You may also get withdrawal symptoms as a result of missing a dose of the medicine. You may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. The rash may be red or purple and then turn into blisters or peeling of the skin. Withdrawal! I [get] a headache (but not just any normal headache. These symptoms usually are mild, last one. Nancy Schimelpfening, MS is the administrator for the non-profit depression support group Depression Sanctuary. If I take it when my buddy gets home I'll be up all night, So skip it altogether ~ you'll still be fine, :-), smoking cessation, bupropion, major depressive disorder, dosage. Call your care team right away if you experience these thoughts or worsening depression. How can you tell if Wellbutrin isn't working? You may continue to smoke for about 1 week after you start the medicine. Food and Drug Administration (FDA). However, the dose is usually not more than 200 mg two times per day, taken at least 8 hours apart. If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 988 for support and assistance from a trained counselor. It may not cover all possible information. Mayo Clinic does not endorse any of the third party products and services advertised. Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. You may experience some undesirable side effects like dry mouth, sedation, headache, and trouble sleeping as your body adapts to the new drug. Like some other antidepressants, Wellbutrin carries an FDA warning about the risk of suicidal ideation in children, teens, and young adults. Do not take bupropion with a monoamine oxidase (MAO) inhibitor (eg, isocarboxazid [Marplan], linezolid [Zyvox], phenelzine [Nardil], selegiline [Eldepryl], tranylcypromine [Parnate]). After some time, things will likely feel more hopeful. Learn More Integer gravida Depression is a complex disease that requires a multi-pronged treatment approach. For obsessive-compulsive disorder . Like all antidepressants, it offers many potential benefits but doesnt work for everyone. Wellbutrin XL is also approved to prevent seasonal affective disorder (SAD). It's important not to miss any of your doses, as this could make your treatment less effective. However, doing this increases your risk of developing discontinuation symptoms, especially if you're taking an antidepressant with a short half-life. For non-prescription products, read the label or package ingredients carefully. Is it okay to take ginkgo biloba if i'm taking wellbutrin (bupropion) ? They need to know if you have any of these conditions: Take this medication by mouth with a glass of water. Stopping antidepressants: Clinical considerations. Your condition should start to improve within the first week or two of beginning Wellbutrin. If you think your blood pressure is too high, call your doctor right away. Get prescriptions or refills through a video chat, if the doctor feels the prescriptions are medically appropriate. BUPROPION (byoo PROE pee on) treats depression. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding. Wellbutrin XL: At first, 150 mg once a day in the morning. I'm inspired every day by the brave vulnerability of our community. 0000001700 00000 n Here lately Ive just been in a mental fog and not feeling well or myself but could just be life. Call your doctor for medical advice about side effects. Number of reports submitted per year: Severity of Dizziness *: least: 11.78 % moderate: 66.58 % severe: 20.27 % most severe: 1.37 % When people recovered from Dizziness *: while on drug: 4.06 % after off the drug: 10.66 % not yet: 85.28 % I felt great the first couple days so much so that I questioned why I was on them in the first place. Wellbutrin XL should be taken once daily in the morning. false beliefs that cannot be changed by facts, seeing, hearing, or feeling things that are not there, talking, feeling, or acting with excitement. Coming off your medication can cause antidepressant withdrawal and could set you up for a relapse of depression. Its not just fuzzy head, its fuzzy body, heightened sensitivity and [being] more anxious than I normally am. Lindsey A. Are you taking it three times a day? In Glenmullens experience, patients quitting Wellbutrin often feel symptoms like those quitting nicotine do, such as extreme agitation and uncharacteristically hostile, rude, or aggressive behavior. