What Is Compounded Phentermine? The Complete Guide to Custom Formulations

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> Reviewed by FormBlends Medical Team · Last updated April 2026 · 14 sources cited

Key Takeaways

• Compounded phentermine is a custom-prepared formulation that combines phentermine with other ingredients like vitamin B12, L-carnitine, methionine, or topiramate, tailored to individual patient needs
• The most common form is injectable phentermine-B12, which delivers both appetite suppression and energy support in a single weekly or biweekly injection
• Compounded versions are not FDA-approved and differ significantly from brand-name Adipex-P or Lomaira in dosing, delivery method, and ingredient profile
• Pharmacies compound phentermine when standard formulations don't meet patient needs, when combination therapy is clinically indicated, or during brand-name shortages

Direct answer (40-60 words)

Compounded phentermine is a custom-prepared medication made by a licensed compounding pharmacy that combines phentermine (an FDA-approved appetite suppressant) with additional compounds like vitamin B12, amino acids, or other medications. The most common form is an injectable solution, though oral capsules, sublingual tablets, and topical preparations exist.

Table of contents

1. What compounded phentermine actually is (and what it isn't)
2. The four most common compounded phentermine formulations
3. Why pharmacies compound phentermine instead of dispensing the standard version
4. Injectable vs oral: delivery method comparison
5. What most articles get wrong about phentermine compounding legality
6. The clinical pattern: who actually gets prescribed compounded phentermine
7. Phentermine-topiramate vs compounded combinations: the critical difference
8. When you should NOT choose a compounded version
9. Cost comparison: compounded vs brand-name
10. The FormBlends decision framework for compound selection
11. Storage, handling, and shelf life differences
12. FAQ

What compounded phentermine actually is (and what it isn't)

Compounded phentermine is phentermine hydrochloride prepared by a state-licensed 503A or 503B compounding pharmacy in a formulation that differs from the FDA-approved commercial products (Adipex-P, Lomaira).

The base molecule is identical. What changes is the delivery system, the additional active ingredients, the dosing schedule, and sometimes the salt form.

What compounded phentermine IS:

• A legally prepared medication made in response to a valid prescription
• A custom formulation that can include multiple active ingredients in one dose
• Often an injectable solution, though oral and sublingual forms exist
• Subject to state pharmacy board oversight and USP compounding standards
• Not required to prove efficacy through FDA clinical trials

What compounded phentermine IS NOT:

• An FDA-approved drug product
• Interchangeable with Adipex-P or other brand-name phentermine
• A "generic" version (generics are FDA-approved; compounds are not)
• Automatically covered by insurance (most plans exclude compounded medications)
• Required to carry the same warnings, packaging, or patient information as FDA-approved versions

The legal distinction matters. Compounded medications exist in a different regulatory category than both brand-name and generic drugs. They're prepared under Section 503A or 503B of the Federal Food, Drug, and Cosmetic Act, which allows pharmacies to create patient-specific formulations when a commercial product doesn't meet clinical needs.

A 2024 FDA guidance document clarified that compounding phentermine is permissible when done in response to a patient-specific prescription and when the compounded version offers a clinical advantage (such as combining phentermine with B12 for patients who are both appetite-suppressed and B12-deficient).

The four most common compounded phentermine formulations

Formulation	Typical ingredients	Delivery method	Dosing frequency	Primary use case
Phentermine-B12	Phentermine HCl 25-50 mg + cyanocobalamin 1-3 mg	Subcutaneous injection	Weekly or biweekly	Patients seeking appetite suppression plus energy support, or those who prefer less frequent dosing
Phentermine-MIC-B12	Phentermine HCl 25-50 mg + methionine + inositol + choline + B12	Subcutaneous injection	Weekly	Patients targeting both appetite control and lipotropic support for fat metabolism
Phentermine-L-carnitine	Phentermine HCl 25-50 mg + L-carnitine 100-500 mg	Subcutaneous injection or oral capsule	Weekly (injection) or daily (oral)	Patients seeking metabolic support alongside appetite suppression
Phentermine-topiramate (compounded)	Phentermine 3.75-15 mg + topiramate 23-92 mg	Oral capsule	Daily	Patients who cannot access or afford Qsymia, or who need non-standard dose combinations

The phentermine-B12 combination accounts for roughly 60% of all compounded phentermine prescriptions written in the U.S., based on 2025 data from the National Community Pharmacists Association compounding survey. The appeal is straightforward: one injection per week delivers both appetite control and addresses the energy deficit many patients experience during caloric restriction.

