Everything That Could Go Wrong for This Drugmaker Did

Opioids. Vaginal mesh. Testosterone. These have become some of the ugliest words in the pharmaceutical industry, telegraphing medical treatments gone awry, in some cases leaving behind disabled customers, epic legal battles, and vast capital destruction. Some of the industry’s largest companies have been mired in lawsuits and government probes over these issues. But no company has been haunted by the drug industry’s worst nightmares as mercilessly as Endo International Plc.

Just about everything that can go wrong in the world of pharma has gone wrong at Endo, which makes both branded and generic drugs. Through a dealmaking spree largely led by its former chief executive officer, the company amassed debt of more than $8 billion—five times its market capitalization. That might be tolerable for a high-growth company, but Endo faces cratering prices for generic medicines even as it must deal with a slew of litigation involving its products.

The new leadership says the Dublin, Ireland-based company can fix all this; it will just take time. “It’s very important to know that we’re not running or hiding from our challenges,” says CEO Paul Campanelli. “We’re well-equipped to handle these types of issues.”

That includes writing massive checks to get beyond some of Endo’s legal woes. As of November 2017 company officials have agreed to pay more than $3.5 billion in settlements in more than 46,000 suits over its vaginal mesh inserts alone. Endo may have to shell out more to resolve all the mesh cases, according to its U.S. Securities and Exchange Commission filings. Analysts say that should largely contain the problems over the vaginal device, but it will still drain much-needed cash.

“This is not a growth story,” Gabelli & Co. analyst Kevin Kedra says. “There’s significant pressures, mostly stemming from the debt load, and they’re probably not going to be able to make a significant dent in that until 2019.”

Campanelli has been slashing costs to help keep Endo’s finances in check. The company now operates with a staff of around 2,700, down from about 6,000 before he took the job in September 2016. It also stopped marketing its opioid pain drugs at the end of 2016.

Opana
Photographer: Rich Pedroncelli/AP

Litigation related to Endo’s marketing of opioids remains the biggest wild card. The drugmaker faces at least 125 cases filed by U.S. state attorneys general, counties, and municipalities, alleging its salespeople downplayed the health risks of the extended-release version of its painkiller Opana while overstating its benefits, according to SEC filings. Other opioid makers, such as Johnson & Johnson and Purdue Pharma LP, face identical claims. The companies have denied the allegations.

The states and local governments have hired lawyers who helped negotiate the tobacco industry’s $246 billion master settlement in the late 1990s to handle the opioid suits. There’s no exact figure for the damages sought, and estimates of potential damages vary widely. Bloomberg Intelligence litigation analyst Holly Froum figures the total liability for all opioid makers, including Endo, could be as little as $5 billion or as high as $50 billion. “It’s obviously in a very early stage, and these things typically take years to resolve,” Campanelli says.

The company has shown it can be proactive when the need arises. Its extended version of Opana became the subject of controversy: The drug has been linked to outbreaks of viral infections like HIV as people abusing it spread diseases by sharing needles. U.S. regulators took the unprecedented step last June of asking the company to take the drug off the market. Endo could have appealed that decision, but Campanelli opted to comply—cutting off a drug that racked up around $533 million in sales in a three-year period starting in 2014.

Campanelli is busy putting out fires that were years in the making. In 2013 the drugmaker hired Rajiv De Silva, an ex-Valeant Pharmaceuticals International Inc. executive and former McKinsey & Co. consultant. At the time, Valeant was blazing a new trail for Big Pharma expansion: buying up other companies, cutting research, and jacking up drug prices. With De Silva as CEO, Endo became a prolific dealmaker, acquiring companies and drug rights—from acquisitions in the hundreds of millions of dollars to vying for assets in the $10 billion-plus range against Valeant. De Silva insisted at the time that Endo wasn’t another Valeant, which ran into massive financial and legal troubles, and said he was doing deals to build a company that didn’t need to rely on deals to grow. He declined to comment for this story.

