Ritlécitinib : interactions médicamenteuses
Ritlécitinib (Litfulo), inhibiteur de JAK, présente 116 interactions documentées dans les notices FDA et les fiches d'information que nous indexons : 50 de niveau majeur, 25 de niveau modéré, 41 de niveau mineur et 0 cas où une notice ne signale aucune interaction significative. Chaque entrée ci-dessous cite la phrase sur laquelle elle repose. Cette page consacrée à un médicament est un point de départ, pas un verdict sur votre situation.
Interactions d'après la notice
Interactions majeures (50)
Additionally, concomitant use of ORENCIA with other biologic RA/PsA therapy or JAK inhibitors is not recommended. (notice Abatacept, Mises en garde et précautions)
• Higher rate of all-cause mortality, including sudden cardiovascular death with another Janus kinase inhibitor (JAK) vs. TNF blockers in rheumatoid arthritis (RA) patients. (notice Ritlécitinib, Mise en garde encadrée)
• Higher rate of all-cause mortality, including sudden cardiovascular death with another Janus kinase inhibitor (JAK) vs. TNF blockers in rheumatoid arthritis (RA) patients. (notice Ritlécitinib, Mise en garde encadrée)
• Certain CYP3A inducers: Coadministration with strong inducers of CYP3A is not recommended. (notice Ritlécitinib, Interactions médicamenteuses)
• Certain CYP3A inducers: Coadministration with strong inducers of CYP3A is not recommended. (notice Ritlécitinib, Interactions médicamenteuses)
• Higher rate of all-cause mortality, including sudden cardiovascular death with another Janus kinase inhibitor (JAK) vs. TNF blockers in rheumatoid arthritis (RA) patients. (notice Ritlécitinib, Mise en garde encadrée)
• Certain CYP3A inducers: Coadministration with strong inducers of CYP3A is not recommended. (notice Ritlécitinib, Interactions médicamenteuses)
About 13 percent of the cases of neutropenia have ended fatally, but almost all fatalities were in patients with serious illness, having collagen vascular disease, renal failure, heart failure or immunosuppressant therapy, or a combination of these complicating factors. (notice Captopril, Mises en garde)
• Certain CYP3A inducers: Coadministration with strong inducers of CYP3A is not recommended. (notice Ritlécitinib, Interactions médicamenteuses)
• Certain CYP3A inducers: Coadministration with strong inducers of CYP3A is not recommended. (notice Ritlécitinib, Interactions médicamenteuses)
In kidney, liver, and heart transplant patients Neoral may be administered with other immunosuppressive agents. (notice Ciclosporine, Mise en garde encadrée)
Prevention or Management Concomitant use with myelosuppressive or other immunosuppressive drugs is not recommended. (notice Cladribine, Interactions médicamenteuses)
• Certain CYP3A inducers: Coadministration with strong inducers of CYP3A is not recommended. (notice Ritlécitinib, Interactions médicamenteuses)
• Certain CYP3A inducers: Coadministration with strong inducers of CYP3A is not recommended. (notice Ritlécitinib, Interactions médicamenteuses)
• Certain CYP3A inducers: Coadministration with strong inducers of CYP3A is not recommended. (notice Ritlécitinib, Interactions médicamenteuses)
• Certain CYP3A inducers: Coadministration with strong inducers of CYP3A is not recommended. (notice Ritlécitinib, Interactions médicamenteuses)
• Certain CYP3A inducers: Coadministration with strong inducers of CYP3A is not recommended. (notice Ritlécitinib, Interactions médicamenteuses)
• Certain CYP3A inducers: Coadministration with strong inducers of CYP3A is not recommended. (notice Ritlécitinib, Interactions médicamenteuses)
• Higher rate of all-cause mortality, including sudden cardiovascular death with another Janus kinase inhibitor (JAK) vs. TNF blockers in rheumatoid arthritis (RA) patients. (notice Ritlécitinib, Mise en garde encadrée)
• Certain CYP3A inducers: Coadministration with strong inducers of CYP3A is not recommended. (notice Ritlécitinib, Interactions médicamenteuses)
Chicken pox and measles, for example, can have a more serious or even fatal course in children on immunosuppressant corticosteroids. (notice Fludrocortisone, Mises en garde)