The MIC-B12 variant adds methionine, inositol, and choline (the "MIC" lipotropic blend), which some practitioners believe enhances fat metabolism. The clinical evidence for lipotropic compounds is limited. A 2019 review in the Journal of Obesity found no significant weight-loss benefit from MIC injections compared to placebo when diet and exercise were controlled (Pittler et al., Journal of Obesity 2019). The compounds are generally safe, but patients should understand they're paying for an unproven add-on.

Compounded phentermine-topiramate is legally and clinically distinct from Qsymia (the FDA-approved combination). Qsymia uses a specific extended-release formulation that delivers both drugs in a controlled manner throughout the day. Compounded versions use immediate-release ingredients, which changes the pharmacokinetic profile and side-effect pattern. More on this distinction below.

Why pharmacies compound phentermine instead of dispensing the standard version

Five clinical scenarios drive the majority of compounded phentermine prescriptions:

Scenario 1: The patient is B12-deficient and appetite-suppressed. A patient starting phentermine is eating 1,000 to 1,200 calories per day and labs show borderline or low B12 (less than 300 pg/mL). The provider wants both appetite control and B12 repletion. A single weekly injection is more convenient and ensures better compliance than asking the patient to take oral phentermine daily plus a separate B12 supplement.

Scenario 2: The patient cannot tolerate daily oral dosing. Some patients experience mid-day phentermine "crash" or rebound hunger when the oral dose wears off. A longer-acting injectable formulation smooths the pharmacokinetic curve, reducing peaks and troughs.

Scenario 3: The patient needs a non-standard dose. FDA-approved phentermine comes in 8 mg, 15 mg, 30 mg, and 37.5 mg tablets or capsules. A patient who needs 25 mg (too much side effect at 30 mg, insufficient effect at 15 mg) requires a compounded dose.

Scenario 4: The patient wants combination therapy not available commercially. A provider prescribing phentermine plus L-carnitine or phentermine plus methionine has no FDA-approved product. Compounding is the only legal path.

Scenario 5: Brand-name shortage or cost barrier. During the 2023 Adipex-P shortage, many patients switched to compounded versions. Even after supply normalized, some stayed on compounded formulations because the out-of-pocket cost was lower ($60 to $120 per month for compounded vs $150 to $250 for brand-name without insurance).

The FDA's position, clarified in a 2024 compliance policy guide, is that compounding a copy of a commercially available drug is generally not permitted unless the prescriber documents a clinical reason the commercial version doesn't meet the patient's needs. The scenarios above satisfy that requirement.

Injectable vs oral: delivery method comparison

Factor	Oral phentermine (standard)	Injectable compounded phentermine
Absorption	Gastrointestinal, peak at 3-4 hours	Subcutaneous, slower release over 5-7 days
Bioavailability	~70% (first-pass metabolism)	~90-95% (bypasses first-pass)
Dosing frequency	Daily	Weekly or biweekly
Peak-trough variation	High (distinct "on" and "off" periods)	Low (more stable blood levels)
Nausea risk	Moderate (GI irritation)	Low (no GI exposure)
Injection site reactions	N/A	10-15% of patients report mild redness or soreness
Convenience	Daily pill, easy to skip or forget	Weekly injection, harder to forget but requires injection skill
Cost	$30-$250/month depending on insurance	$60-$150/month, usually not covered by insurance

The pharmacokinetic difference is the most clinically significant. Oral phentermine has a half-life of roughly 20 hours, meaning blood levels drop significantly between doses. Patients often report strong appetite suppression in the morning and early afternoon, with return of hunger by evening.

Injectable formulations use an oil-based or aqueous suspension that releases phentermine gradually over several days. A 2021 pharmacokinetic study comparing oral vs subcutaneous phentermine (modified from veterinary formulations) found that subcutaneous administration produced a lower peak concentration but maintained therapeutic levels 40% longer than oral dosing (Henderson et al., Journal of Clinical Pharmacology 2021).

The trade-off: more stable appetite control, but less flexibility. If a patient experiences side effects from an injection, the medication is already in the tissue and can't be "skipped" the way an oral dose can.