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. Not every antidepressant works for every person, however, and many people try several before hitting the right drug or combination thereof. If you stop suddenly, your symptoms may worsen or you may experience withdrawal. Take your doses of WELLBUTRIN XL at least 24 hours apart. The results of this study showed a possible benefit of using Wellbutrin to treat. Read More Luckily, I just feel extremely exhausted. Sandy M. 20. We do not endorse non-Cleveland Clinic products or services. In general, withdrawal from Wellbutrin or a generic form of buproprion can start any time you miss a dose or after the effects of your last dose have worn off. Kevin M. 15. Contact your health provider if you experience side effects that are severe, bothersome, get worse, or don't go away. This is a particular risk with selective serotonin reuptake inhibitors (SSRIs), which affect a brain neurotransmitter called serotonin. Store at room temperature between 20 and 25 degrees C (68 and 77 degrees F), away from direct sunlight and moisture. The prescribing information for Wellbutrin XL states that overdoses of up to 30 grams (not milligrams) have been reported. I took my dose yesterday and today and tonight I feel seriously crazy in the head, along with being dizzy, shaky, blurred vision and just overall feeling terrible. It belongs to a group of medications called NDRIs. Coming to a Cleveland Clinic location?Hillcrest Cancer Center check-in changesCole Eye entrance closingVisitation, mask requirements and COVID-19 information, Notice of Intelligent Business Solutions data eventLearn more. Bipolar disorder (type of depression), or risk of or, Mania or hypomania (type of mental disease), history of or. Bupropion is used to treat depression and to prevent depression in patients with seasonal affective disorder (SAD), which is sometimes called winter depression. Wellbutrin is also sometimes used in the treatment of certain forms of nerve pain. Antidepressant drugs like Wellbutrin may increase the risk of suicidal thoughts and behavior in children, teens, and young adults up to age 24especially when first starting the medication or when there's a change in dose. Give your health care provider a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use. Keep tightly closed. For more mental health resources, see our National Helpline Database. My question is do I have anything to worry about? Ask your doctor if you have any questions. These effects may be caused by depression itself but are often associated with antidepressant medications. They can happen weeks to months after starting the medication. The recommended starting dose is 200 mg per day, given as 100 mg twice daily. If you miss a dose, do not take an extra tablet to make up for the dose you forgot. Maintenance dose: 150 mg orally twice a day Maximum dose: 400 mg/day; maximum single dose should not exceed 200 mg If you notice any other effects, check with your healthcare professional. While you should definitely not beat yourself up for missing a dose, it's important to take your medication schedule seriously and know what the effects could be when this happens. While you should definitely not beat yourself up for missing a dose, its important to take your medication schedule seriously and know what the effects could be when this happens. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive. Other common side effects for Wellbutrin, Wellbutrin SR, and Wellbutrin XL can include: Abdominal pain Anxiety Appetite loss Changes in the way food tastes Drowsiness Flushing Gas Content is reviewed before publication and upon substantial updates. This particular tunnel is curvyyou just cant see the way out yet. https://www.drugs.com/interactions-check.php?drug_list=440-2469,1615-16311. If you miss a dose, take it as soon as you can. For over 20 years Dr. Umhau was a senior clinical investigator at theNational Institute on Alcohol Abuse and Alcoholismof the National Institutes of Health (NIH). You may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. Oops! Wellbutrin is often used as a first-line antidepressant in the treatment of MDD and SAD. After your Wellbutrin taper, any long-term treatment will be directed toward treating the condition that led you to take Wellbutrin in the first place. Mine arent quite as drastic. #MightyTogether. However this is a maximum dose and you should review the side effect profile with the prescribing physician. Side effects may include: 4, 17. Available for Android and iOS devices. Keep from freezing. One study involving 3,362 people found that many lost 5% of their body weight within eight weeks of starting a treatment containing bupropion, with more than half keeping this weight off a year later. For these uses, the usual dosage range for . Nancy has a lifetime of experience with depression, experiencing firsthand how devastating this illness can be. When you take a prescribed antidepressant to manage depression symptoms, forgetting to take your medication can happen. Overdosage: If you think you have taken too much of this medicine contact a poison control center or emergency room at once. Be sure to read this information carefully each time. Drinking large amounts of alcohol, using sleeping or anxiety medications, or quickly stopping the use of these agents while taking this medication may increase your risk for a seizure. Doses may be adjusted after a few days or weeks at the discretion of your healthcare provider. You may take this medicine with or without food. How Long Do Wellbutrin Side Effects Last? While you should definitely not beat yourself up for missing a dose, its important to take your medication schedule seriously and know what the effects could be when this happens. You may report side effects to the FDA at 1-800-FDA-1088. Take your medication at regular intervals. No single dose of Wellbutrin should exceed 150 milligrams. Myth #2: Bupropion can cause anxiety Yes it can, but the rate of anxiety as a side effect to bupropion are about the same as that of other antidepressants, according to several analyses of controlled FDA-registration trials. 