De Silva’s biggest acquisition was the $8.05 billion purchase of Par Pharmaceutical in May 2015, which gave Endo a large foothold in the generics business. Endo, which assumed Par’s debt, financed the deal with borrowings and proceeds from a $2.3 billion equity offering. The Par buyout came at the height of the company’s run: Endo’s stock price peaked around $96 in April 2015. That was more than triple the level when De Silva took over. But concerns over litigation and debt, as well as post-Valeant angst over specialty drugmakers, conspired to drive the stock down over the following year. Ultimately, Campanelli replaced De Silva. “We said from Day One, we’re not fixing this in 12 months,” Campanelli says.

Testim testosterone gel.
Photographer: Jacqueline Larma/AP Photo

Another hangover from the De Silva era is Endo’s testosterone litigation. The company faces about 1,300 patient suits claiming its testosterone-boosting gels caused fatal heart attacks in some users. How those suits might fare remains uncertain. Two federal court juries in Chicago last year held AbbVie Inc. responsible for injuries suffered by men taking its AndroGel testosterone booster—a product similar to Endo’s—and awarded a total of $290 million in damages. But one of those verdicts was later thrown out by a judge. In November, Endo’s Auxilium unit won the first case to come to trial over its Testim testosterone gel.

Still, Endo’s problems could get worse. The company is likely to face many more Opana suits before any settlement is reached, says Richard Ausness, a University of Kentucky law professor, and Endo may be forced to take extreme measures to pay them out. It could adopt the playbook used by companies sued for selling asbestos-laced products in the 1980s and 1990s by setting up a bankruptcy trust to resolve opioid cases, according to Ausness. That would allow the company to hold down settlement amounts, he says.

“Their debt numbers look terrible. And when you factor in the thousands of opioid suits they may wind up facing, they may have no choice but to ask the bankruptcy courts to help them dispose of those cases,” he says.

Campanelli has heard the B-word before. “The use of the word ‘bankruptcy’—it’s not something that we’re contemplating at this point in time,” he says. “We’re looking to collaborate to deal with the opioid situation. If we ever got to that process, and I’m not saying that we’re thinking of it, it would be years and years before we would be addressing it.”

It’s also possible that any opioid manufacturer settlement could be structured in such a way that Endo doesn’t end up underwater. “There could be some giant master settlement—it would just make life that much more difficult for Endo, but I don’t think these state AGs are going to make Endo go out of business,” says Gabelli’s Kedra.

Despite the financial and legal clouds, Endo officials say they’re concentrating on expanding the business and working on new injectable drugs. The company is also developing one of its key products, Xiaflex, which is used to treat a hand deformity and curvature of the penis, for new uses such as improving the appearance of cellulite. Cosmetic drugs, such as Allergan Plc’s Botox, have turned into powerhouses for pharma companies, and Campanelli has been praising Xiaflex’s prospects. “It fits the model of the new Endo,” he says. Campanelli, however, still has plenty of problems from the old Endo to fix first.

    BOTTOM LINE – Generic drugmaker Endo has agreed to pay billions of dollars in settlements for vaginal mesh suits—and possibly faces much more for testosterone and opioid claims.

    Read more: http://www.bloomberg.com/news/articles/2018-01-26/everything-that-could-go-wrong-for-this-drugmaker-did

    Acid reflux drug linked to more than doubled risk of stomach cancer study

    There are more than 50m prescriptions for proton pump inhibitors in the UK, though they have previously been linked to side-effects and increased risk of death

    A drug commonly used to treat acid reflux is linked to a more than doubled risk of developing stomach cancer, researchers have claimed.

    Proton pump inhibitors (PPIs) reduce the amount of acid made by the stomach and are used to treat acid reflux and stomach ulcers.

    A study published in the journal Gut identified an association between long-term use of the drug and a 2.4 times higher risk of developing stomach cancer. In the UK, there are more than 50m prescriptions for PPIs every year but they have been linked to side-effects and an increased risk of death.