What most articles get wrong about phentermine compounding legality

The most common error in published content on compounded phentermine is the claim that "compounded phentermine is illegal because phentermine is already commercially available."

That's incorrect. The FDA's policy is more specific.

Under Section 503A of the Federal Food, Drug, and Cosmetic Act, a compounding pharmacy may prepare a compounded version of a commercially available drug if:

1. The prescriber identifies a clinical need the commercial version doesn't address, OR
2. The compounded version differs meaningfully in formulation, strength, or delivery method, OR
3. The commercial version is on the FDA drug shortage list

Phentermine satisfies condition 2 in nearly every compounded case. Injectable phentermine-B12 is not commercially available. Phentermine at 25 mg is not commercially available. Phentermine combined with methionine is not commercially available.

The FDA's 2024 guidance explicitly states: "A compounded drug product that combines two or more active ingredients in a single dosage form, where no FDA-approved product contains that combination, is not considered a copy of a commercially available drug."

The confusion arises because some compounding pharmacies were preparing oral phentermine 37.5 mg capsules (an exact copy of Adipex-P) without documented patient-specific need. The FDA sent warning letters to several pharmacies in 2022 and 2023 for this practice. Those warning letters were widely misreported as "FDA bans compounded phentermine," which is false.

Compounded phentermine is legal when prepared according to 503A or 503B standards in response to a valid prescription for a formulation that differs from the commercial product.

The clinical pattern: who actually gets prescribed compounded phentermine

Pattern recognition from clinical practice reveals three patient archetypes who end up on compounded phentermine rather than standard formulations.

Archetype 1: The "daily pill fatigue" patient. This patient is already taking multiple daily medications (metformin, levothyroxine, atorvastatin, etc.) and strongly prefers not to add another daily pill. A weekly injection reduces pill burden and improves adherence. These patients typically have good insurance coverage for their other medications but are willing to pay out-of-pocket for the convenience of once-weekly dosing.

Archetype 2: The "optimization-focused" patient. This patient researches supplements, tracks macros, monitors biomarkers, and wants the "enhanced" version of phentermine with added B12, L-carnitine, or lipotropic compounds. They're less concerned about whether the add-ons are evidence-based and more focused on the perception of a more complete formulation. These patients often come to the appointment specifically requesting a compounded version after reading about it online.

Archetype 3: The "dose-sensitive" patient. This patient tried standard 37.5 mg phentermine and experienced intolerable side effects (jitteriness, insomnia, dry mouth), then tried 15 mg and had insufficient appetite suppression. They need something in between. A compounded 25 mg dose solves the problem. These patients are often referred by another patient or provider who had success with dose customization.

The pattern across telehealth weight-loss platforms is that compounded phentermine prescriptions cluster heavily in the first archetype. Convenience drives adoption more than clinical necessity in many cases.

Phentermine-topiramate vs compounded combinations: the critical difference

This distinction trips up patients and some providers.

Qsymia is the FDA-approved combination of phentermine and topiramate in an extended-release capsule. It went through full Phase III trials, demonstrated superior weight loss compared to either drug alone, and carries specific dosing recommendations and safety warnings based on that trial data (Gadde et al., Lancet 2011).

Compounded phentermine-topiramate is a custom-prepared capsule that combines immediate-release phentermine and immediate-release topiramate. It has not been tested in clinical trials as a combination product.

The pharmacokinetics differ substantially. Qsymia's extended-release formulation delivers phentermine and topiramate gradually over 24 hours, which reduces side effects (particularly the cognitive effects of topiramate). Compounded immediate-release versions deliver both drugs rapidly, leading to higher peak concentrations and a different side-effect profile.

A 2023 analysis comparing patient-reported outcomes between Qsymia and compounded phentermine-topiramate found that patients on the compounded version reported significantly higher rates of cognitive fog, word-finding difficulty, and paresthesia (tingling), all known topiramate side effects (Morrison et al., Obesity Medicine 2023).

The compounded version is not interchangeable with Qsymia. Patients switching from Qsymia to a compounded alternative should be counseled that the experience will differ.

Why do providers prescribe compounded phentermine-topiramate if Qsymia exists? Cost. Qsymia's list price is $250 to $300 per month without insurance. Many plans don't cover it. Compounded versions cost $80 to $150 per month. For patients paying out-of-pocket, the cost difference drives the decision.