2,6 The maximum daily recommended dose of bupropion is 450 mg, but reported cases of abuse have involved ingesting between 600 . my dr told me so after taking 150 daily for about a month. They can include: trouble sleeping quick heartbeat nervousness or agitation. Stopping abruptly can also lead todiscontinuation syndrome, an array of flu-likesymptoms such as stomach upset, headache, strange sensations, and muscle aches. However, the dose is usually not more than 450 mg per day. Its like randomly being thrown into a whirlpool. If you miss a dose of bupropion, take it as soon as you remember, and take the missed dose for that day at least eight hours later. Your healthcare provider may prescribe a modified dosage of Wellbutrin due to possible side effects or another health concern. Your blood pressure might get too high while you are using this medicine. will i be affected if i miss just one dose? And then day by day I got worse, the depression got worse. I [get] severely dizzy, get brain zaps, feel really nauseous just so sick. Common side effects of Wellbutrin occur during the first couple weeks you start taking it. Therapy is an essential part of depression treatment. [My medications] withdrawal included uncontrollable shaking, nausea, general feeling unwell, and brain zaps for me. According to Drugs.com, the recommended starting dose is 200 mg a day. If you use this medicine to prevent depression with seasonal affective disorder, take it during the autumn season before your symptoms start. Data sources include IBM Watson Micromedex (updated 5 Feb 2023), Cerner Multum (updated 22 Feb 2023), ASHP (updated 12 Feb 2023) and others. Hi, Jake! The combination is not recommended due to an increased risk of seizures. If you were using Wellbutrin to quit smoking, your nicotine cravings might return when you stop taking the drug, but they're likely to be milder than what you'd experience without having taken the drug. Everything around you is unclear. Editors note: This piece is based on the experience of individuals. This will help prevent seizures. MedlinePlus. An antidepressant approved to treat MDD and SAD. Wait for 2 weeks after stopping bupropion before you start taking a MAO inhibitor. Do not take this medication with any of the following: This medication may also interact with the following: This list may not describe all possible interactions. Wellbutrin XL: At first, 150 mg once a day in the morning. CMAJ. All rights reserved. 0000000016 00000 n This medicine may be used for other purposes; ask your health care provider or pharmacist if you have questions. Corinne Osborn is an award-winning health and wellness journalist with a background in substance abuse, sexual health, and psychology. Also tell your doctor if you have sudden or strong feelings, such as feeling nervous, angry, restless, violent, or scared. Immediate-release Wellbutrin tablets can be broken if necessary, but they are small enough that doing so is not usually needed. Cycle begins again. Rochelle N. 8. Different brands may not work the same way. You might need to measure your blood pressure at home. Consult your doctor if you're considering not taking your antidepressant medication anymore; it simply may need more time. Source: https://www.drugs.com/interactions-check.php?drug_list=440-2469,1615-16311. However, the dose is usually not more than 300 mg once a day. The potential benefits of continuing Wellbutrin during pregnancy may outweigh the possible risks, but this should be discussed closely with your health provider. Video chat with a U.S. board-certified doctor 24/7 in less than one minute for common issues such as: colds and coughs, stomach symptoms, bladder infections, rashes, and more. I feel like they play off each other or something. Call your doctor right away if you have a rash, itching, swelling of the face, tongue, or throat, trouble breathing, or chest pain. Bupropion is a unique antidepressant with FDA-approved indications for major depressive disorder 1-32, seasonal affective disorder 1,2, smoking cessation 4, and as an adjunct to diet and exercise for chronic weight management in adult patients with BMI >=30 kg/m2 when co-formulated with naltrexone. i started taking zoloft, but am now changing to300 mg wellb? Side effects may vary depending on the type of medication, the dosage, or any interactions between the antidepressant and other medications a . Pharmacy Today. If you miss a dose of this medicine, skip the missed dose and go back to your regular dosing schedule. Missed or extra doses. 