    A link between PPIs and a higher stomach cancer risk has previously been identified by academics but never in a study that first eliminates a bacteria suspected of fuelling the illnesss development.

    Research by the University of Hong Kong and University College London found that after the Helicobacter pylori was removed, the risk of developing the disease still rose in line with the dose and duration of PPI treatment.

    They compared the use of PPI against another drug which limits acid production known as H2 blockers in 63,397 adults. The participants selected had been treated with triple therapy, which combines PPI and antibiotics to kill off the H pylori bacteria over a week, between 2003 and 2012.

    Scientists then monitored them until they either developed stomach cancer, died or reached the end of the study at the end of 2015.

    During this period, 3,271 people took PPIs for an average of almost three years, while 21,729 participants took H2 blockers. A total of 153 people developed stomach cancer, none of whom tested positive for H plyori but all had long-standing problems with stomach inflammation, the study found.

    While H2 blockers were found to have no link to a higher risk of stomach cancer, PPIs was found connected to an increased risk of more than double.

    Daily use of PPIs was associated with a risk of developing the illness that was more than four times higher (4.55) than those who used it weekly. Similarly, when the drug was used for more than a year, the risk of developing stomach cancer rose five-fold, and as high as eight-fold after three or more years, the findings showed.

    The study concluded no firm cause and effect could be drawn, but doctors should exercise caution when prescribing long-term PPIs even after successful eradication of H plyori.

    Responding to the study, Stephen Evans, professor of pharmacoepidemiology at the London School of Hygiene and Tropical Medicine, said: Many observational studies have found adverse effects associated with PPIs.

    The most plausible explanation for the totality of evidence on this is that those who are given PPIs, and especially those who continue on them long-term, tend to be sicker in a variety of ways than those for whom they are not prescribed.

    Read more: https://www.theguardian.com/science/2017/oct/31/acid-reflux-drug-linked-to-more-than-doubled-risk-of-stomach-cancer-study

    Trump Officials Dispute the Benefits of Birth Control to Justify Rules

    When the Trump administration elected to stop requiring many employers to offer birth-control coverage in their health plans, it devoted nine of its new rule’s 163 pages to questioning the links between contraception and preventing unplanned pregnancies.

    In the rule released Friday, officials attacked a 2011 report that recommended mandatory birth-control coverage to help women avoid unintended pregnancies. That report, requested by the Department of Health and Human Services, was done by the National Academies of Sciences, Engineering and Medicine — then the Institute of Medicine — an expert group that serves as the nation’s scientific adviser.

    “The rates of, and reasons for, unintended pregnancy are notoriously difficult to measure,” according to the Trump administration’s interim final rule. “In particular, association and causality can be hard to disentangle.”

    Multiple studies have found that access or use of contraception reduced unintended pregnancies. 

    Claims in the report that link increased contraceptive use by unmarried women and teens to decreases in unintended pregnancies “rely on association rather than causation,” according to the rule. The rule references another study that found increased access to contraception decreased teen pregnancies short-term but led to an increase in the long run.

    “We know that safe contraception — and contraception is incredibly safe — leads to a reduction in pregnancies,” said Michele Bratcher Goodwin, director of the Center for Biotechnology and Global Health Policy at the University of California, Irvine, School of Law. “This has been data that we’ve had for decades.”

    Riskier Behavior

    The rules were released as part of a broader package of protections for religious freedom that the administration announced Friday.

    The government also said imposing a coverage mandate could “affect risky sexual behavior in a negative way” though it didn’t point to any particular studies to support its point. A 2014 study by the Washington University School of Medicine in St. Louis found providing no-cost contraception did not lead to riskier sexual behavior.

    The rule asserts that positive health effects associated with birth control “might also be partially offset by an association with negative health effects.” The rule connects the claim of negative health effects to a call by the National Institutes of Health in 2013 for the development of new contraceptives that stated current options can have “many undesirable side effects.” 