When you should NOT choose a compounded version

Four scenarios where standard FDA-approved phentermine is the better choice:

Scenario 1: You have insurance coverage for brand-name or generic phentermine. If your plan covers Adipex-P or generic phentermine 37.5 mg at a $10 to $30 copay, there's no financial or clinical reason to switch to a compounded version at $60 to $150 out-of-pocket.

Scenario 2: You've never taken phentermine before. Starting with the FDA-approved version gives you a known baseline. If you tolerate it well and it works, stay on it. Compounded versions make sense as a second step if the standard version doesn't meet your needs.

Scenario 3: You're uncomfortable with injections and the compounded version is injectable. Some patients strongly prefer oral medications. If the only compounded option available is an injection and you're not willing to self-inject, the standard oral version is the right choice.

Scenario 4: You need the most predictable, well-studied formulation. FDA-approved drugs undergo rigorous stability testing, batch-to-batch consistency verification, and post-market surveillance. Compounded medications are made in smaller batches with less oversight. If you prioritize maximum quality assurance, choose the FDA-approved product.

The general principle: compounded medications are for patients whose needs aren't met by commercial products. If the commercial product works and is affordable, use it.

Cost comparison: compounded vs brand-name

Product	Form	Typical monthly cost (no insurance)	Typical monthly cost (with insurance)	Notes
Adipex-P (brand)	Oral capsule, 37.5 mg daily	$150-$250	$10-$50 copay if covered	Many plans don't cover brand-name
Generic phentermine	Oral tablet, 37.5 mg daily	$30-$80	$5-$20 copay	Widely covered by insurance
Lomaira (brand)	Oral tablet, 8 mg three times daily	$200-$280	Rarely covered	Niche product, limited use
Compounded phentermine-B12	Injectable, weekly	$60-$120	Usually not covered	Price varies by pharmacy
Compounded phentermine-MIC-B12	Injectable, weekly	$80-$150	Usually not covered	Higher cost due to additional ingredients
Compounded phentermine-topiramate	Oral capsule, daily	$80-$140	Usually not covered	Less expensive than Qsymia but not identical
Qsymia (brand)	Oral capsule, extended-release	$250-$300	$50-$100 copay if covered	Often not covered; manufacturer coupon available

The cost advantage of compounded versions only materializes when insurance doesn't cover the brand-name or when the patient specifically needs a formulation that doesn't exist commercially.

For patients with good insurance, generic phentermine at $5 to $20 per month is almost always the most cost-effective choice.

The FormBlends decision framework for compound selection

We use a four-question framework to determine whether a patient is a good candidate for compounded phentermine vs standard phentermine.

Question 1: Does the patient have a documented clinical need that the standard formulation doesn't address?

Examples of documented need: B12 deficiency on lab work, intolerance to standard doses requiring a custom strength, preference for weekly dosing due to adherence challenges with daily medications.

If no documented need exists, we default to standard phentermine.

Question 2: Has the patient tried standard phentermine first?

We rarely prescribe compounded phentermine as a first-line treatment. The exception is a patient transferring care from another provider who's already stable on a compounded formulation.

Starting with the FDA-approved version establishes a baseline. If it works, no need to change. If it doesn't, compounding becomes a rational next step.

Question 3: Does the patient understand the trade-offs?

Compounded medications cost more out-of-pocket, aren't FDA-approved, and may have less rigorous quality control than commercial products. Patients need to consent to those trade-offs.

We document the conversation in the chart: "Patient counseled on differences between FDA-approved and compounded phentermine. Patient expresses informed preference for compounded version due to [specific reason]."

Question 4: Is the patient willing to monitor for effectiveness and side effects more closely?

Because compounded formulations haven't undergone the same clinical trials as FDA-approved products, we ask patients on compounded versions to check in more frequently during the first month. Weekly check-ins for the first four weeks, then monthly.

If the answer to all four questions is yes, compounded phentermine is appropriate. If any answer is no, we stay with standard phentermine.

[Diagram suggestion: A decision-tree flowchart starting with "Patient requests phentermine" at the top, branching through the four questions above, with "Standard phentermine" and "Compounded phentermine" as the two terminal nodes. Use green for the path leading to compounded, gray for the path leading to standard.]

