use of the drug

"Ursofalk" is prescribed by a doctor in the presence of pathologies of the liver and bile ducts:

• cirrhosis;
• reflux esophagitis;
• cystic fibrosis;
• liver damage due to alcohol and other poisonings;
• primary cholangitis;
• bile duct atresia;
• hepatitis of various types with complications (cholestasis);
• cholesterol stones in the gall bladder;
• bile stagnation;
• prevention of colon cancer, especially in patients at risk.

Ursofalk price, where to buy

You can buy the suspension and tablets at any pharmacy with a doctor's prescription. The price of 100 capsules of Ursofalk is on average 2,200 rubles. You can buy Ursofalk in Moscow for a price starting from 220 rubles (10 pcs.). The price of Ursofalk suspension in Novosibirsk and St. Petersburg averages 1,200 rubles per pack. 250 mg.

In Ukraine, you can buy capsules for an average price of 150 UAH. for 10 pcs. You can buy Ursofalk 500 mg at a price starting from 1800 UAH. for 50 capsules. You can purchase the suspension in Kyiv, Odessa, etc. at a price of 600 UAH.

• Online pharmacies in RussiaRussia
• Online pharmacies in UkraineUkraine
• Online pharmacies in KazakhstanKazakhstan

LuxPharma* special offer

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Suspension "Ursofalk": instructions for use

The suspension is prescribed to patients weighing up to 47 kg - these can be both children and adults. The amount depends on body weight (general formula: 10 mg of product per kilogram of body weight). In the case of children, the following rules apply:

1. Weight 5-7 kg: quarter scoop.
2. Weight 8-12 kg: half.
3. From 13 to 18 kg: three quarters.
4. From 19 to 25 kg – 1 spoon.
5. From 26 to 35 kg – 1.5.
6. From 36 to 50 kg – 2.
7. From 51 to 65 kg – 2.5.
8. From 66 to 80 kg – 3.
9. From 81 kg and more – 4.