    The rule also describes an Agency for Healthcare Research and Quality review that found oral contraceptives increased users’ risk of breast cancer and vascular events, making the drugs’ use in preventing ovarian cancer uncertain.

    Federal officials used all of these assertions to determine the government “need not take a position on these empirical questions.”

    “Our review is sufficient to lead us to conclude that significantly more uncertainty and ambiguity exists in the record than the Departments previously acknowledged.”

      Read more: http://www.bloomberg.com/news/articles/2017-10-06/trump-officials-dispute-birth-control-benefits-to-justify-rules

      Rule that patients must finish antibiotics course is wrong, study says

      Experts suggest patients should stop taking the drugs when they feel better rather than completing their prescription

      Telling patients to stop taking antibiotics when they feel better may be preferable to instructing them to finish the course, according to a group of experts who argue that the rule long embedded in the minds of doctors and the public is wrong and should be overturned.

      Patients have traditionally been told that they must complete courses of antibiotics, the theory being that taking too few tablets will allow the bacteria causing their disease to mutate and become resistant to the drug.

      But Martin Llewelyn, a professor in infectious diseases at Brighton and Sussex medical school, and colleagues claim that this is not the case. In an analysis in the British Medical Journal, the experts say the idea that stopping antibiotic treatment early encourages antibiotic resistance is not supported by evidence, while taking antibiotics for longer than necessary increases the risk of resistance.

      There are some diseases where the bug can become resistant if the drugs are not taken for long enough. The most obvious example is tuberculosis, they say. But most of the bacteria that cause people to become ill are found on everybodys hands in the community, causing no harm, such as E coli and Staphylococcus aureus. People fall ill only when the bug gets into the bloodstream or the gut. The longer such bacteria are exposed to antibiotics, the more likely it is that resistance will develop.

      The experts say there has been too little research into the ideal length of a course of antibiotics, which also varies from one individual to the next, depending in part on what antibiotics they have taken in the past.

      In hospital, patients can be tested to work out when to stop the drugs. Outside hospital, where repeated testing may not be feasible, patients might be best advised to stop treatment when they feel better, they say. That, they add, is in direct contravention of World Health Organisation advice.

      Other experts in infectious diseases backed the group. I have always thought it to be illogical to say that stopping antibiotic treatment early promotes the emergence of drug-resistant organisms, said Peter Openshaw, president of the British Society for Immunology.

      This brief but authoritative review supports the idea that antibiotics may be used more sparingly, pointing out that the evidence for a long duration of therapy is, at best, tenuous. Far from being irresponsible, shortening the duration of a course of antibiotics might make antibiotic resistance less likely.

      Alison Holmes, a professor of infectious diseases at Imperial College London, said a great British authority, Prof Harold Lambert, had made the same point in a Lancet article entitled Dont keep taking the tablets as early as 1999. It remains astonishing that apart from some specific infections and conditions, we still do not know more about the optimum duration of courses or indeed doses in many conditions, yet this dogma has been pervasive and persistent.

      Jodi Lindsay, a professor of microbial pathogenesis at St Georges, University of London, said it was sensible advice. The evidence for completing the course is poor, and the length of the course of antibiotics has been estimated based on a fear of under-treating rather than any studies, she said. The evidence for shorter courses of antibiotics being equal to longer courses, in terms of cure or outcome, is generally good, although more studies would help and there are a few exceptions when longer courses are better for example, TB.

      But the Royal College of GPs expressed concerns. Recommended courses of antibiotics are not random, said its chair, Prof Helen Stokes-Lampard. They are tailored to individual conditions and in many cases, courses are quite short for urinary tract infections, for example, three days is often enough to cure the infection.

      We are concerned about the concept of patients stopping taking their medication midway through a course once they feel better, because improvement in symptoms does not necessarily mean the infection has been completely eradicated. Its important that patients have clear messages and the mantra to always take the full course of antibiotics is well known. Changing this will simply confuse people.

