Pantoloc

Pantoloc is an FDA-approved medication that minimizes acid production in the stomach. This medicine is only available with a medical professional’s prescription. Doctors widely prescribe Pantoloc for treating stomach and intestine diseases associated with acid production, including acid reflux, heartburn, peptic ulcer, and Zollinger-Ellison syndrome. Besides these diseases, it also helps in preventing stomach ulcers and acidity caused by the long-term use of painkillers. Suitable for adults and children within a specific age group, their doses may vary depending on their medical conditions. Therefore, patients should always follow the doses as per their doctor’s recommendations. Lastly, the medication should not be shared with other individuals, even if they have a similar condition.

Pantoloc is a prescription medication containing the active ingredient Pantoprazole. It is a proton pump inhibitor, or PPI, that effectively reduces stomach acid production. This medication is FDA-approved and widely used to treat gastroesophageal reflux disease (GERD), erosive esophagitis, and Zollinger-Ellison syndrome, providing significant relief from symptoms such as heartburn and acid reflux.

Pantoloc is available in various forms and strengths, including 20 mg and 40 mg delayed-release tablets, 40 mg granules for oral suspension, and 40 mg intravenous injections. The tablets and granules are taken orally, typically once daily, with or without food, while the intravenous form is administered in a hospital setting. It is suitable for adults and children aged five and above. It works by restricting the enzyme in the stomach lining responsible for acid production, thereby reducing acid levels and allowing healing of the esophagus and stomach.

Like every medication, Pantoloc can cause specific side effects such as headache, diarrhea, nausea, abdominal pain, and dizziness. It is necessary to stick to the prescribed dosage and inform your medical practitioner of any pre-existing conditions or other medications you are taking to avoid adverse interactions. If a dose is missed, take it as soon as possible, but skip it if it is almost time for the next dose. In case of an overdose, get medical attention right away. Store Pantoloc at a controlled room temperature, away from moisture and heat, & keep it out of reach of children. Pantoloc provides effective, long-lasting relief for acid-related disorders when used as directed by your healthcare provider.

Pantoloc is used for:

• Treatment of Heartburn
• Treatment of Peptic ulcer disease
• Treatment of Zollinger-Ellison syndrome
• Treatment of Gastroesophageal reflux disease or acid reflux

Forms & Strengths of Pantoloc?

This medication is available in the following forms and strengths:

• Delayed-Release Tablets: 20 mg and 40 mg
• Granules for Oral Suspension: 40 mg
• Intravenous Injection: 40 mg

What Are the Recommended Dosage of Pantoloc?

The doses of Pantoloc for acid reflux treatment may differ for each patient, depending on their medical condition. Therefore, it is advisable to follow the dosage recommendations mentioned on your prescription label. However, it is important to note that the following dosage includes only the average doses of Pantoloc. If you have been prescribed a different dose, consult a medical professional before changing it. 

Dose for Erosive Esophagitis

• For Adults: The recommended dose is 40 mg orally once daily for eight weeks.
• For Children: These dosage recommendations are based on the body weight of children 5 years of age and above.
  • Between 15 Kg and 40 Kg: 20 mg of Pantoloc orally once daily for up to 8 weeks
  • 40 Kg and Above: 40 mg orally once daily for up to 8 weeks.

Dose for Gastroesophageal Reflux Disease

• For Adults: Take 40 mg of Pantoloc once daily and continue for eight weeks. If it is an IV infusion, the recommended dose is 40 mg once a day, given for 2 minutes or over 15 minutes. Follow the routine for 7 to 10 days.
• For Children: These dosage recommendations are based on the body weight of children 5 years of age and above.
  • 15 Kg to Under 40 Kg: 20 mg of Pantoloc orally once daily for up to 8 weeks
  • 40 Kg and Above: 40 mg orally once daily for up to 8 weeks.

Dose for Zollinger-Ellison Syndrome

For Adults: Take 40 mg of Pantoloc orally twice daily. The maximum daily dose of this medicine is 240 mg per day. If it is an IV infusion, the recommended dose is 80 mg every 12 hours for 2 or 15 minutes. Follow the routine for 7 to 10 days.

[Note: Remember, these recommendations may vary from person to person. Discuss it with your doctor, and they’ll customize your dosage accordingly.]

