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Altostrata

Tips for tapering off Zyprexa (olanzapine)

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erer

Hey all, I was looking for a bit of help switching from tablet form olanzapine, to a liquid suspension form made from orodisperable tablets. I tried switching over on the weekend, and ran into trouble with insomnia on the second night. My current dose is 3.75mg tablet form, so I mixed a 5 mg orodisperable tablet into 20ml of water, then cut 5ml out, hopefully giving me 3.75mg liquid form. This didn't seem to work for me should I try increasing the dose slightly to say 4mg and see if that works?

 

It seems you did everything correctly. Could it be that it is the change from the regular pills to the orodispersible ones that is doing this? Because there are different additives in the pills. It could be like it is when changing from one brand name to another.

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bubble

Hey all, I was looking for a bit of help switching from tablet form olanzapine, to a liquid suspension form made from orodisperable tablets. I tried switching over on the weekend, and ran into trouble with insomnia on the second night. My current dose is 3.75mg tablet form, so I mixed a 5 mg orodisperable tablet into 20ml of water, then cut 5ml out, hopefully giving me 3.75mg liquid form. This didn't seem to work for me should I try increasing the dose slightly to say 4mg and see if that works?

 

Hello Simack. My math isn't really good but: 5 mg / 20 ml gives 0.25 mg per ml. When you take 5 ml of that suspension 5x 0.25= 1.25 mg and not 3.75 (according to me :) You would need 15 ml to get 3.75 (according to my feeble maths)... 

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Meimeiquest

Do I understand that you took out 5ml, then consumed the rest? That would be right.

 

Some ideas with sympathy, having been through the Zyprexa insomnia:

You might try taking a solid 2.5 mg tablet and then using a liquid for the rest.

You might, heavy sigh, need to get pretty low on the Pristiq before you can tolerate a Zyprexa taper. Pristiq is stimulating.

You might, heavier sigh, have to build up your insomnia tolerance...that depends a lot on your overall life situation.

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Altostrata

Meimei's suggestion of combining a solid tablet with the liquid for a little while to make the transition is a good one (as are the others, but they're more difficult).

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simack

Thanks for the help everyone, yeah I was cutting the 5ml out then drinking the 15ml. I might try taking the solid 2.5 and the rest liquid and see how that goes.

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simack

Sorry, Just another quick question, should I titrate the solid tablet down, while increasing the liquid?, or should it be ok to just drop the 2.5 solid after a while?

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Altostrata

I'd stick with the solid and titrate the liquid portion to taper until you hit the dosage of the solid.

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erer

I have a question to those who have experience with Olanzapine tapering. How soon after a cut did you feel the WD effects? 

 

I am asking because I know olanzapine has a long half life and when I was tapering Cymbalta I would get the WD symptoms already the next day. I am wondering what people's experience is with Olanzapine.

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simack

I Usually notice it around the second third day after a cut

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erer

I Usually notice it around the second third day after a cut

Thanks for answering. Do you take your meds in the morning or in the evening?

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erer

Sharing my experience here as a warning to anyone who is taking Olanzapine. It is about storing medicine.

 

For safety reasons my boyfriend keeps my meds in his car, but for a couple of weeks we have had minus degrees here (up to -25*C / - 13 F). I had previously searched for storing information in Estonian advanced patient information booklets, but there it said that Olanzapine requires no special storing conditions. Now I have found out that English language sources clearly state that this drug is to be kept from freezing http://www.drugs.com/cons/olanzapine.html

 

Being on the frozen-unfrozen meds for 2-3 weeks brought a bad wave on for me which led me to look for reasons. Now it is my 10th day back on regular meds and I am starting to feel better. I am also taking Diazepam which has the exact same story connected to it - the drug should not be frozen. So I had 2 meds ruined for a while. Hope this doesn't happen to anyone else.

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simack

Thanks for the heads up about storage, and sorry for the late reply, I usually take my doses right before bed.