      The UKs chief medical officer, Prof Dame Sally Davies, said: The message to the public remains the same: people should always follow the advice of healthcare professionals. To update policies, we need further research to inform them.

      [The National Institute for Health and Care Excellence] is currently developing guidance for managing common infections, which will look at all available evidence on appropriate prescribing of antibiotics.

      The Department of Health will continue to review the evidence on prescribing and drug-resistant infections, as we aim to continue the great progress we have made at home and abroad on this issue.

      Read more: https://www.theguardian.com/society/2017/jul/26/rule-patients-must-finish-antibiotics-course-wrong-study-says

      People taking heartburn drugs could have higher risk of death, study claims

      Research suggests people on proton pump inhibitors are more likely to die than those taking different antacid or none at all

      Millions of people taking common heartburn and indigestion medications could be at an increased risk of death, research suggests.

      The drugs, known as proton pump inhibitors (PPIs), neutralise the acid in the stomach and are widely prescribed, with low doses also available without prescription from pharmacies. In the UK, doctors issue more than 50m prescriptions for PPIs every year.

      Now researchers say the drugs can increase risk of death, both compared with taking a different type of acid suppressant and not taking any at all.

      We saw a small excess risk of dying that could be attributed to the PPI drug, and the risk increased the longer they took them, said Ziyad Al-Aly, an epidemiologist from the University of Washington and co-author of the study.

      The team say the study suggests those who take the drugs without needing to could be most at risk. They urged people taking PPIs to check whether this was necessary.

      Previous research has raised a range of concerns about PPIs, including links to kidney disease, pneumonia, more hip fractures and higher rates of infection with C difficile, a superbug that can cause life-threatening sepsis, particularly in elderly people in hospitals.

      But the latest study is the first to show that PPIs can increase the chance of death. Published in the journal BMJ Open, it examined the medical records of 3.5 million middle-aged Americans covered by the US veterans healthcare system.

      The researchers followed 350,000 participants for more than five years and compared those prescribed PPIs to a group receiving a different type of acid suppressant known as an H2 blocker. They also took into account factors such as the participants age, sex and conditions ranging from high blood pressure to HIV.

      The results show that those who took PPIs could face a 25% higher risk of death than those who took the H2 blocker.

      In patients on [H2 blocker] tablets, there were 3.3 deaths per 100 people over one year. In the PPI group, this figure was higher at 4.7 per 100 people per year, said Al-Aly.

      The team also reported that the risk of death for those taking PPIs was 15% higher than those taking no PPIs, and 23% higher than for those taking no acid suppressants at all.

      Similar levels of increased risk were seen among people who used PPIs but had no gastrointestinal conditions, a result which the authors speculated might be driving the higher risk seen overall.

      Gareth Corbett, a gastroenterologist from Addenbrookes hospital in Cambridge who was not involved with the study, cautioned against panic, pointing out that in most cases the benefits of PPI far outweighed any risk. What was more, he said, while the increased risk sounded high, it was still very low for each person.

      PPIs are very effective medicines, proven to save lives and reduce the need for surgery in patients with bleeding gastric and duodenal ulcers and several other conditions, he said.

      The studys authors said it was important that PPIs were used only when necessary and stopped when no longer needed.

      Corbett agreed that many people take PPIs unnecessarily. They could get rid of their heartburn by making lifestyle changes, such as losing weight and cutting back on alcohol, caffeine and spicy foods, he said.

      The authors said the study was observational, meaning it did not show that PPIs were the cause of the increased risk of death, and that it was unclear how the drugs would act to affect mortality. They said the drugs could affect components within cells, known as lysosomes, that help break down waste material, or shortening protective regions at the end of chromosomes, known as telomeres.

      Aly said people on PPIs should check with their GP whether the drugs were still needed, adding: In some cases we expect that PPIs can be safely stopped, particularly in patients who have been taking them for a long time.

