ACC for children - instructions for use, side effects and reviews

What a parent needs to know

Often, for complex treatment, therapists prescribe additional antibiotics. The combined use of powder and some antibiotics can cause reduced activity of the latter.

According to the instructions, “ACC” in powder form should be consumed immediately after antibiotics. However, the drug cannot be combined with vasodilating medications. The combination of such drugs can lead to a strong vasodilating effect.

Before diluting ACC granules for a child, it is recommended to learn about the main contraindications. This may include:

• diabetes;
• peptic ulcer disease at the time of exacerbation;
• if you have an allergic reaction to substances in the product;
• formation of blood clots in sputum.

It is prohibited to use the medication during pregnancy, as there is a risk of penetration of the active components of the drug into the amniotic fluid. "ACC" should be used with caution in the presence of cystic fibrosis, purulent discharge, liver and kidney failure, and problems with the functioning of the urinary system.

Instructions for use of ACC powder (100 and 200 mg) for children of different ages

Children's immunity develops gradually. This is the reason for special susceptibility to colds. One of the most unpleasant symptoms of a cold is a cough.

It can be dry and wet. A dry cough causes pain and discomfort in the throat area. To treat it, ACC powder is prescribed for children.

This article discusses the instructions for using ACC powder (100 and 200 mg) for children, collects reviews from parents about the children's medicine, and indicates the price of the drug.

Composition and pharmacological properties

ACC is a medicine to combat cough. Produced in Germany and Slovenia, it has an expectorant and anti-inflammatory effect .

The main active ingredient of the drug is acetylcysteine. Auxiliary components are sodium saccharinate, ascorbic acid, sucrose and flavoring.

The drug is available in tablet and powder format. The second option is prescribed in childhood.

The drug package contains 20 packets of granules. They are white in color and have a pleasant aroma. Depending on the additive, it can be lemon, orange or honey.

ACC gives an expectorant effect. It is also prescribed when purulent type of sputum occurs.

It is possible to use the drug for preventive purposes, for chronic diseases of the respiratory system.

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Dosage - 100 or 200 mg

How to drink ACC powder for children? Mucolytic therapy involves following the dosage prescribed by the doctor.

At the age of 2 to 6 years, it is allowed to take 100 mg of the drug no more than 3 times a day. At the age of 6 to 14 years, a single dose is 200 mg. But the number of techniques is reduced to two.

The daily dose for adolescents over the age of 14 years is 400-600 mg of the drug per day. This amount is spread over 2 doses.

In severe cases of the disease, the dosage is increased. If the child’s body weight exceeds 30 kg, then the daily dose of the drug can reach 800 mg.

Changing the dosage on your own is not recommended ; this may lead to worsening side effects or the development of an allergic reaction.

How to dilute and take, special instructions

Before use, ACC powder must be dissolved in hot water. For 100 mg of the drug you will need 100 ml of liquid.

The resulting ACC solution (suspension) for children is taken orally, hot, regardless of food.

Without supervision from medical representatives, the drug can be used for no longer than 5 days. In case of complications of the disease, the course of treatment is extended. But this nuance is discussed with the attending physician.

If you have diabetes mellitus, ACC should be used with caution. The composition of the drug includes sucrose. This is taken into account when prescribing dosage.

Possibility of combination with other substances

Combining ACC powder with agents of a similar effect can lead to stagnation of mucus in the respiratory organs.

Simultaneous use with antibiotics such as tetracycline, penicillin and cephalosporin is undesirable. Acetylcysteine ​​reduces the antibacterial effect of these components.

ACC increases the vasodilatory effect of nitroglycerin, so it is advisable to reduce its dosage.

Any combination of ACC with medications is discussed with a pediatrician to prevent possible side effects.

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In what proportions to dilute the product:

• 10% solution for children – for 1–2 ml of solution Inject 9–18 ml of sodium chloride solution 0.9%;
• 20% solution for adolescents - 2 ml of medicine must be diluted with 8 ml of saline solution;
• 50% solution for adults – 3 ml of solution. The injection is combined with 3 ml of physiological solution.

The correct proportion must be selected by the doctor. An opened ampoule of ACC is stored in the refrigerator for up to 24 hours and the medicine is allowed to be used only for inhalation.