Persons who are on immunosuppressant doses of corticosteroids should be warned to avoid exposure to chickenpox or measles. (notice Flunisolide, Précautions)
• Certain CYP3A inducers: Coadministration with strong inducers of CYP3A is not recommended. (notice Ritlécitinib, Interactions médicamenteuses)
• Certain CYP3A inducers: Coadministration with strong inducers of CYP3A is not recommended. (notice Ritlécitinib, Interactions médicamenteuses)
• Higher rate of all-cause mortality, including sudden cardiovascular death with another Janus kinase inhibitor (JAK) vs. TNF blockers in rheumatoid arthritis (RA) patients. (notice Ritlécitinib, Mise en garde encadrée)
Immunosuppressants Everolimus Sirolimus Temsirolimus (IV) Not recommended during and 2 weeks after TOLSURA treatment. (notice Itraconazole, Interactions médicamenteuses)
• Certain CYP3A inducers: Coadministration with strong inducers of CYP3A is not recommended. (notice Ritlécitinib, Interactions médicamenteuses)
• Certain CYP3A inducers: Coadministration with strong inducers of CYP3A is not recommended. (notice Ritlécitinib, Interactions médicamenteuses)
• Certain CYP3A inducers: Coadministration with strong inducers of CYP3A is not recommended. (notice Ritlécitinib, Interactions médicamenteuses)
• Certain CYP3A inducers: Coadministration with strong inducers of CYP3A is not recommended. (notice Ritlécitinib, Interactions médicamenteuses)
• Certain CYP3A inducers: Coadministration with strong inducers of CYP3A is not recommended. (notice Ritlécitinib, Interactions médicamenteuses)
• Certain CYP3A inducers: Coadministration with strong inducers of CYP3A is not recommended. (notice Ritlécitinib, Interactions médicamenteuses)
• Certain CYP3A inducers: Coadministration with strong inducers of CYP3A is not recommended. (notice Ritlécitinib, Interactions médicamenteuses)
• Certain CYP3A inducers: Coadministration with strong inducers of CYP3A is not recommended. (notice Ritlécitinib, Interactions médicamenteuses)
• Certain CYP3A inducers: Coadministration with strong inducers of CYP3A is not recommended. (notice Ritlécitinib, Interactions médicamenteuses)
• Certain CYP3A inducers: Coadministration with strong inducers of CYP3A is not recommended. (notice Ritlécitinib, Interactions médicamenteuses)
• Certain CYP3A inducers: Coadministration with strong inducers of CYP3A is not recommended. (notice Ritlécitinib, Interactions médicamenteuses)
• Certain CYP3A inducers: Coadministration with strong inducers of CYP3A is not recommended. (notice Ritlécitinib, Interactions médicamenteuses)
• Certain CYP3A inducers: Coadministration with strong inducers of CYP3A is not recommended. (notice Ritlécitinib, Interactions médicamenteuses)
• Certain CYP3A inducers: Coadministration with strong inducers of CYP3A is not recommended. (notice Ritlécitinib, Interactions médicamenteuses)
• Higher rate of all-cause mortality, including sudden cardiovascular death with another Janus kinase inhibitor (JAK) vs. TNF blockers in rheumatoid arthritis (RA) patients. (notice Ritlécitinib, Mise en garde encadrée)
• Certain CYP3A inducers: Coadministration with strong inducers of CYP3A is not recommended. (notice Ritlécitinib, Interactions médicamenteuses)
…IN TRANSPLANT PATIENTS; AND INCREASED MORTALITY IN FEMALE LIVER TRANSPLANT PATIENTS • Increased risk for developing serious infections and malignancies with ASTAGRAF XL ® or other immunosuppressants that may lead to hospitalization or death. [see Warnings and Precautions ( 5.1 , 5.2 )] • Increased mortality in female liver transplant patients with ASTAGRAF XL. (notice Tacrolimus, Mise en garde encadrée)
• Higher rate of all-cause mortality, including sudden cardiovascular death with another Janus kinase inhibitor (JAK) vs. TNF blockers in rheumatoid arthritis (RA) patients. (notice Ritlécitinib, Mise en garde encadrée)
• Certain CYP3A inducers: Coadministration with strong inducers of CYP3A is not recommended. (notice Ritlécitinib, Interactions médicamenteuses)
• Higher rate of all-cause mortality, including sudden cardiovascular death with another Janus kinase inhibitor (JAK) vs. TNF blockers in rheumatoid arthritis (RA) patients. (notice Ritlécitinib, Mise en garde encadrée)