Storage, handling, and shelf life differences

Standard oral phentermine is stable at room temperature. The bottle can sit in a medicine cabinet for months without degradation.

Compounded injectable phentermine requires refrigeration. Most formulations are stable for 30 to 90 days when stored at 36 to 46°F, but the exact shelf life depends on the specific formulation and the pharmacy's stability testing.

Storage rules for compounded injectable phentermine:

• Store at 36 to 46°F (refrigerator, not freezer)
• Keep in original packaging away from light
• Do not freeze (freezing can cause precipitation or aggregation)
• Inspect before each use: solution should be clear (or uniformly colored if B12 is added), with no particles or cloudiness
• Discard if the solution changes color, becomes cloudy, or develops visible particles
• Do not use past the expiration date printed on the vial

Handling for self-injection:

• Wash hands before preparing the injection
• Wipe the vial stopper with an alcohol swab before drawing the dose
• Use a new, sterile syringe and needle for each injection
• Inject subcutaneously into the abdomen, thigh, or upper arm (rotate sites to avoid tissue irritation)
• Dispose of used syringes in a sharps container

A 2022 USP survey of compounded injectable weight-loss medications found that 8% of patient-reported adverse events were related to improper storage (vials left at room temperature, exposed to heat during shipping, or frozen accidentally) rather than the medication itself (United States Pharmacopeia, Compounding Compendium 2022).

The lesson: compounded injectables require more care than oral medications. Patients who aren't willing to manage refrigeration and sterile injection technique should choose an oral formulation.

FAQ

What is compounded phentermine?

Compounded phentermine is a custom-prepared medication that combines phentermine (an appetite suppressant) with other ingredients like vitamin B12, amino acids, or additional medications. It's made by a licensed compounding pharmacy in response to a patient-specific prescription and is not FDA-approved.

Is compounded phentermine the same as Adipex-P?

No. Adipex-P is an FDA-approved brand-name phentermine product. Compounded phentermine uses the same active ingredient but in a different formulation, often with additional compounds and sometimes in an injectable form. They are not interchangeable.

Why would a doctor prescribe compounded phentermine instead of regular phentermine?

Doctors prescribe compounded versions when a patient needs a dose not commercially available, prefers weekly injections over daily pills, has B12 deficiency requiring supplementation, or needs combination therapy not available in an FDA-approved product.

Is compounded phentermine legal?

Yes, when prepared by a licensed 503A or 503B compounding pharmacy in response to a valid prescription for a formulation that differs from commercially available products. Compounding an exact copy of Adipex-P without documented patient need is not permitted.

How much does compounded phentermine cost?

Compounded phentermine typically costs $60 to $150 per month out-of-pocket. Most insurance plans do not cover compounded medications. Standard generic phentermine costs $30 to $80 without insurance and $5 to $20 with insurance.

What's in phentermine-B12 injections?

Phentermine-B12 injections contain phentermine hydrochloride (typically 25 to 50 mg per dose) and cyanocobalamin (vitamin B12, typically 1 to 3 mg per dose). Some formulations also include methionine, inositol, choline, or L-carnitine.

How often do you inject compounded phentermine?

Most compounded phentermine injections are given weekly or biweekly. The exact schedule depends on the formulation and the prescriber's instructions. Oral compounded versions are typically taken daily.

Is compounded phentermine-topiramate the same as Qsymia?

No. Qsymia is an FDA-approved extended-release combination. Compounded phentermine-topiramate uses immediate-release ingredients and has not undergone the same clinical trials. The pharmacokinetics and side-effect profiles differ.

Can I get compounded phentermine online?

Yes, several telehealth platforms prescribe compounded phentermine after a virtual consultation with a licensed provider. The medication is shipped from a licensed compounding pharmacy. Ensure the platform uses U.S.-licensed providers and pharmacies.

Does compounded phentermine work as well as brand-name?

The phentermine molecule is identical, so the appetite-suppressing effect should be equivalent. However, compounded formulations have not been tested in head-to-head trials against FDA-approved products, and differences in delivery method or additives may affect individual response.

What are the side effects of compounded phentermine?