• Go through the patient information leaflet provided by your pharmacist thoroughly.
• Follow the instructions as they are mentioned on the prescription label unless directed otherwise.
• Do not exceed or subceed the doses without consulting your medical provider.
• Pantoloc tablets are taken orally, with or without food, or as your doctor prescribes. If the tablets are oral granules, they should be taken 30 minutes before a meal.
• Avoid breaking, chewing, or crushing your tablets. Swallow it as a whole.
• If you are unable to swallow your medication, you can ask your medical practitioner. They will suggest alternate options suiting your needs.
• If you are taking the oral granules, mix the content with applesauce or apple juice. This mixture can be taken either by mouth or through a nasogastric tube.
• Complete the course of your medication, even if your symptoms are improving.
• If your condition does not improve or worsen over time, contact a healthcare professional immediately.
• Take your medicines at the same time every day to get the most benefit from it.

[Note: Your doctor will decide the right amount for you based on your condition, following guidelines and studies on the drug. They’ll adjust it as needed over time.]

Pantoloc works by reducing the amount of acid produced in the stomach. It contains Pantoprazole, a proton pump inhibitor (PPI), which blocks the enzyme responsible for acid production. By lowering stomach acid levels, Pantoloc helps heal acid-related damage to the stomach and esophagus, relieving symptoms like heartburn and preventing further irritation.

Common Side Effects of Pantoloc: This medication can cause some side effects, which are usually temporary. Generally, these effects last from a few days to weeks, but if it stays for a long time and gets intense over time or even bothers you, immediately seek medical assistance. Common side effects of Pantoloc may include:

• Headache: This is one of the most common side effects of Pantaloc. Headaches are reported in approximately 12% of pantoprazole users. The exact mechanism behind why this side effect occurs is not fully understood, but it may be related to systemic changes induced by acid suppression. To manage this side effect, ensure adequate hydration and rest, and consider using over-the-counter pain relievers if your healthcare provider approves.
• Nausea: Nausea is one of the most common gastrointestinal side effects associated with the use of Pantoloc. It may result from the body’s adjustment to decreased stomach acid levels, which affect digestion. To help alleviate this symptom, eating fewer, more frequent meals and avoiding rich or spicy foods are suggested. If you experience worrisome nausea, you should talk to your doctor or healthcare provider. 
• Stomach Pain: Reduced stomach acid can alter digestive processes, potentially leading to abdominal discomfort and pain. Consuming a balanced diet and avoiding foods that trigger symptoms may assist in managing this pain.
• Vomiting: Vomiting may be associated with gastrointestinal disturbances due to altered acid levels. Staying hydrated and eating bland foods can help manage this side effect. If vomiting persists, consult your healthcare provider.
• Diarrhea: Changes in stomach acidity can affect gut flora balance, leading to loose stools. Maintaining hydration and consuming a diet rich in soluble fiber may help manage diarrhea. If it becomes severe or persistent, seek medical advice.
• Flatulence: Altered digestion due to reduced acid levels can lead to increased fermentation by gut bacteria, causing flatulence. Eating slowly, avoiding carbonated beverages, and reducing intake of gas-producing foods like beans and lentils can help alleviate this symptom.
• Upper Respiratory Tract Infection: While not directly listed as a common side effect of pantoprazole, some studies suggest that acid suppression may increase susceptibility to respiratory infections. This could be due to bacterial overgrowth in the upper gastrointestinal tract, which may be aspirated. Maintaining good hygiene and monitoring for respiratory symptoms is advisable.
• Dizziness: The cause of some users experiencing dizziness while using Pantaloc is not entirely clear, but it may be related to the systemic effects of the medication. This is most likely to occur when you suddenly stand up after sitting or lying for long periods of time. To manage dizziness and reduce the risk of falling and hurting yourself, you should stand up slowly and avoid sudden movements. 
• Fatigue: Fatigue has been reported in some individuals taking pantoprazole. This may be due to the body’s adjustment to the medication. Ensuring adequate rest and engaging in light physical activity can help boost energy levels. If fatigue continues, discuss it with your doctor.
• Dry Mouth: Dry mouth is a less common side effect of pantoprazole. It may result from reduced saliva production. Chewing sugar-free gum, staying hydrated, and avoiding caffeine can help alleviate dry mouth.
• Weakness: Some individuals may experience weakness while taking pantoprazole. This could be related to electrolyte imbalances or other systemic effects. Maintaining a balanced diet & staying hydrated are important. If weakness persists, seek medical evaluation to determine the underlying cause.
• Muscle Spasms: Muscle spasms are rare but can occur, potentially due to electrolyte disturbances like low magnesium levels associated with long-term PPI use. Regular monitoring of electrolyte levels and discussing supplementation with your healthcare provider can help prevent this issue.