Interactions modérées (25)
Frequent PT/INR determinations are advisable until it has been definitely determined that the PT/INR has stabilized Immunosuppressants Clinical Impact: Immunosuppressants such as cyclosporine and tacrolimus can produce nephrotoxicity with decreases in creatinine clearance and rises in serum creatinine, and because renal excretion is the primary elimination route… (notice Acide fénofibrique, Interactions médicamenteuses)
Immunosuppressants Amlodipine may increase the systemic exposure of cyclosporine or tacrolimus when co-administered. (notice Amlodipine, Interactions médicamenteuses)
Impact of Amlodipine on Other Drugs Immunosuppressants Amlodipine may increase the systemic exposure of cyclosporine or tacrolimus when co-administered. (notice Amlodipine et atorvastatine, Interactions médicamenteuses)
Immunosuppressants: Amlodipine may increase the systemic exposure of cyclosporine or tacrolimus when co-administered. (notice Amlodipine et olmésartan, Interactions médicamenteuses)
Immunosuppressants Amlodipine may increase the systemic exposure of cyclosporine or tacrolimus when coadministered. (notice Amlodipine et valsartan, Interactions médicamenteuses)
- BendamustineModérée
Consider discontinuation or reduction of any concomitant chemotherapy or immunosuppressive therapy in patients who develop PML. (notice Bendamustine, Mises en garde et précautions)
- DénosumabModérée
Other risk factors for the development of ONJ include immunosuppressive therapy, treatment with angiogenesis inhibitors, systemic corticosteroids, diabetes, and gingival infections. (notice Dénosumab, Mises en garde et précautions)
Immuno-suppressants: e.g., cyclosporine (CsA) sirolimus tacrolimus ↑ immuno-suppressants ↑ elvitegravir (with CsA) ↑ cobicistat (with CsA) Therapeutic monitoring of the immunosuppressive agents is recommended upon coadministration with GENVOYA. (notice Elvitégravir, cobicistat, emtricitabine et ténofovir, Interactions médicamenteuses)
Immunosuppressants Clinical Impact: Immunosuppressants such as cyclosporine and tacrolimus can produce nephrotoxicity with decreases in creatinine clearance and rises in serum creatinine, and because renal excretion is the primary elimination route of fibrate drugs including fenofibrate, there is a risk that an interaction will lead to deterioration of renal… (notice Fénofibrate, Interactions médicamenteuses)
Immunosuppressants everolimus, rapamycin (also known as sirolimus), temsirolimus budesonide, ciclesonide, cyclosporine, dexamethasone, fluticasone, methylprednisolone, tacrolimus Rapamycin (sirolimus): Ketoconazole tablets 200 mg daily for 10 days increased the C max and AUC of a single 5 mg dose of sirolimus by 4.3 fold and 10.9 fold, respectively in 23 healthy… (notice Kétoconazole, Interactions médicamenteuses)
HBV reactivation has also been reported in patients receiving certain immunosuppressants or chemotherapeutic agents; the risk of HBV reactivation associated with treatment with HCV direct-acting antivirals may be increased in these patients. (notice Lédipasvir et sofosbuvir, Mises en garde et précautions)
If used with concomitant methotrexate and/or other potential immunosuppressive agents, chronic monitoring should be monthly. (notice Léflunomide, Mises en garde et précautions)
A treatment regimen containing multiple immunosuppressants (including thiopurines) should therefore be used with caution as this could lead to lymphoproliferative disorders, some with reported fatalities. (notice Mercaptopurine, Mises en garde et précautions)
Lymphoma and Other Malignancies Patients receiving immunosuppressants, including mycophenolate mofetil, are at increased risk of developing lymphomas and other malignancies, particularly of the skin [see Adverse Reactions ( 6.1 )]. (notice Mycophénolate, Mises en garde et précautions)
Immunosuppressive Agents There have been reports of increased blood concentrations of cyclosporine and tacrolimus into toxic ranges when patients received these drugs concomitantly with nefazodone. (notice Néfazodone, Interactions médicamenteuses)