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herewego

So I take it from this thread that the orally disintegrating wafers are not the same as the orodisperable ones. If they had been the same thing I could have just told the doctor I was concerned for my weight as some think the orally disintegrating ones may cause less weight gain. Does anyone know why the orodisperable ones were made? If I can find out the reason (if in some way to benefit the patient other than easier tapering) I could give that reason to my doctor.

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herewego

I talked with 2 pharmacists in Canada today and they both told me that orodispersable olanzapine is the same thing as ODT(orally disintegrating) Olanzapine. Does anyone know for sure if this is untrue? Because if it is true then anyone wanting to switch to orodisperable olanzapine can just tell their doctor that they read case studies online that people who took ODT Olanzapine gained less weight and they are concerned about their weight (which would not be untrue for most people taking olanzapine since most gain weight!).

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scallywag

If 2 pharmacists have told you that the 2 formulations are the same, they probably are.  Have you checked with the manufacturer?

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Altostrata

I talked with 2 pharmacists in Canada today and they both told me that orodispersable olanzapine is the same thing as ODT(orally disintegrating) Olanzapine. Does anyone know for sure if this is untrue? Because if it is true then anyone wanting to switch to orodisperable olanzapine can just tell their doctor that they read case studies online that people who took ODT Olanzapine gained less weight and they are concerned about their weight (which would not be untrue for most people taking olanzapine since most gain weight!).

 

Those case studies are probably not accurate. The amount of active ingredient will be the same across formulations and cause the same systemic problems.

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herewego

I could be wrong but I think I was told (and I could be using the wrong words!) that the dissolving olanzapine is absorbed/metabolized differently and that is why there may be less weight gain. It was actually my doctor who told me it may cause less weight gain and gave me some samples of the dissolving kind which I did not continue to buy because I was told it was more expensive and because I did not intend to stay on this medication. Even if it is not true it still could be used as an excuse to try out the dissolving kind - to see if it helps with weight gain(I think the theory is not definitely proven but is in question) - with also the intent to use to more easily taper. I found the case studies before this last post but I don't know how to do links to it. Anyone could look it up.

 

As far as I could find out the olanzapine that dissolves on your tongue (and can be put in liquids) is called olanzapine orodispersible (not orodisperable) (Eli Lilly calls them zyprexa zydis).

 

According to Eli Lilly, zyprexa comes in 4 forms – two oral, two injectable. Of the two oral forms one is swallowed, the other dissolves on the tongue.  The manufacturer in Canada for generic olanzapine did not get back to me, but according to the pharmacists in Canada there are only 2 oral forms – the one you swallow and the one that dissolves on your tongue which can also be put in liquid. I think the dissolving one is more expensive.

 

The instructions below say that the one that dissolves on your tongue can also be taken in liquid – see below.

 

Olanzapine Teva (in Canada called orally disintegrating or ODT olanzapine - I added this part in brackets) tablets break easily, so you should handle the tablets carefully. Do not handle the tablets with wet hands as the tablets may break up.

1. Hold the blister strip at the edges and separate one blister cell from the rest of the strip by gently tearing along the perforations around it.

2. Carefully peel off the backing.

3. Gently push the tablet out.

4. Put the tablet in your mouth. It will dissolve directly in your mouth, so that it can be easily swallowed.

You can also place the tablet in a full glass or cup of water, orange juice, apple juice, milk or coffee, and stir. With some drinks, the mixture may change colour and possibly become cloudy. Drink it straight away.

 

For those wondering, zyprexa is the name brand form – while olanzapine is the cheaper generic form of zyprexa.

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herewego

I was able to find two different studies that suggested weight loss with the disintegrating one and one study that said there was no difference in weight gain. Even if your doctor says it may cause no difference you can still ask to try it to see if it does. Most doctors want you to keep taking your medication and I think most would not say no to this request if they felt it made you more comfortable and you wanted to try it. He/she doesn't need to know you want to use it to try to taper - unless you have a very good relationship with your doctor and he/she supports your tapering.