Serious Side Effects of Pantoloc: Besides primary effects, Pantoloc for managing GERD can also lead to certain serious reactions. If these effects are not addressed, they can cause life-threatening situations. Therefore, if you are experiencing any unusual signs that seem serious, visit your physician and discuss the condition with them. Serious side effects of Pantoloc may include:

• • Liver Damage: In rare instances, Pantoloc has been associated with liver damage, which may manifest itself as abdominal pain, jaundice or yellowing of the skin/eyes, dark urine, clay-colored stools & loss of appetite. The exact mechanism behind why this happens is not fully understood, but hypersensitivity reactions may lead to liver inflammation. Tell your doctor of any pre-existing liver conditions before starting treatment with Pantoloc to minimize the risk of hepatic issues. Monitoring of liver function may be recommended regularly during prolonged therapy. If signs of liver damage appear, discontinue use and seek immediate medical attention. Signs may include:
    • Yellowing of the skin or eyes
    • Stomach pain
    • Dark urine
    • Clay-colored stools
    • Not feeling hungry
  • Muscle damage: This medication can cause muscle-related issues such as myalgia and, in severe cases, rhabdomyolysis that can lead to kidney damage. The exact cause behind this is not still entirely understood, but it may be due to electrolyte imbalances or immune-mediated responses. To reduce the risk, you should stay hydrated and avoid activities that may cause excessive muscle strain during treatment. Its signs are:
    • Tenderness/weakness
    • Unusual muscle pain
    • Brown urine
  • Severe allergic reactions: While rare, Pantoloc can cause allergic reactions and, in some cases, severe symptoms that require immediate medical attention. Some people may also experience a certain kind of allergic reaction known as DRESS, which stands for Drug Reaction with Eosinophilia & Systemic Symptoms. This is also known by the name multi-organ hypersensitivity. This reaction can affect multiple body parts, including your liver, heart, and kidneys. To prevent this, you should not use Pantoloc if you have ever had a hypersensitivity reaction to pantoprazole or any other inactive or active ingredient present in the product. If you are uncertain about what ingredients are present, you should ask your pharmacist, doctor, or healthcare provider. You should discontinue using this medicine and seek immediate medical attention if you experience any of the symptoms mentioned here. These include:
    • Rash
    • Skin blistering or peeling
    • Swelling on the face or throat
    • Difficulty while breathing
    • Hives
• Kidney problems: Some patients may develop a rare but acute kidney problem known as tubulointerstitial nephritis, which can happen during any time of being treated with pantoprazole. You should discontinue using the medication & seek immediate medical assistance if you notice a decrease in your urine output or if there is blood present in your urine. 
• Antibiotic-associated diarrhea: This medication can cause an overgrowth of germs known as Clostridioides difficile or C. diff. Use Pantoloc only as prescribed to prevent this and maintain good hygiene practices. If symptoms occur, contact your healthcare provider promptly. Immediately call your physician or medical provider if you have persistent diarrhea that does not resolve, watery diarrhea, blood in your stool, fever that begins during the initial or final days of treatment with this drug, or severe stomach cramps. 
• Severe skin reactions: This medication can cause severe skin reactions such as Stevens-Johnson Syndrome (SJS) & Toxic Epidermal Necrolysis (TEN), which can become fatal if not properly treated. If you develop a rash while being treated with Pantoloc, you should discontinue using it and call a licensed healthcare professional. Signs and symptoms of TEN & SJS may include:
• • • Red, watery, or painful eyes
    • Flat red rash or blisters on sensitive areas such as mouth, nose, genitals, and other skin areas.
    • Red or purple painful skin that appears to be burned or peels off
• Lupus: Certain medications, including Pantoloc, can cause certain kinds of lupus or worsen your existing lupus symptoms. Lupus is an autoimmune disorder in which the patient’s immune system begins to attack other organs or cells in the body. Tell your physician or healthcare provider immediately if you experience new or worsening symptoms of joint pain or rash on the skin of your cheeks or arms. 
• Vitamin B-12 deficiency: This medication can cause your body to absorb less vitamin B-12 than usual, which can cause low vitamin B-12 levels. Individuals who have been using Pantoloc for long periods of time (three years or more) are at an increased risk of developing Vitamin B-12 deficiency. You should discontinue using Pantoloc and call your doctor or healthcare provider immediately if you have a sore tongue, weakness, or a sensation of tingling or numbness in your feet or hands. 
• Hypomagnesemia: This medication can cause low levels of magnesium in some people using it. This condition is also known as hypomagnesemia, which may be serious. Some people have an increased risk of developing this condition, especially those who have been using Pantoloc for a long time now or are taking other medications that can cause low levels of magnesium in the body. You should discontinue using pantoprazole and immediately call your doctor or healthcare provider if you experience symptoms such as seizures, muscle spasms, dizziness, and changes in your heartbeat. 
• Bone loss and fractures: This medication can cause bone loss, which further increases the risk of fractures. This risk is higher in geriatric patients and people who have been using Pantoloc for a long time or at an increased dose. 
• Injection site reaction: This medication can cause inflammation and pain around the skin area when the infusion is administered. You should tell your doctor or healthcare provider if you have swelling, pain, or redness in the area where this medication is administered. 