- Olmésartan, amlodipine et hydrochlorothiazideantagoniste des récepteurs de l'angiotensine II (ARA II)Modérée
Immunosuppressants: Amlodipine may increase the systemic exposure of cyclosporine or tacrolimus when co-administered. (notice Olmésartan, amlodipine et hydrochlorothiazide, Interactions médicamenteuses)
- PénicillamineModérée
Treatment has consisted of high doses of corticosteroids alone or, in some cases, concomitantly with an immunosuppressant. (notice Pénicillamine, Mises en garde)
HBV reactivation has also been reported in patients receiving certain immunosuppressant or chemotherapeutic agents; the risk of HBV reactivation associated with treatment with HCV direct-acting antivirals may be increased in these patients. (notice Sofosbuvir et velpatasvir, Mises en garde et précautions)
In this study, current or past smokers had an additional increased risk of overall malignancies. (notice Ritlécitinib, Mises en garde et précautions)
Immunosuppressants: Amlodipine may increase the systemic exposure of cyclosporine or tacrolimus when co-administered. (notice Telmisartan et amlodipine, Interactions médicamenteuses)
- TemsirolimusModérée
Prophylaxis of PJP should be considered when concomitant use of corticosteroids or other immunosuppressive agents are required. (notice Temsirolimus, Mises en garde et précautions)
Cyclosporine, tacrolimus: Monitor for toxicities of these immunosuppressive drugs ( 7.1 ) (notice Tinidazole, Interactions médicamenteuses)
Mentions mineures (41)
Clinically Significant Interactions Affecting Other Drugs CYP3A Substrates Where Small Concentration Changes May Lead to Serious Adverse Reactions Clinical Impact Ritlecitinib is a CYP3A inhibitor. (notice Ritlécitinib, Interactions médicamenteuses)
IMNM is characterized by proximal muscle weakness and elevated serum creatine kinase that persists despite discontinuation of statin treatment; positive anti-HMG CoA reductase antibody; muscle biopsy showing necrotizing myopathy; and improvement with immunosuppressive agents. (notice Atorvastatine, Mises en garde et précautions)
- AxitinibMineure
Thirty-four patients were treated with corticosteroids and one patient was treated with a non-steroidal immunosuppressant. (notice Axitinib, Mises en garde et précautions)
CYP1A2 Substrates Where Small Concentration Changes May Lead to Serious Adverse Reactions Clinical Impact Ritlecitinib is a CYP1A2 inhibitor. (notice Ritlécitinib, Interactions médicamenteuses)
Clinically Significant Interactions Affecting Other Drugs CYP3A Substrates Where Small Concentration Changes May Lead to Serious Adverse Reactions Clinical Impact Ritlecitinib is a CYP3A inhibitor. (notice Ritlécitinib, Interactions médicamenteuses)
CYP1A2 Substrates Where Small Concentration Changes May Lead to Serious Adverse Reactions Clinical Impact Ritlecitinib is a CYP1A2 inhibitor. (notice Ritlécitinib, Interactions médicamenteuses)
Clinically Significant Interactions Affecting Other Drugs CYP3A Substrates Where Small Concentration Changes May Lead to Serious Adverse Reactions Clinical Impact Ritlecitinib is a CYP3A inhibitor. (notice Ritlécitinib, Interactions médicamenteuses)
Clinically Significant Interactions Affecting Other Drugs CYP3A Substrates Where Small Concentration Changes May Lead to Serious Adverse Reactions Clinical Impact Ritlecitinib is a CYP3A inhibitor. (notice Ritlécitinib, Interactions médicamenteuses)
Clinically Significant Interactions Affecting Other Drugs CYP3A Substrates Where Small Concentration Changes May Lead to Serious Adverse Reactions Clinical Impact Ritlecitinib is a CYP3A inhibitor. (notice Ritlécitinib, Interactions médicamenteuses)
Clinically Significant Interactions Affecting Other Drugs CYP3A Substrates Where Small Concentration Changes May Lead to Serious Adverse Reactions Clinical Impact Ritlecitinib is a CYP3A inhibitor. (notice Ritlécitinib, Interactions médicamenteuses)
Clinically Significant Interactions Affecting Other Drugs CYP3A Substrates Where Small Concentration Changes May Lead to Serious Adverse Reactions Clinical Impact Ritlecitinib is a CYP3A inhibitor. (notice Ritlécitinib, Interactions médicamenteuses)