If the doctor’s prescription is in doubt, you can read the instructions for the Fluimucil solution (Italy). There are no differences between it and ACC injections in composition, form, concentration, indications and method of use. Therefore, both drugs are structural analogues and using Fluimucil’s instructions, you can correctly dilute ACC Inject for inhalers.

Interaction with other drugs and other types of interactions

The use of antitussives together with acetylcysteine ​​can increase sputum stagnation due to a decrease in the cough reflex.

When used simultaneously with antibiotics such as tetracycline (except for doxycycline), ampicillin, amphotericin B, cephalosporins, aminoglycosides, they may interact with the thiol group of acetylcysteine, which leads to a decrease in the activity of both drugs. Therefore, the interval between the use of these drugs should be at least 2 hours. This does not apply to cefixime and loracarbef.

Activated carbon reduces the effectiveness of acetylcysteine.

It is not recommended to dissolve acetylcysteine ​​with other drugs in the same glass.

Acetylcysteine ​​reduces the hepatotoxic effect of paracetamol.

There is a synergism between acetylcysteine ​​and bronchodilators.

Acetylcysteine ​​can be a cysteine ​​donor and increase glutathione levels, which helps detoxify oxygen free radicals and certain toxic substances in the body.

The simultaneous use of nitroglycerin and acetylcysteine ​​can lead to an increase in the vasodilating effect of nitroglycerin.

Upon contact with metals or rubber, sulfides with a characteristic odor are formed, so glassware should be used to dissolve the drug.

ACC 100 for children 20 effervescent tablets instructions for use

1 effervescent tablet contains:

active substance: acetylcysteine ​​– 100.0 mg;

excipients: citric anhydride – 679.85 mg; sodium hydrogen carbonate – 291.00 mg; mannitol – 65.00 mg; ascorbic acid – 12.50 mg; lactose anhydride – 75.00 mg; sodium citrate – 0.65 mg; saccharin – 6.00 mg; blackberry flavor “B” – 20.00 mg.

Description ACC® 100

white, round, flat tablets with a blackberry odor.

Pharmacodynamics

The presence of sulfhydryl groups in the structure of acetylcysteine ​​promotes the rupture of disulfide bonds of acidic mucopolysaccharides of sputum, which leads to a decrease in the viscosity of mucus. It has a mucolytic effect, facilitates the discharge of sputum due to a direct effect on the rheological properties of sputum. The drug remains active in the presence of purulent sputum.

With the prophylactic use of acetylcysteine, there is a decrease in the frequency and severity of exacerbations in patients with chronic bronchitis and cystic fibrosis.

ACC® 100 indications for use

Respiratory diseases accompanied by the formation of viscous, difficult to separate sputum: acute and chronic bronchitis, obstructive bronchitis, pneumonia, bronchiectasis,

bronchial asthma, bronchiolitis, cystic fibrosis.

Acute and chronic sinusitis, inflammation of the middle ear (otitis media).

Pregnancy and lactation period

For safety reasons, due to insufficient data, the use of the drug during pregnancy and lactation is only possible if the expected benefit to the mother outweighs the potential risk to the fetus or infant.

ACC® 100 dosage:

In the absence of other prescriptions, it is recommended to adhere to the following dosages:

Adults and teenagers over 14 years of age:

2-3 times a day, 2 effervescent tablets (400 - 600 mg of acetylcysteine ​​per day).

Children aged 6 to 14 years: 3 times a day, 1 effervescent tablet, or 2 times a day, 2 effervescent tablets (300 - 400 mg acetylcysteine).

Children aged 2 to 5 years: 2-3 times a day, 1 effervescent tablet (200 - 300 mg acetylcysteine).

Cystic fibrosis:

For patients with cystic fibrosis and a body weight of more than 30 kg, if necessary, the dose can be increased to 800 mg of acetylcysteine ​​per day.

Children over 6 years of age are recommended to take 2 effervescent tablets (600 mg acetylcysteine ​​per day) 3 times a day.

Children aged 2 to 6 years – 1 effervescent tablet 4 times a day (400 mg acetylcysteine ​​per

day).

Effervescent tablets should be dissolved in half a glass of water and taken after meals. The tablets should be taken immediately after dissolution; in exceptional cases, the ready-to-use solution can be left for 2 hours.

Additional fluid intake enhances the mucolytic effect of the drug.

For short-term colds, the duration of use is 5–7 days.