      Read more: https://www.theguardian.com/science/2017/jul/04/people-taking-heartburn-drugs-could-have-higher-risk-of-death-study-claims

      In Seattle US old-timers rediscover the high life on cannabis tours

      Retirement home residents take a trip to a producer

      Forget bingo, tea dances and seaside trips. Residents from a chain of Seattle retirement homes are going on Pot for Beginners tours to learn about and buy cannabis in the city, where its now legal.

      Connie Schick said her son roared with laughter when he heard she was joining a field trip to a cannabis-growing operation, an extraction plant and shop. The 79-year-old, who smoked the odd joint in the 70s, wanted to know how legalisation has changed the way the drug is used and produced.

      Schick was one of eight women, from their late 60s to mid-80s, who descended from a minibus emblazoned with the name of their assisted living centre, El Dorado West, outside Vela cannabis store last Tuesday.

      You can only play so many games of bingo, said Schick. My son thought it was hilarious that I was coming here, but Im open-minded and want to stay informed. Cannabis has come so far from the days when you smoked a sly joint and got into trouble if they found out. We used to call it hemp then and didnt know its strength. It just used to make me sleepy, so I didnt see the point.

      Schick, who uses a wheelchair after suffering a stroke, is interested in the therapeutic effects of cannabis. Its so different now. There are so many ways you can take it, and all these different types to help with aches and pains.

      They used to say it was a gateway drug to other things, like cocaine Lots of peoples views are changing.

      Certainly, the number of people aged 65 or older taking cannabis in the US is growing. The proportion of this age group who reported cannabis use in the past year rose more than tenfold from 0.2% to 2.1% between 2002 and 2014, according to the National Survey on Drug Use and Health. A Gallup poll last year showed that 3% of those over 65 smoke cannabis.

      Much of this is attributed to the ageing of the baby-boomer generation, who dabbled with the drug when they were young and are returning to it for medical or recreational use as it becomes legal and more normalised. Cannabis is now legal for medical use in 29 states and for medical and recreational use in eight (since 2012 in Seattle and the rest of Washington state).

      Most of the women on the tour were more interested in the medical use, although Denise Roux, 67, said: I would like to buy it to get high too but Im a cheap high, it doesnt take much.

      A seminar over sandwiches was held for thegroup as they sat in front of the large windows of the cultivation room, where they could see scores of plants growing under intense lighting.

      They were told about the different strains: uplifting sativa plants and more sedating indicas. They learned about tetrahydrocannabinol (THC), which gives a high, and cannabidiol (CBD) which does not, making CBD-rich cannabis appealing for medical use. A scientist in a lab coat who worked in the processing facility spoke about terpenes fragrant oils secreted by glands in the flower that give strains their different smells and flavours. Vials were sniffed and various ways to take cannabis were also covered, including smoking, vaporising and eating it.

      Roux, a retired administrative assistant, said: Im a big Google girl, but I wanted to talk to people who know about it so I can understand it all better. I have an autoimmune disease, which stops my appetite, and Im interested in marijuana from that standpoint. She added she had used cannabis recreationally in the 80s and had returned to it to help with her illness. I use a vape. It makes me sleepy and its a pain control, and it gives me an appetite.

      After the briefing, it was time for shopping. The store looked like an upmarket jewellers, with muted lighting and art on the walls, except the glass cabinets in the store were stocked with pre-rolled joints, edibles including chocolates and sweets, vape pens and bags of different strains of cannabis rather than diamond rings and necklaces.

      Darlene Johnson, 85, a former nurse, perused their contents. On the advice of a bearded bud tender, she bought a deep tissue and joint gel and a tincture to put in drinks, which she hopes will help with her severe neck pain. I wanted a non-psychoactive option, she said. I dont want to get high. I used to work in the emergency room and saw people come in sick from taking too many drugs, though not usually marijuana.