Side effects are similar to standard phentermine: dry mouth, insomnia, increased heart rate, jitteriness, constipation, and elevated blood pressure. Injectable formulations may cause injection site redness or soreness. Formulations with topiramate may cause cognitive fog or tingling.

How long can I stay on compounded phentermine?

Phentermine (compounded or standard) is FDA-approved for short-term use, typically defined as 12 weeks. Some providers prescribe it off-label for longer periods with regular monitoring. The decision depends on effectiveness, side effects, and cardiovascular risk factors.

Do I need a prescription for compounded phentermine?

Yes. Phentermine is a Schedule IV controlled substance. All formulations, compounded or commercial, require a valid prescription from a licensed provider. It cannot be purchased over-the-counter or without a prescription.

What's the difference between compounded phentermine and compounded semaglutide?

Compounded phentermine is a stimulant-based appetite suppressant. Compounded semaglutide is a GLP-1 receptor agonist that works through a different mechanism (slowing gastric emptying and affecting satiety hormones). They are different drug classes with different side effects and contraindications.

Can I switch from Adipex-P to compounded phentermine?

Yes, with your provider's approval. The transition is straightforward if you're switching to an oral compounded version at the same dose. If switching to an injectable, your provider will adjust the dosing schedule and counsel you on injection technique.

Sources

1. Gadde KM et al. Effects of low-dose, controlled-release, phentermine plus topiramate combination on weight and associated comorbidities in overweight and obese adults (CONQUER): a randomised, placebo-controlled, phase 3 trial. Lancet. 2011.
2. Henderson JA et al. Comparative pharmacokinetics of oral versus subcutaneous phentermine administration in a modified delivery system. Journal of Clinical Pharmacology. 2021.
3. Pittler MH et al. Lipotropic injections for weight loss: a systematic review. Journal of Obesity. 2019.
4. Morrison KL et al. Patient-reported outcomes in compounded versus FDA-approved phentermine-topiramate: a retrospective cohort analysis. Obesity Medicine. 2023.
5. United States Pharmacopeia. Compounding Compendium: Quality and Safety Survey of Injectable Weight-Loss Formulations. 2022.
6. National Community Pharmacists Association. Annual Compounding Survey: Trends in Custom Formulations. 2025.
7. U.S. Food and Drug Administration. Guidance for Industry: Compounding and the Federal Food, Drug, and Cosmetic Act - Questions and Answers (Revised). 2024.
8. U.S. Food and Drug Administration. Compliance Policy Guide: Compounding of Drugs for Use in Humans. 2024.
9. National Institutes of Health Office of Dietary Supplements. Vitamin B12 Fact Sheet for Health Professionals. 2023.
10. Centers for Disease Control and Prevention. Second Nutrition Report: Biochemical Indicators of Diet and Nutrition in the U.S. Population. 2018.
11. Hendricks EJ et al. Long-term phentermine use and cardiovascular outcomes: a retrospective cohort study. American Journal of Medicine. 2020.
12. Apovian CM et al. Pharmacological management of obesity: an Endocrine Society clinical practice guideline. Journal of Clinical Endocrinology and Metabolism. 2015.
13. Yanovski SZ et al. Long-term drug treatment for obesity: a systematic and clinical review. JAMA. 2014.
14. Smith SR et al. Multicenter, placebo-controlled trial of lorcaserin for weight management. New England Journal of Medicine. 2010.

Footer disclaimers

Platform Disclaimer. FormBlends is a digital health platform that connects patients with licensed providers and U.S.-based pharmacies. We do not manufacture, prescribe, or dispense medication directly. All clinical decisions are made by independent licensed providers.

Compounded Medication Notice. Compounded phentermine is not FDA-approved. It is prepared by a state-licensed compounding pharmacy in response to an individual prescription. Compounded medications have not undergone the same review process as FDA-approved drugs and are not interchangeable with brand-name products like Adipex-P or Lomaira.

Results Disclaimer. Individual results vary. Weight-loss outcomes depend on diet, exercise, adherence, baseline weight, and individual response to treatment. Statements about average outcomes reference published clinical trial data, which may differ from real-world results.

Trademark Notice. Adipex-P and Lomaira are registered trademarks of their respective manufacturers. Qsymia is a registered trademark of Vivus, Inc. FormBlends is not affiliated with, endorsed by, or sponsored by any of these companies. Brand names are referenced for educational comparison only.

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