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herewego

I should say not weight loss - but less weight gained - correction to the above post

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Evoldnahturt

To anyone considering diluting Olanzapine in water, it's the drug itself that's water insoluble:

https://en.wikipedia.org/wiki/Olanzapine (Look for "Solubility in water" at the bottom of the column on the right)

 

You can dissolve a orodisperable tablet in water, but the drug itself will not dissolve into the water.  I strongly suspect that trying to keep it evenly distributed in a solution by stirring while measuring would not get consistent enough results, especially closer to the end of a taper where you need tiny and more precise amounts of the drug.  I believe the only options for tapering past 2.5mg are weighing it on a scale or using a compounding pharmacy to create a liquid, tablet, capsule, etc. at your specified dose.  I would suggest going with a compounding pharmacy, if you can, to keep the dose more consistent and to allow you to get to a much lower dose before jumping to zero.  How low you go is up to you, but I intend to reach the limits of my chosen pharmacy's ability.  Most, I've discovered, can't get to a very low dose, but I found one that claims to be able to get as low as 0.01mg.

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scallywag

Evoldnahturt:  For other drugs, some people have used a compounding solution compatible with their drug that they purchased at a compounding pharmacy. I don't know if one is available that works with Zyprexa. Worth asking though, no?

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Evoldnahturt

I didn't realize that was an option.  I'll look in to that.  Thanks!

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herewego

I am discouraged. Evold is right - olanzapine is not soluble in water. There are 7 levels of solubility ranging from very soluble (dissolves in less than 1 part water) to practically insoluble (dissolves in more than 10,000 parts). Guess which one olanzapine is? Practically insoluble.

 

I have been crushing up my pills and putting them in 20 ml of water and letting it sit for over an hour but the powder does settle at the bottom and when I stir it up right be for taking it into the syringe it doesn't seem to stay suspended long enough for me to pipe up the right amount of medication. I am suspecting because it is practically insoluble it is very hard to get accurate amounts of the medication measured in water each time.

 

I phoned a compounding pharmacy and they do not sell compounding solutions - the pharmacist said each medication is tailor made with a compounding solution which means I would need a doctors prescription to do this. Blah.

 

Is the pharmacist telling the truth?

Do they not sell compounding solutions on their own?

Has anyone come off olanzapine using a slow liquid taper made without the help of a compounding pharmacy?

 

I guess I could try using a scale but I'm not sure I could wrap my brain around the math and with such a small pill.  Has anyone come off olanzapine successfully using a slow taper with a digital scale to a very small final amount?

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Altostrata

Yes, as stated in the first post in this topic, you need a prescription for a liquid made by a compounding pharmacy. Please read http://survivingantidepressants.org/index.php?/topic/3743-tips-for-tapering-off-zyprexa-olanzapine/?p=42858
 
https://www.caymanchem.com/pdfs/11937.pdf
 

Olanzapine is sparingly soluble in aqueous buffers. For maximum solubility in aqueous buffers, olanzapine should first
be dissolved in DMSO and then diluted with the aqueous buffer of choice. Olanzapine has a solubility of approximately
0.5 mg/ml in a 1:1 solution of DMSO:PBS (pH 7.2) using this method. We do not recommend storing the aqueous
solution for more than one day.

 
http://www.perrigo.com/files/rx/pdfs/pds173-ORA-Plus.pdf
 

ORA-Plus is an aqueous-based vehicle
consisting of a synergistic blend of suspending
agents that have a high degree of colloidal
activity. The suspending agents form a
structured, gel-like matrix which suspends
particles and allow for little settling. ORA-Plus
is buffered to a slightly acidic pH to help reduce
degradation of medicinal agents through
oxidation. An anti-foam agent is incorporated in
ORA-Plus to allow for vigorous shaking with
minimal foam.

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herewego

Yeah thanks. I have read this thread a couple times and I saw about the DMSO but was scared to try that as I had read it can possibly affect your eye sight. I had somehow missed the part of the ORA-Plus. My question is do you have to first dissolve the powder in DMSO and then suspend it in ORA-Plus, or can you put the powder straight into the ORA-Plus without using the DMSO and will this be accurate? Thanks again

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Altostrata

As I read the instructions from a drug supplier,

 

"For maximum solubility in aqueous buffers, olanzapine should first be dissolved in DMSO and then diluted with the aqueous buffer of choice."