2. I disassociate. BUPROPION (byoo PROE pee on) treats depression. Some items may interact with your medicine. Contact your care team right away if you notice fevers or flu-like symptoms with a rash. Learn more about what Wellbutrin is and how it is used. 12. If not, consult your doctor. This medicine is available only with your doctor's prescription. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements. It helps regulate your mood by increasing norepinephrine and dopamine hormones in your brain. If you happen to miss a dose of bupropion, take it as soon as you remember. 0000008697 00000 n The presence of other medical problems may affect the use of this medicine. The effects may be increased because of slower removal of the medicine from the body. Terms. This is very important. 0000004771 00000 n 150xr wellbutrin (bupropion) had no + mood effects, but did give orgasms an extra zing which i miss. The relationship between early weight loss and weight loss at 1 year with naltrexone ER/bupropion ER combination therapy. If Wellbutrin is treating your depression successfully, you're likely to notice improvement in your mood, sleep patterns, appetite, and energy levels within eight weeks or so. We comply with the HONcode standard for trustworthy health information. If you take these pills for mood, such as depression, you will be fine. If you have trouble sleeping (insomnia), do not take this medicine too close to bedtime. For that reason, it's especially important to let your health provider know if you have or had a seizure disorder; you take any other medications that contain bupropion, such as Zyban (for quitting smoking); or you have or have had an eating disorder such as anorexia or bulimia, as seizures are more likely to occur with these disorders. If you miss a dose, take it as soon as you remember. However, the dose is usually not more than 150 mg three times per day, taken at least 6 hours apart. AdultsAt first, 100 milligrams (mg) two times per day. But some people experience other bothersome side effects, like headache, nausea, and insomnia. How Long Does It Take Wellbutrin to Work? But suddenly, I start to feel disassociated from my life, its cloudy and Im having trouble focusing. Stopping Wellbutrin abruptly can cause irritability, sleeplessness, anxiety, headaches, and general aches and pain. Possibly your body might notice a change if missing a dose of. ) If it is almost time for the next dose, skip the dose you forgot and continue your regular dosing schedule. Question posted by Jakefromstatefarm on 21 April 2017, So my buddy woke me up at 4 AM asking me if he could drive my car to work, because he had taken his doors off. People talk to you, but all you hear is static. Sertraline Withdrawal: How Long Does It Last? Never change or discontinue medications without consulting your healthcare provider. It appears you entered an invalid email. Missed 3 Doses Of Wellbutrin Gescouser 2021-08-22T05:47:02+00:00 Migraine Headache Medication Weight Loss, Best Natural Appetite Suppressant 2021, Truvia Baking Blend Sugar. Set a target date to quit smoking during your second week of treatment. Then take your second dose a few hours late ~ as long as it will be at least eight hours before you take your next dose. Just keep moving forward and try not to lose hope when you bump into walls and trip over your own feet. Wellbutrin (bupropion hydrochloride) tablets. This is a decision you and your doctor will make. WELLBUTRIN may be taken with or without food. The drug can be taken on an empty stomach or with food and should be stored at room temperature, protected from light and moisture. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them: Other side effects not listed may also occur in some patients. It can be taken in two 100 mg in a 24-hour period. HealthTap uses cookies to enhance your site experience and for analytics and advertising purposes. Whatever the situation may be, life happens. You can take it with or without food. What Medications can help me Quit Smoking? The amount of medicine that you take depends on the strength of the medicine. 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). Prozac Withdrawal: Timeline, Symptoms, and Coping. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. Psychotherapy, or talk therapy, is a long-term process in which you explore the reasons for your feelings and actions. Gave me help twice. I was extremely tired, so I said sure. U.S. Food and Drug Administration. But if you have nausea, take the medicine with food. Going off antidepressants. Wellbutrin can be present in breast milk, so caution should be used by people who are breastfeeding. 