For chronic bronchitis and cystic fibrosis, the drug should be taken for a longer period of time to achieve a preventive effect against infections.

Instructions for patients with diabetes:

1 effervescent tablet corresponds to 0.006 bread. units

Side effects

In rare cases, headaches, inflammation of the oral mucosa (stomatitis) and tinnitus are observed. Extremely rare - diarrhea, vomiting, heartburn and nausea, drop in blood pressure, increase in heart rate (tachycardia).

In isolated cases, allergic reactions such as bronchospasm (mainly in patients with bronchial hyperreactivity), skin rash, itching and urticaria are observed. In addition, there are isolated reports of bleeding due to hypersensitivity reactions.

If side effects develop, you should stop taking the drug and consult a doctor.

Overdose

In case of an erroneous or intentional overdose, phenomena such as diarrhea, vomiting, stomach pain, heartburn and nausea are observed. To date, no severe or life-threatening side effects have been observed.

Interaction with other tools

With the simultaneous use of acetylcysteine ​​and antitussives, mucus stagnation may occur due to suppression of the cough reflex. Therefore, such combinations should be selected with caution.

There is a synergism between acetylcysteine ​​and bronchiolytics.

The simultaneous use of acetylcysteine ​​and nitroglycerin can lead to an increase in the vasodilatory effect of the latter.

Pharmaceutically incompatible with antibiotics (penicillins, cephalosporins, erythromycin, tetracycline and amphotericin B) and proteolytic enzymes.

Upon contact with metals and rubber, sulfides with a characteristic odor are formed.

Reduces the absorption of penicillins, cephalosporins, tetracycline (they should be taken no earlier than 2 hours after ingestion of acetylcysteine).

special instructions

For patients with bronchial asthma and obstructive bronchitis, acetylcysteine ​​should be prescribed with caution under systematic monitoring of bronchial patency.

When treating patients with diabetes, it is necessary to take into account that the tablets contain sucrose: 1 effervescent tablet corresponds to 0.006 bread. units

When working with the drug, you must use glass containers and avoid contact with metals, rubber, oxygen, and easily oxidized substances.

Impact on the ability to drive vehicles and perform other activities that require concentration and speed of psychomotor reactions

There is no data on the negative impact of the drug ACC® 100 in recommended doses on the ability to drive vehicles and perform other activities that require concentration and speed of psychomotor reactions.

ACC® 100 release form

20 or 25 tablets in an aluminum or plastic tube.

1 tube of 20 tablets each or 2 or 4 tubes of 25 tablets each along with instructions for use in a cardboard box.

4 tablets in strips made of 3-layer material: paper/polyethylene/aluminium.

15 strips along with instructions for use in a cardboard box.

Storage conditions

In a dry place, out of reach of children, at a temperature not exceeding 25 °C.

Close the tube tightly after taking the tablet!

Expiration date of the medicine

3 years.

Do not use after the stated expiration date.

Manufacturer

Sandoz d.d., Verovshkova 57, 1000 Ljubljana, Slovenia.

Manufactured by Salutas Pharma GmbH, Germany.

Consumer complaints should be sent to Sandoz CJSC

123317, Moscow, Presnenskaya embankment, 8, building 1

Tel. Fax

Source: https://www.xn--80akhictgepn.xn--p1ai/articul/10710

Inhalations

ACC is also produced in the form of a solution in ampoules for injection. For children under 14 years of age, it is better to use oral forms of the drug. Although in case of severe complications, injections are prescribed.

However, the injection form of ACC in ampoules is very successfully used for inhalation in nebulizers (with the exception of ultrasonic ones). To do this, 3-4 ml of ACC solution is diluted with saline solution of sodium chloride in a 1:1 ratio. Now this method of treatment is gaining great popularity because it is much more effective, since thanks to modern compression or membrane nebulizers, the active solution is sprayed directly onto the respiratory tract and nasopharynx, which improves the secretion of sputum and its discharge, and there is no need to influence the entire body with a large number of medications .