 

You could put olanzapine powder directly into Ora-Plus but you would not have maximum solubility, if that's important to you.

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herewego

I'm not sure if maximum solubility is important or not. Does maximum solubility mean it will be more evenly dispersed throughout the solution (after I add the DMSO and olanzapine to say the ORA-Plus) or could the powder put directly into ORA-Plus be just as evenly dispersed without being dissolved first? I wonder if a pharmacist would answer my question or hesitate to thinking I am being a 'naughty' patient for trying to get off my medicine without a doctor's approval? If I go this route the next question is can I get my hands on DMSO and/or ORA-plus without a doctor's prescription in Canada - I guess I will look into that.

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Evoldnahturt

I guess I could try using a scale but I'm not sure I could wrap my brain around the math and with such a small pill.

 

There's a spreadsheet attached to the first post in this thread that does the math for you:

 

http://survivingantidepressants.org/index.php?/topic/7601-excel-spreadsheet-to-calculate-dose-weights-using-a-scale/

 

The problem is you can only go so far with a milligram scale.  However, it's possible you may be able to go far enough by just weighing to avoid getting sick.  If compounding isn't an option, you could just weigh on a scale until that's no longer possible and then start dilluting the smallest amount you can weigh on a scale.  I would still weigh out the smallest amount you can weigh instead of crushing an entire pill to reduce the risk of up-dosing when you switch to diluting, which is probably a real risk if you aren't sure the Olanzapine is being evenly distributed in the solution.  I'm not sure that this is a good solution, it's just an idea to consider.  Are you not considering using a compounding pharmacy because your doctor doesn't want you to taper off the drug?  If so, I'm sure if you looked hard enough you could find a doctor that would be willing to help you.

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herewego

I think in my situation it may be difficult to find a doctor to support me - I find it daunting, but thanks for the encouragement. I am determined to carefully reduce anyways and will post my method once I figure it out. Thanks for all the suggestions. I think olanzapine is a tricky pill because it is so strong at such small amounts and with it being the least soluble possible (not to mention a very evil medicine with all the horrible possible side effects) makes it not a very fun pill to taper without a compounding pharmacy. But I will find a way!

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scallywag

herewego -- Tell the pharmacist that you're having difficulty swallowing the capsules/tablets and that you were informed that Zyprexa can be dissolved in a liquid, e.g. OraPlus, and you want to know more about how that would work. If you're concerned about what they'll think of you, ask at a pharmacy you'll never go back to, e.g. in a mall the other side of town or in a big chain store (Loblaw, Walmart, etc.)

 

I had a chat with a pharmacist at a compounding pharmacy and he was really helpful.  I've never spent a dime there, only went in to get answers to my questions.

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Evoldnahturt

I just got off the phone with a compounding pharmacist that was able to explain the oxidation issue.  Apparently, one of the molecules does oxidize and turns the olanzapine into something else.  So compounding probably isn't an option because they have to crush it, exposing it to air.  The pharmacist confirmed that an aqueous solution would also continuously expose it to air assuming it survived from the time it was crushed to the time it was mixed into the solution.  We may just have to stay on as low a dose as we can weigh on a scale.  I doubt we'll be able to jump from that to zero.  Hopefully one of us will figure out a solution.  I'll keep looking into it.