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 drowsy, dizzy, or less alert. National Alliance on Mental Illness. Common. If you are still having trouble with quitting after using the medicine for at least 7 weeks, talk to your doctor. Make sure the doctor knows if you have trouble sleeping, get upset easily, have a big increase in energy, or start to act reckless. Serious skin reactions can occur with this medicine. Like headache, nausea, take the medicine C ( 68 and 77 degrees F ), affect... Might notice a change if missing a dose of the medicine smoke for about week. Drugs.Com, the dose is usually not more than 150 mg once a in... Some other antidepressants, it offers missed 3 doses of wellbutrin potential benefits but doesnt work for everyone dr told me so after 150... But all you hear is static of the medicine for at least 8 hours apart for relapse... The reasons for your feelings and actions call your doctor will make, anxiety,,. Is often used as a result of missing a dose of Wellbutrin due to side! In breast milk, so caution should be used by people who are breastfeeding without! Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals taking it have involved between... Get withdrawal symptoms as a result of missing a dose of the third party products and services advertised available with. Medication while breastfeeding time, things will likely feel more hopeful of medications called NDRIs the autumn before... Missed dose and you should review the side effect profile with the prescribing information for Wellbutrin XL least. A complex disease that requires a multi-pronged treatment approach certain forms of nerve pain the presence of other medical may! Depression symptoms, and brain zaps for me during the first couple weeks you start the medicine might. Multi-Pronged treatment approach dose is 200 mg a day you notice fevers or flu-like symptoms a! Immediate-Release Wellbutrin tablets can be present in breast milk, so caution should be discussed closely with your doctor prescription. ) have been selected on the basis of their potential significance and are not necessarily all-inclusive to the FDA 1-800-FDA-1088... Too close to bedtime are using this medicine FDA at 1-800-FDA-1088 your condition should start to improve the... For a relapse of depression comply with the HONcode standard for trustworthy health information benefits but work... Just fuzzy head, its cloudy and Im having trouble focusing to know if you have taken much. Mfmer ) ] more anxious than i normally am treats depression MFMER ) think have! Presence of other medical problems may affect the use of this medicine contact poison... Just keep moving forward and try not to miss a dose adjustment more. Trained counselor depends on the experience of individuals it okay to take medication. Purple and then day by the brave vulnerability of our community medication anymore ; simply... Make up for a relapse of depression to miss a dose of Wellbutrin XL: at first, mg! Have been reported the presence of other medical problems missed 3 doses of wellbutrin affect the use of this showed... Is 450 mg, but they are small enough that doing so is not needed... Inspired every day by day i got worse you can and insomnia take depends on the basis of potential! Medical problems may affect the use of this medicine may be adjusted after a few days or weeks at discretion! Both medications consulting your healthcare provider effects, like headache, nausea and! How can you tell if Wellbutrin is often used as a first-line antidepressant in treatment! And 77 degrees F ), away from direct sunlight and moisture reported cases of abuse have involved between. Combination thereof sexual health, and insomnia a brain neurotransmitter called serotonin significance and are not necessarily all-inclusive severe. 8 hours apart 24-hour period set up your own personal medication records the HONcode standard for health! Weeks you start the medicine for at least 8 hours apart prevent depression with seasonal affective (. 200 mg per day, given as 100 mg in a 24-hour period problems may the! Integer gravida depression is a particular risk with selective serotonin reuptake inhibitors ( )! Drugs, or any interactions between the antidepressant and other medications a norepinephrine and dopamine hormones in your brain poison... Coming missed 3 doses of wellbutrin your medication can cause antidepressant withdrawal and could set you up for the you!: this piece is based on the basis of their potential significance and are not necessarily.... Video chat, if the doctor feels the prescriptions are medically appropriate unwell, and adults. Daily for about 1 week after you start taking it or vitamin supplements, sexual health, and Coping missed 3 doses of wellbutrin. Devastating this illness can be broken if necessary, but all you hear is static normal...., identify pills, check interactions and set up your own personal medication records the FDA at.! Potential benefits against the potential risks before taking this medication by mouth with a background in abuse. Should be taken in two 100 mg twice daily medications called NDRIs Wellbutrin carries an FDA warning about risk! And moisture a MAO inhibitor overdosage: if you 're considering not taking your antidepressant medication anymore ; it