[Note: Remember, this list may not cover all possible side effects. Always consult with your healthcare giver for medical advice about side effects.]

Pantoloc can lead to severe side effects in certain patients, or it may not be a suitable treatment option for specific populations due to their medical conditions. So, if you are using this medication, you should remain cautious as Pantoloc has several warnings, which are as follows:

• Diarrhea: Pantoloc helps by minimizing acid production, and when gastric acid is reduced, the amount of bacteria increases in the digestive system. This whole process leads to serious infection in the digestive tract. So, if you notice watery or bloody diarrhea associated with fever or abdominal pain during your treatment with this medication, tell your medical professional immediately.
• Electrolyte Balance: Using Pantoloc (Pantoprazole) for a prolonged period of time can cause a reduction in blood electrolyte levels, including calcium, potassium, and magnesium. If you are noticing symptoms of electrolyte imbalance, like dry mouth, muscle pain, numb hands/feet, or racing heartbeat, talk to your medical practitioner. They will order blood tests and monitor the electrolyte levels in your blood while you are using this medication.
• Hypersensitivity Reactions: While uncommon, people taking Pantoloc have also reported cases of severe skin reactions. So, beware when using this medication, and if you notice any signs like swollen glands, jaundice, fever, or flu symptoms, tell your medical provider. If left untreated or overlooked, these problems can cause serious medical emergencies.
• Long-Term Use: Using Pantoprazole for an extended period of time (every day for one year) can cause fundic gland polyps. These polyps grow on the stomach’s lining and can become cancerous. Therefore, consult an expert physician and follow the prescribed duration when taking Pantoloc for acid problems.
• Methotrexate Interaction: Pantoprazole may interact with methotrexate when used simultaneously. This interaction can increase the amount of methotrexate in the body, leading to adverse side effects, including anemia, infection, kidney damage, or irregular heartbeat. Therefore, if you are taking these drugs together, tell your medical practitioner and discuss every risk and benefit to avoid any serious complications.
• Osteoporosis Fractures: Prolonged use of Pantoprazole may increase the risk of bone fractures in the wrist, hip, or spine due to weakened bones. This risk is increased if you are prone to osteoporosis. If you have osteoporosis or are at risk, discuss with a medical professional how this medication might affect your condition, its dosing, and whether special monitoring is necessary.
• Skin Conditions: Subacute cutaneous lupus erythematosus (SCLE) is a potential skin condition that might arise in some individuals taking Pantoprazole or similar drugs. Reach out to your healthcare practitioner immediately if you notice a rash on sun-exposed skin areas like the face, arms, or shoulders.

What Are the FDA Boxed Warning for Pantoloc?

Black box warnings, also referred to as boxed warnings, are said to be the most stringent guidelines. The FDA issues these warnings for particular drugs that can cause harmful effects to certain patients. The FDA alerts doctors and patients to be aware of such medications through these warnings. Pantoloc does not have such boxed warnings, meaning this medication is safe for use as long as patients take preventive measures and follow their doctor’s advice.