Treatment regimen

How many times a day you need to take the medicine depends on the complexity of the disease. In this case, the medication can have different dosages: “ACC 100”, “ACC 200” with orange in bags and “ACC 600”. The type of drug also determines the frequency of its use:

• Children from 2 to 6 years old. It is necessary to offer one sachet containing 100 mg of the medicinal substance 2-3 times a day.
• Children from 6 to 14 years old. In this case, the maximum permissible dosage is 400 mg of the active ingredient. Therefore, you can use “ACC for children” in sachets with a dosage of 100 mg of acetylcysteine ​​in the morning and evening. Or you can purchase 200 mg sachets and drink them once a day. However, the treatment regimen must be prescribed by a doctor. It is often best for young children to use the medicine twice a day to avoid excessive mucus production.
• It can be recommended for those people who have difficulty swallowing ACC tablets in sachets. Instructions for use by adult patients suggest consumption of up to 600 mg of acetylcysteine ​​per day. The number of doses will vary depending on the prescribed single dosage.

Thus, adults can use ACC 600 once a day. If a medicine is prescribed with an amount of medicinal component of 200 mg, then three doses are required.

What water to use for dissolution

How to dilute ACC powder so as not to exceed the dosage and prevent adverse reactions? The components included in the product allow the use of plain water to create a solution. The resulting mixture does not emit an unpleasant odor and tastes sweet, which the baby will definitely like.

But before preparing the product, it is important to note that only boiled and hot water should be used. The instructions for taking the medication indicate that diluting the powder with boiling water is prohibited.

How to use ACC tablets

The instructions for use of the effervescent tablet indicate that it must be dissolved in 100 ml of warm water. The drug should be taken immediately, but it can be stored for up to two hours. Treatment involves use after meals, and it is not forbidden to use additional water for drinking.

“ACC” is allowed for use by children from two years of age. Instructions for use of the effervescent tablet contain the following information:

• Patients from 2 to 5 years. It is allowed to take one pill containing 100 mg of active substance 2-3 times a day.
• Children from 6 to 14 years old. You can drink one piece of ACC 100 three times a day. Also at this age, ACC 200 may be recommended, but twice a day.
• Teenagers and adults. Use the drug with a dosage of 200 mg up to three times a day. “ACC Long” may also be indicated, which contains a loading dose of the medicinal component (600 mg). You need to drink it once a day.

If the disease is not complicated, the course of treatment usually does not exceed a week. For chronic pathologies, therapy may be longer.

When should you start taking it?

The instructions for the drug indicate the main diseases leading to the appearance of an acute cough. It is recommended to start taking ACC powder during the following processes:

• cystic fibrosis;
• bronchiolitis, COPD, bronchial asthma, bronchiectasis
• lung abscess;
• actively developing pneumonia;
• acute, chronic or obstructive bronchitis;
• tracheitis and laryngotracheitis.

To determine how to dilute the “ACC” powder, you should consider in detail the instructions for taking the drug.

When is it appointed?

It is convenient to use “ACC” in a bag. Instructions for use suggest its use, as well as other forms of release, for the following diseases:

• tracheitis;
• acute or chronic sinusitis;
• pneumonia;
• bronchial asthma;
• laryngitis;
• bronchitis in acute, chronic or obstructive stages;
• otitis media;
• lung abscess.

The active component is derived from the amino acid cysteine. It has pronounced expectorant and mucolytic properties. It has its effect due to the destruction of the bonds of the resulting sputum, which becomes more liquid and is easily removed.

Drug interactions

Thrombo ACC enhances:

- the effect of anticoagulants and antiplatelet drugs (for example, warfarin and other coumarin derivatives, heparin, dipyridamole, sulfinpyrazone)

-effect of other platelet aggregation inhibitors, such as ticlopidine, clopidogrel: possible increase in bleeding time

-action of antidiabetic drugs – hypoglycemic effect of sulfonylurea derivatives

-desirable and undesirable effects of non-steroidal anti-inflammatory and antirheumatic drugs

-desirable and undesirable effects of methotrexate

-risk of gastrointestinal bleeding when used simultaneously with glucocorticoids or alcohol

- concentration of digoxin, barbiturates and lithium in blood plasma

- the effect of sulfonamides and combinations of sulfonamides, including co-trimoxazole

-action of triiodothyronine

- action of valproic acid.

The drug weakens:

-action of aldosterone antagonists (spironolactone and canrenone)

-action of loop diuretics (for example, furosemide)

-effect of uricosuric drugs (probenecid, sulfinpyrazone)

-action of ACE inhibitors

When taking tetracyclines simultaneously, non-absorbable complexes may form. Thus, an interval of at least 1-3 hours must be observed between doses of these drugs.

