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In patients with severe renal impairment (CL crless than 30 mL/min/1.73 m 2) not on hemodialysis, the recommended starting dosage is 5 mg once daily and should not exceed 10 mg once daily [see Warnings and Precautions (5.1)and Use in Specific Populations (8.6)]

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The combination keeps its chemical structure even when it is under stress that would break down other materials

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In addition to age and genetics, cumulative noise exposure, smoking, and medications can all contribute to age-related hearing loss