IMNM is characterized by proximal muscle weakness and elevated serum creatine kinase that persist despite discontinuation of statin treatment; positive anti-HMG CoA reductase antibody; muscle biopsy showing necrotizing myopathy without significant inflammation; and improvement with immunosuppressive agents. (notice Ézétimibe et simvastatine, Mises en garde et précautions)
Clinically Significant Interactions Affecting Other Drugs CYP3A Substrates Where Small Concentration Changes May Lead to Serious Adverse Reactions Clinical Impact Ritlecitinib is a CYP3A inhibitor. (notice Ritlécitinib, Interactions médicamenteuses)
IMNM is characterized by proximal muscle weakness and elevated serum CK, which persist despite discontinuation of statin treatment; positive anti-HMG CoA reductase antibody, muscle biopsy showing necrotizing myopathy, and improvement with immunosuppressive agents. (notice Fluvastatine, Mises en garde et précautions)
CYP1A2 Substrates Where Small Concentration Changes May Lead to Serious Adverse Reactions Clinical Impact Ritlecitinib is a CYP1A2 inhibitor. (notice Ritlécitinib, Interactions médicamenteuses)
Clinically Significant Interactions Affecting Other Drugs CYP3A Substrates Where Small Concentration Changes May Lead to Serious Adverse Reactions Clinical Impact Ritlecitinib is a CYP3A inhibitor. (notice Ritlécitinib, Interactions médicamenteuses)
Clinically Significant Interactions Affecting Other Drugs CYP3A Substrates Where Small Concentration Changes May Lead to Serious Adverse Reactions Clinical Impact Ritlecitinib is a CYP3A inhibitor. (notice Ritlécitinib, Interactions médicamenteuses)
Clinically Significant Interactions Affecting Other Drugs CYP3A Substrates Where Small Concentration Changes May Lead to Serious Adverse Reactions Clinical Impact Ritlecitinib is a CYP3A inhibitor. (notice Ritlécitinib, Interactions médicamenteuses)
Clinically Significant Interactions Affecting Other Drugs CYP3A Substrates Where Small Concentration Changes May Lead to Serious Adverse Reactions Clinical Impact Ritlecitinib is a CYP3A inhibitor. (notice Ritlécitinib, Interactions médicamenteuses)
Clinically Significant Interactions Affecting Other Drugs CYP3A Substrates Where Small Concentration Changes May Lead to Serious Adverse Reactions Clinical Impact Ritlecitinib is a CYP3A inhibitor. (notice Ritlécitinib, Interactions médicamenteuses)
IMNM is characterized by: proximal muscle weakness and elevated serum creatine kinase, which persist despite discontinuation of statin treatment; positive anti-HMG CoA reductase antibody; muscle biopsy showing necrotizing myopathy; and improvement with immunosuppressive agents. (notice Lovastatine, Mises en garde)
CYP1A2 Substrates Where Small Concentration Changes May Lead to Serious Adverse Reactions Clinical Impact Ritlecitinib is a CYP1A2 inhibitor. (notice Ritlécitinib, Interactions médicamenteuses)
Clinically Significant Interactions Affecting Other Drugs CYP3A Substrates Where Small Concentration Changes May Lead to Serious Adverse Reactions Clinical Impact Ritlecitinib is a CYP3A inhibitor. (notice Ritlécitinib, Interactions médicamenteuses)
Clinically Significant Interactions Affecting Other Drugs CYP3A Substrates Where Small Concentration Changes May Lead to Serious Adverse Reactions Clinical Impact Ritlecitinib is a CYP3A inhibitor. (notice Ritlécitinib, Interactions médicamenteuses)
Immunosuppressive Drugs Tacrolimus: Tacrolimus has been shown to be metabolized via the CYP3A system. (notice Nifédipine, Précautions)
Clinically Significant Interactions Affecting Other Drugs CYP3A Substrates Where Small Concentration Changes May Lead to Serious Adverse Reactions Clinical Impact Ritlecitinib is a CYP3A inhibitor. (notice Ritlécitinib, Interactions médicamenteuses)
Clinically Significant Interactions Affecting Other Drugs CYP3A Substrates Where Small Concentration Changes May Lead to Serious Adverse Reactions Clinical Impact Ritlecitinib is a CYP3A inhibitor. (notice Ritlécitinib, Interactions médicamenteuses)