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Evoldnahturt

One option might be to weigh as small an amount as possible and start dividing piles.  For instance, you could divide the pile in half, and divide those two piles in half, leaving you with four equally sized piles.  You could then eat three of those four piles to drop 25%, for example.  Not very accurate, but it allows you to keep dropping.  If you were to drop by 25%, I would hold for at least three and three-quarters of a month (or just round up to four months) so that you're not exceeding the 10% drop rule.  I remember a member on here describing how they successfully tapered by dividing into piles.  They didn't even use a scale, they just divided piles until they got to nearly nothing.  I would post a link to their story, but I couldn't find it.  We also could consider using these scoops instead of weighing.  That would make this process easier and may get more consistent results at even lower amounts.  That way we have a smaller pile to divide up and it may be closer to the same amount each time we scoop it.  I'm ordering some and will let you know how they compare to my scale:

 

10mg scoops:

http://www.powdercity.com/products/mg-measuring-scoops?variant=850329813

 

1-3mg scoops:

http://www.powdercity.com/products/1-3mg-yellow-microscoops?variant=1070838436

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herewego

Thanks scallywag & Evoldnahturt for the info & suggestions. I now have ORA-Plus and have both the dissolving and tablet olanzapine. On the ORA-Plus bottle it gives instructions on how to mix a crushed tablet into the solution. I had thought it would work better with the dissolving olanzapine before I saw the instructions but maybe most medicine is not made in the dissolving form so they didn't include that. The dissolving one can be put in liquid & drink so I don't think the oxidation issue would be a problem.

 

Crushing the tablet for me would also work even if it changes into something slightly different once crushed and put in liquid as I've been taking it in liquid form (crushing and putting in water) for over a month and have been ok. We were thinking of using a scale too but then I was thinking how well would the actual olanzapine be evenly distributed in each pill since so much of it is filler and we were going to try a scale in the $500. range with low linearity but I figured maybe with the ORA-Plus, since it can be easily stirred it may give a more even distribution of olanzapine - I don't know.

 

I didn't end up looking into where they sell DMSO. Tonight will be the first night I use the ORA-Plus so we'll see how evenly it distributes - I may try making solutions with both the dissolving and the crushed tablet and see which one I feel more confident about once I see how the solutions look. Happy tapering everyone!

Edited by scallywag
insert paragraph breaks

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Evoldnahturt

Crushing the tablet for me would also work even if it changes into something slightly different once crushed and put in liquid as I've been taking it in liquid form (crushing and putting in water) for over a month and have been ok.

 

I wonder if dissolving it in water doesn't cause any problems because you're drinking it immediately after you dissolve it, or do you?  I found this:

 

"Zyprexa Zydis orally disintegrating tablets may come in a bottle or a blister pack. If it comes in a blister pack, do not remove the blister from the outer pouch until you are ready to take Zyprexa Zydis orally disintegrating tablets. Do not push the tablet through the foil. Peel back the foil on the blister pack and place the tablet on your tongue. Take the tablet immediately after opening the blister pack. Do not store the removed tablet for future use."

 

At the following link:  https://www.drugs.com/cdi/zyprexa-zydis-orally-disintegrating-tablets.html

 

However, the fact that it's available in a bottle without any warning about taking it quickly after dissolving it causes me to continue to question whether it really oxidizes or not.

 

 

We were thinking of using a scale too but then I was thinking how well would the actual olanzapine be evenly distributed in each pill since so much of it is filler and we were going to try a scale...

 

A coworker used to be a chemical engineer.  He specifically spent much of his career manufacturing drugs.  I asked him about this several months ago when trying to figure out how to taper at the lower doses.  He mentioned that in order for each pill to be a specific dose, they have to make sure the batch is homogenized very well.  His opinion was that even at the granular level, it would be consistent.  I've thought about this and it seems like this would have to be true in order for each pill to not deviate too much from its intended strength.

 

 

we were going to try a scale in the $500. range

 

I use a cheap scale:

 

https://www.amazon.com/gp/product/B0012TDNAM/ref=oh_aui_search_detailpage?ie=UTF8&psc=1

 