      Her friend, Nancy Mitchell, 80, has never tried cannabis. She has MS and had read that cannabis could help with her symptoms. I wanted to know more details, she said. My kids keep telling me, Mom, try it. I dont want to smoke things, but I see there are other ways.

      Smoking is not allowed at El Dorado West. Village Concepts, which runs the chain, has a no-smoking policy and it is illegal to consume cannabis in public in the state.

      The chains director of corporate development, Tracy Willis, said: There was one man who was smoking it on his patio and he refused to stop, so he had to leave. If youre using an edible, we dont have any issue with it, thats your own business. We treat it as a recreational thing.

      The tours began in response to questions from residents.They wanted to know where it was sold, how much money was made from it, where it was grown, said Willis. Weve had a good reaction [to the tours] from nine out of 10 relatives, but some are horrified. One angry daughter said we were encouraging marijuana use. Her mother told her to butt out.

      Participants
      Participants on the tour learned about different ways to use cannabis. Photograph: Jason Redmond/Reuters

      Read more: https://www.theguardian.com/society/2017/jul/01/seattle-retirement-home-cannabis-tours

      Vaginal Womb Detox Herbal Tampons For Women It Works

      Vaginal Womb Detox Herbal Tampons For Women It Works. Product Name: Vaginal Detox Herbal Tampons For Women
      Tampons are manufactured in the most sterile environment that has been approved by the "GMP" standard (quality standard). They do not contain any chemical additives and have passed more than 1000 clinical trials that confirmed the safety of the ingredients – no side effects and are absolutely non-toxic.
      Main Ingredients:
      Refined from Osthol, Stemona sessilifolia (Miq.)Miq, Kochiascoparia, motherwort,Rhizoma smilacis glabrae,Angelica,Rhizoma chuianxiong and borneol.
      Healthy Function:
      These ingredients regulate the function of endocrine gland secretion, normalize blood circulation, improve facial skin complexion/wrinkles/hyper-pigmentation. They also treat the following gynecological ailments: endometriosis, cervical erosion and dysplasia, pelvic inflammatory disease.
      Main changes after using tampons
      Step 1 :Generally,the tampon will be pulled out from vagina after 3 days later. you can see that the tampon is bigger than before.it adsorpts lots of toxins from vagina, vaginal itching, pain, odor and other gynecological symptoms were relieved.
      Step 2 : erosion, thick secretions and bacteria adsorbed on the tampon were discharged continuously.urinary frequency,urgency were disappear gradually,leucorrhea was reduced and the odor disappeared.
      Step 3: enhance the vaginal tissue metabolism,fast the healing of the vaginal and uterine wound caused by childbirth,abortion,becomes smooth to restore the women’s vagina.
      Step 4: ovarian androgen secretion of hormones return to normal levels, regulating qi and blood, balance the endocrine,
      Suitable to the people:
      1.Abnormal vaginal discharge(Leucorrhea),vagina itching,Irregular menstruation,Menstrual pain,
      2.Endometritis,cervical erosion,annex inflammation,vagintis,pelvic inflammatory,yeast infection and other kinds of gynecological diseases.
      3. ovarian cysts,uterine fibroids and other uertus disease
      4. Melasma,dark spots,bad sexual life.
      Specifications: 1g each tampon
      Directions:
      1. Wash your hands and open the foil bag containing one tampon
      2. Pull out the string of the tampon;
      3. Insert the tampon inside vagina approximately 7 cm deep;
      4. You must remove the tampon 3 days later;
      5. Clean vagina with warm water
      6. Insert next tampon 24 hours later after removing the first one;
      7. Used for healthcare for the perineum;
      Warning:
      1. Do not use tampons 7 days before the onset of menstruation and wait at least 3 days after your last day of menstruation before using a tampon
      2. Do not use tampons during menstruation, or if you are pregnant or if you are a virgin
      Avoid using tampons, if you are allergic to any ingredients of the tampon (see the ingredient listing above)
      3. You may soak the tampon in a glass of water and use the liquid for douching.
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