Caution should be exercised when taking cyclosporine or tacrolimus concomitantly.

If it is necessary to use Thrombo ACC and the above drugs in a complex manner, the interval between them should be at least 1-3 hours.

Consider the composition of the granules

The composition of the drug "ACC" in sachets has a powerful effect on the entire bronchopulmonary system. Of course, only acetylcysteine ​​is the medicinal component, but it is necessary to familiarize yourself with the additional components of the granules. According to the instructions for use, the auxiliary composition of the powder in sachets is as follows:

• sucrose, which gives the medicine a pleasant sweetish taste;
• flavoring agent that imparts a characteristic smell and taste;
• saccharin, which acts as a sugar substitute, to soften the taste of the medicine;
• ascorbic acid, which is an antioxidant.

Due to the presence of sucrose, caution should be exercised when administered to people with a history of diabetes mellitus.

Parents' opinion

There are many positive reviews about the drug ACC on the Internet. Among the advantages, parents note:

1. the medicine helps a lot with wet coughs, it goes away quickly;
2. Many children drink powder and tablets well, as they like their taste;
3. granules and tablets dissolve easily;
4. The drug has a convenient dosage regimen.

Negative reviews are due to the fact that ACC can cause allergies, the mucolytic has contraindications, and not all children like the taste of the syrup. Parents also point out that the medicine is expensive.

Application Features

It is recommended to use with caution in patients with a history of gastric and duodenal ulcers, especially in the case of concomitant use of other drugs that irritate the gastric mucosa.

There are isolated reports of severe skin reactions (Stevens-Johnson and Lyell syndromes) when taking acetylcysteine, so if changes occur in the skin or mucous membranes, you should immediately stop using the drug and consult your doctor regarding further use.

Overdose

As a rule, one should distinguish between a chronic overdose of acetylsalicylic acid, accompanied by disorders mainly of the nervous system, such as drowsiness, dizziness, confusion or nausea (poisoning with salicylic acid or its compounds), and acute poisoning.

Symptoms of acute poisoning: severe disturbance of the acid-base balance. Even at therapeutic doses, respiratory alkalosis may occur due to rapid breathing. It is compensated by increased excretion of bicarbonate by the kidneys, so the blood pH remains in the normal range. At toxic doses, such compensation is insufficient, so blood pH and bicarbonate concentration decrease.

Blood pCO2 values ​​may remain normal. External signs indicate a clinical picture of metabolic acidosis. In fact, such manifestations are a combination of respiratory and metabolic acidosis, the causes of which are: respiratory failure caused by toxic doses, accumulation of acid, partly due to reduced renal excretion (sulfuric and phosphoric acid, as well as salicylic, lactic, acetoacetic acid, etc. .), caused by a violation of carbohydrate metabolism. In addition, electrolyte balance is disrupted and extensive potassium loss occurs.

Mild to moderate acute poisoning (200-400 mcg/ml): acid-base imbalance, possible electrolyte imbalance (eg, potassium loss), hypoglycemia, skin rash, gastrointestinal bleeding, hyperventilation, tinnitus, nausea , vomiting, visual and hearing impairment, headache, dizziness and confusion.

Severe poisoning (more than 400 mcg/ml): delirium, tremor, shortness of breath, increased sweating, exicosis, hyperthermia and coma may develop.

Fatal poisoning: Death usually occurs as a result of respiratory arrest.

Treatment: The choice of treatment for acetylsalicylic acid poisoning is based on the severity, stage and clinical symptoms of poisoning. As therapy, the usual measures are taken to reduce the absorption of the active substance, control water and electrolyte balance, as well as normalize impaired thermoregulation and breathing.

Priority attention should be paid to measures that promote the removal and normalization of acid-base and electrolyte balance. In addition to intravenous administration of bicarbonate and potassium chloride solutions, diuretics can be prescribed. Urine should be alkaline to increase the degree of ionization of salicylates and reduce tubular reabsorption.

It is recommended to monitor blood pH, pCO2, bicarbonate levels, potassium, etc. In severe cases, intensive therapy (forced alkaline diuresis, hemodialysis) and diazepam for seizures may be required.