IMNM is characterized by proximal muscle weakness and elevated serum creatine kinase that persist despite discontinuation of statin treatment; positive anti-HMG CoA reductase antibody; muscle biopsy showing necrotizing myopathy; and improvement with immunosuppressive agents. (notice Pitavastatine, Mises en garde et précautions)
Clinically Significant Interactions Affecting Other Drugs CYP3A Substrates Where Small Concentration Changes May Lead to Serious Adverse Reactions Clinical Impact Ritlecitinib is a CYP3A inhibitor. (notice Ritlécitinib, Interactions médicamenteuses)
IMNM is characterized by proximal muscle weakness and elevated serum creatine kinase that persist despite discontinuation of statin treatment; positive anti-HMG CoA reductase antibody; muscle biopsy showing necrotizing myopathy; and improvement with immunosuppressive agents. (notice Pravastatine, Mises en garde et précautions)
In some cases, vasculitis resolved/improved with drug discontinuation; however, more severe cases required treatment with additional measures including corticosteroids, immunosuppressant therapy, and plasmapheresis. (notice Propylthiouracile, Mises en garde)
Clinically Significant Interactions Affecting Other Drugs CYP3A Substrates Where Small Concentration Changes May Lead to Serious Adverse Reactions Clinical Impact Ritlecitinib is a CYP3A inhibitor. (notice Ritlécitinib, Interactions médicamenteuses)
IMNM is characterized by proximal muscle weakness and elevated serum creatine kinase that persist despite discontinuation of statin treatment; positive anti-HMG CoA reductase antibody; muscle biopsy showing necrotizing myopathy; and improvement with immunosuppressive agents. (notice Rosuvastatine, Mises en garde et précautions)
IMNM is characterized by proximal muscle weakness and elevated serum creatine kinase that persist despite discontinuation of statin treatment; positive anti-HMG CoA reductase antibody; muscle biopsy showing necrotizing myopathy without significant inflammation; and improvement with immunosuppressive agents. (notice Simvastatine, Mises en garde et précautions)
Clinically Significant Interactions Affecting Other Drugs CYP3A Substrates Where Small Concentration Changes May Lead to Serious Adverse Reactions Clinical Impact Ritlecitinib is a CYP3A inhibitor. (notice Ritlécitinib, Interactions médicamenteuses)
In some cases, vasculitis resolved/improved with drug discontinuation; however, more severe cases required treatment with additional measures including corticosteroids, immunosuppressant therapy, and plasmapheresis. (notice Thiamazole, Mises en garde)
Clinically Significant Interactions Affecting Other Drugs CYP3A Substrates Where Small Concentration Changes May Lead to Serious Adverse Reactions Clinical Impact Ritlecitinib is a CYP3A inhibitor. (notice Ritlécitinib, Interactions médicamenteuses)
Clinically Significant Interactions Affecting Other Drugs CYP3A Substrates Where Small Concentration Changes May Lead to Serious Adverse Reactions Clinical Impact Ritlecitinib is a CYP3A inhibitor. (notice Ritlécitinib, Interactions médicamenteuses)
CYP1A2 Substrates Where Small Concentration Changes May Lead to Serious Adverse Reactions Clinical Impact Ritlecitinib is a CYP1A2 inhibitor. (notice Ritlécitinib, Interactions médicamenteuses)
Clinically Significant Interactions Affecting Other Drugs CYP3A Substrates Where Small Concentration Changes May Lead to Serious Adverse Reactions Clinical Impact Ritlecitinib is a CYP3A inhibitor. (notice Ritlécitinib, Interactions médicamenteuses)
CYP1A2 Substrates Where Small Concentration Changes May Lead to Serious Adverse Reactions Clinical Impact Ritlecitinib is a CYP1A2 inhibitor. (notice Ritlécitinib, Interactions médicamenteuses)
Vérifiez Ritlécitinib avec tout ce que vous prenez. Ajoutez votre liste complète ; toutes les paires sont vérifiées en une fois.
Ouvrir dans le vérificateurCeci n'est pas un avis médical. Le niveau de gravité reflète la formulation de la notice, pas votre situation. Une alerte « majeure » peut être courante sous surveillance et une alerte « mineure » peut compter à forte dose. Demandez conseil à un pharmacien.