I plan on using it to get down to 10mg and then divide into piles from there.  I personally feel better about that than diluting it, considering the fact that Olanzapine isn't soluble in anything I'm comfortable eating.  I'm not confident I could dilute it in ORA-Plus.  I bought some and played with it, but couldn't determine anything just through playing with it.  A compounding pharmacist I spoke to raised concerns about trying to homogenize after adding a bulking agent or putting it in a liquid, since they can't dissolve the drug in anything edible.  They explained that this usually isn't a problem, but could be at really low doses.  I assume, at the factory, a solvent that is later removed is used to homogenize the Olanzapine with the filler.  This is an assumption and may or may not be true, but I can't imagine how else they could homogenize after adding filler.  Compounding pharmacists, apparently, aren't able to reproduce this process. This explained why no compounding pharmacist claimed to be able to compound past 0.25mg.  Most weren't even able to get that low.  They can do the math and compound it for you, but can't be sure that it's homogenized well enough to ensure you're getting consistent doses once you get to the lower doses.  I figured that if a compounding pharmacist has such issues with homogenizing, I probably would too.  I looked into DMSO.  It scared me.  Especially considering how sensitive I am, and a lot of us become, to medications.

 

I found that story where a member successfully tapered by dividing piles:

 

http://survivingantidepressants.org/index.php?/topic/10072-hudgens-success-story/?p=181314

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Evoldnahturt

Imagine you're near the end of your taper and there's a small number of specs left.  Because you can't dissolve those specs, they're just going to float around in that solution.  If the solution is small enough, you may get one or a few one day, and none the next.  Eyeballing would likely be much more accurate than that at the really small doses.  This will likely be true before you get near the end of your taper, but to a somewhat lesser degree.  By the way, how did the switch to ORA-Plus go last night?

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herewego

Hi Evoldnahturt,
I read you can mix the ORA-Plus with up to 50% of another approved liquid, including water, and have the effects of the ORA-Plus remain stable (the olanzapine evenly suspended, not sinking to the bottom). But they suggest to do slightly more than 50% of the ORA-Plus and slightly less of the other liquid, say water, to make sure you have at least 50% of the ORA-Plus.

 

I tried dissolving ODT Olanzapine in just ORA-Plus and it did not dissolve as it does in water - I even waited an hour and stirred it about - it still looked like there were little chunks. Then I dissolved another in just under 10 ml of water and added just over 10 ml of the ORA-Plus and it seemed to mix and suspend evenly through out. The little olanzapine particles that do not dissolve are yellow and the yellow particles seemed evenly dispersed. I also crushed a regular tablet and mixed some ORA-Plus with that (for the powder you do that first) and then added the water and it was murky yellow same as when I make my solution in water w/o ORA-Plus. The difference was the little particles of the olanzapine that does not dissolve did not seem to sink to the bottom, but because of the filler that does not dissolve, I couldn't see how evenly the actual olanzapine was dispersed (though I am sure it was workable and could be done if I had to). I just like that I can see the actual olanzapine particles evenly dispersed as with the ODT olanzapine.

 

I definitely think using the ORA-Plus is way better than just using a water solution and mixing it and quickly piping it out as the olanzapine particles sink so quickly to the bottom and I could see with the ODT Olanzapine in just water that when you stir it in a circle a concentrated ball forms in the middle (probably the same with regular olanzapine - but too murky to see this effect) so if you piped that you might get too much but if you were too slow or took too much from the top you might get too little. I am sure a good scale would work for getting down to the smaller amounts too, but if you are using a solution then I definitely think using ORA-Plus is the way to go.

 

So regarding last night, I slept more than 8 hrs and also had morning grogginess for a good while, so I am wondering if I was getting less than the amount of olanzapine I was trying for this past month with how I was piping it up, and when I switched to the ORA-Plus, because it was more evenly dispersed throughout, I got much closer to the actual amount I had been trying for and may have then kind of updosed. I am confident I will get even amounts now that I have the ORA-Plus.

 

Now I am wondering if I can save a dose for 24 hours in the refrigerator. I had read on the first page of this topic that the crushed tablets made into a liquid can be refrigerated for 48 hours, but that with the ODT olanzapine you should throw away any unused amounts left over. It seems like such a waste to me of both ORA-Plus and the ODT Olanzapine, as I would be throwing more than half of each solution away each night. And I would be throwing away even more as I taper. So I refrigerated the ODT & ORA-Plus solution I made last night and took it tonight. Hopefully that was ok. If anyone knows for sure if that is a no no please let me know.

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