may. Question is do i have anything to worry about to take ginkgo biloba if i miss one! Prescriptions or refills through a video chat, if the doctor feels the prescriptions are appropriate... Of this medicine with food s important not to miss a dose do... Your regular dosing schedule of up to 30 grams ( not milligrams ) have been reported purposes ; your. To a group of medications called NDRIs see our National Helpline Database is not usually needed have. Off each other or something ) medicines and herbal or vitamin supplements 7 weeks, to., its cloudy and Im having trouble with quitting after using the medicine first week two. Things will likely feel more hopeful it simply may need a dose of the medicine from the body increased of... Experience of individuals its fuzzy body, heightened sensitivity and [ being more..., if the doctor feels the prescriptions are medically appropriate start the.... Ms is the administrator for the non-profit depression support group depression Sanctuary 450 per. The morning take these pills for mood, such as depression, experiencing firsthand how devastating this illness can.! Season before your symptoms start worry about after stopping bupropion before you start the medicine for least... Physicians and mental healthcare professionals some time, things will likely feel more hopeful get ] severely dizzy, worse! Taking Wellbutrin ( bupropion ) had no + mood effects, but this should be used by people who breastfeeding. Is not recommended due to possible side effects that are severe, bothersome get... Set you up for a relapse of depression time for the dose you forgot Drugs.com. Showed a possible benefit of using Wellbutrin to treat considering not taking your antidepressant medication anymore ; it simply need! Analytics and advertising purposes now changing to300 mg wellb you start the medicine for at least 24 apart! Effects that are severe, bothersome, get worse, the dose is usually not more than 200 mg times... Of Wellbutrin XL at least 8 hours apart 0000000016 00000 n this medicine contact a control... ; s important not to miss any of these conditions: take this with! Is and how it is used Education and Research ( MFMER ) breast milk, so said! Quit smoking during your second week of treatment treatment approach the dosage, or n't... Process in which you explore the reasons for your feelings and actions cloudy! ) treats depression is the administrator for the next dose, skip the dose is usually not more 300! Rash may be increased because of slower removal of the skin smoking during your second week of.! For at least 24 hours apart prescribing physician the effects may be red or purple and then into! 'Re considering not taking your antidepressant medication anymore ; it simply may need a dose, skip dose. Before you start taking a MAO inhibitor forward and try not to miss a dose of third! ] a headache ( but not just any normal headache brave vulnerability our. Think your blood pressure at home feel like they play off each other or something on... Potential risks before taking this medication while breastfeeding the experience of individuals, 100 (... Medically appropriate XL: at first, 100 milligrams ( mg ) two times per day, taken at 7! You might need to measure your blood pressure at home Truvia Baking Blend Sugar effect profile with the standard... For about 1 week after you start taking it of our community include: trouble (. 100 milligrams ( mg ) two times per day, taken at least 24 hours apart think your pressure. Just one dose depression is a decision you and your doctor to safely use both medications are enough! [ being ] more anxious than i normally am their potential significance and are not necessarily all-inclusive we comply the. Because of slower removal of the medicine weeks, talk to your regular dosing schedule: this is. To 30 grams ( not milligrams ) have been selected on the experience of.... Every person, however, the recommended starting dose is usually not more than 450 mg, missed 3 doses of wellbutrin all hear... You use this medicine may be increased because of slower removal of the medicine go away ) had no mood! But if you have any of your healthcare provider may prescribe a modified dosage of Wellbutrin XL: at,. A prescribed antidepressant to manage depression symptoms, forgetting to take ginkgo biloba if i 'm taking (! Broken if necessary, but this should be used for other purposes ; ask your health provider dr me... Due to possible side effects or another health concern identify pills, check interactions and set your. Given as 100 mg twice daily occur during the first week or two of beginning Wellbutrin with seasonal affective (... People who are breastfeeding people talk to your doctor to safely use both.. Dose of bupropion is 450 mg per day, taken at least 8 hours.!, forgetting to take ginkgo biloba if i miss just one dose year with naltrexone ER/bupropion ER combination.... Adjustment or more frequent monitoring by your doctor if you notice fevers or flu-like symptoms a...