Release form and packaging

10 or 20 tablets are placed in a blister pack made of polyvinyl chloride film and printed varnished aluminum foil.

3 contour packages (10 tablets each) or 5 contour packages (20 tablets each), together with instructions for medical use in the state and Russian languages, are placed in a cardboard pack.

At what age can it be given?

The most suitable age category for children to start taking ACC is 2 years old. For such children, children's ACC 100 is used. It is possible to use the medicine before the age of two, but the use must be supervised by a qualified doctor. Only granulated ACC powder is used.

Release forms for use by children (with a daily dose of acetylcysteine):

Pharmacological properties

Pharmacokinetics

When used, the drug is absorbed in the small intestine, as it has a shell that is resistant to the action of gastric juice. Maximum levels of the drug in plasma are observed 3 hours after its administration.

Under the action of enzymes, acetylsalicylic acid (ASA) is hydrolyzed into salicylic acid in the liver and partially in the small intestinal mucosa. In addition, salicylic acid is glucuronidized in the liver. Due to enzymatic esterase activity, the concentration of acetylsalicylic acid in plasma quickly falls, while the concentration of the main metabolite, salicylic acid, increases and reaches a maximum 4 hours after taking the drug.

The distribution of acetylsalicylic acid and salicylic acid in tissues and body fluids is carried out primarily by passive diffusion, which depends on the pH level and concentration. Therefore, salicylates accumulate in tissues with low pH values.

The volume of distribution of salicylates depends on the dose. When using low (antithrombotic) doses, it is about 0.2 l/kg, which indicates a predominantly extracellular distribution due to high binding to plasma proteins - from 89 to 90%.

The half-life of acetylsalicylic acid in the blood is from 15 to 20 minutes. Acetylsalicylic acid undergoes complete transformation and is therefore excreted from the body only in the form of metabolites in the urine. When using therapeutic doses of acetylsalicylic acid, its primary metabolite, salicylic acid, is found in the urine mainly in the form of a glycine conjugate (salicylic uric acid - 75%), as well as in the form of ester and ether glucuronides (from 5 to 10% and as free salicylic acid (10%). ).

Increasing the pH of urine, for example, with bicarbonate infusion, significantly increases the excretion of salicylates (5-10 times).

Pharmacodynamics

Acetylsalicylic acid is a non-steroidal anti-inflammatory drug. When prescribing low doses (30-300 mg), the main mechanism of action of acetylsalicylic acid is the inactivation of the enzyme cyclooxygenase, as a result of which the synthesis of prostaglandins, prostacyclins and thromboxane from arachidonic acid is disrupted.

Irreversible disruption of the synthesis of thromboxane A2 in platelets causes the antiplatelet effect of acetylsalicylic acid. In addition, acetylsalicylic acid blocks the platelet release reaction, which results in the release of a large number of substances that can also cause platelet aggregation, such as ADP (adenosine diphosphate), serotonin, platelet activating factor, etc.

In doses of 30-300 mg, ASA effectively inhibits thrombus formation on damaged endothelium of the vascular wall, preventing the growth of platelet thrombus. Thus, the antiplatelet effect of acetylsalicylic acid is manifested, aimed at the prevention and treatment of diseases associated with increased platelet aggregation.

The drug improves platelet function in patients with cerebrovascular diseases, peripheral arterial diseases, coronary heart disease (including myocardial infarction) and other vascular diseases. In addition, acetylsalicylic acid reduces thromboembolism and reduces the number of restenoses in patients (after heart surgery).

Why does it help?

The main cause of a wet cough is almost always accumulated mucus in the bronchi. Due to the active component, which destroys it and makes it less viscous, rapid coughing occurs. This is how the body tries to get rid of excess mucus, which promotes rapid recovery.

The powder has a beneficial effect on patients suffering from acute and chronic diseases of the bronchi and lungs. At the same time, acetylcysteine ​​helps protect cells from damage, which often happens during the inflammatory process. Therefore, the drug is also prescribed by doctors as a preventive measure.

It is known that the effect of the drug occurs quite quickly, since upon entering the body, the active substance is immediately absorbed into the blood. The component reaches maximum levels in inflamed organs in 1-3 hours.

There is no mention in the instructions, but doctors know that with prolonged use of the drug, its effectiveness begins to sharply decrease. Therefore, the use of the powder must be combined with other medications if longer treatment is necessary.