When considering treatment with Pantoloc, it is advisable that patients should discuss every risk and benefit with their medical practitioner. Doing so will prevent any serious complications in the near future. Here are some of the precautions that patients should be mindful of during their treatment with Pantoloc:

• Before starting your treatment with this medication, let your doctor know if you have any allergies or are allergic to the ingredients involved in its formulation. The product may contain certain inactive components that can cause severe allergic reactions.
• Patients with kidney issues should talk to their practitioner before starting the treatment with Pantoloc. They should discuss factors like how the medication may affect their condition and how their condition may affect the effectiveness and dosing of this medication.
• Patients with serious liver diseases are generally advised to take this medicine no more than 20mg daily. If you have any liver problems, talk to your doctor about the impact of this medication on your medical condition.
• Prolonged use of Pantoprazole can result in vitamin B12 deficiency. If you are a vegetarian or have reduced levels of vitamin B12, discuss with your healthcare provider if any specific monitoring is needed.
• If you are undergoing surgery or any medical procedure, inform your medical professional about the products you use. This includes every prescription drug, over-the-counter drug, and herbal product.
• When considering treatment with Pantoloc, inform your doctor about your or your family’s medical history. This step prevents you from any serious complications in the near future. It also helps healthcare professionals prescribe the right dosage to suit your condition.
• Pantoloc can reduce magnesium levels in the body. If you have hypomagnesemia or a history of low magnesium levels in the blood, tell your healthcare provider beforehand.
• Pantoprazole can affect the results of tests for neuroendocrine tumors. Therefore, your doctor will ask you to stop taking this medicine at least 14 days before the test. They might also ask you to repeat the test if necessary.
• If you are pregnant or planning to have a baby, avoid using this medication unless it is clearly needed, as it has the potential to cause harm to the unborn baby. Therefore, pregnant women should consult their doctor before taking this medication.
• Pantoprazole may enter into the breast milk of nursing women, thus passing to the child while breastfeeding. So, talk to a medical practitioner regarding this situation. They will suggest alternate treatment options that are best suited for you.
• Pantoprazole is sometimes used to treat erosive esophagitis for a brief period in children aged five years and older. This condition is related to gastroesophageal reflux disease (GERD), which causes irritation and damage to the throat from stomach acid. Your child’s doctor will give the right dose of Pantoprazole for this treatment.

Pantoloc is contraindicated in:

• Patients with hypersensitivity reactions to Pantoprazole, soya, or other ingredients involved in the formulation of this medication.
• Co-administration with atazanavir

Generally, patients are advised not to miss a dose of their medication, but if you have somehow forgotten to take a dose of Pantoloc, follow the below instructions:

• Take the missed dose as soon as possible or whenever you remember.
• If it is close to the time of your next medication, you can skip the missed dose and follow your regular dosing schedule.
• Do not take extra doses of Pantoloc simultaneously to make up for the skipped dose.
• Use medication apps or set phone reminders to avoid missing doses.
• You can also organize your pills on a weekly basis in a separate container for taking medications timely.
• If you are still unsure about the missed doses, seek medical guidance. The expert will suggest you alternate options.

[Note: If you have missed a dose of your medication and are unsure about when to take the next one, immediately consult your doctor or pharmacist.]

Doctors usually advise not to take extra doses of Pantoloc, but if someone has mistakenly overdosed, visit the nearest clinic. While there are no reported cases of Pantoloc overdosage, patients should remain cautious while taking their doses. If you have exceeded your maximum daily dose of Pantoloc and are experiencing unusual symptoms, discontinue the medication use and get medical assistance immediately, or seek help by calling 911.

[Note: If you consumed more than the recommended dose, get medical help right away or call the Poison Help line at 1-800-222-1222.]

• Store Pantoloc medication below the temperature of 30°C.
• Keep your medication in its original container.
• Do not store the tablets in damp areas like the bathroom or near the sink.
• Avoid flushing the medication down the hate.
• Keep your medication safe in a locked container away from children and pets.
• Do not store them under direct sunlight.
• Protect the medication from light and moisture.
• Place safety locks on the medication container to protect your children from poisoning.
• Discard unused or expired medication in safe ways to prevent pets, children, and other people from consuming it.
• Ask a medical professional or pharmacist how to properly dispose of your medication’s container without damaging the environment.
• Do not use a medication if its expiration date has passed. The expiration date is the last day of the month mentioned on the back of the prescription label or carton.
• The best way to eliminate unwanted medications is to give them in the medicine take-back program.

[Note: Discuss with your healthcare professional about the proper disposal of any unused medicine and any questions you may have regarding its storage.]

Drug interactions occur when one or more medications are taken simultaneously. These interactions can either increase the risk of developing side effects in certain patients or impact the working of one of the drugs. Either way, it results in adverse reactions. Therefore, patients need to be aware of the drugs that may interact with Pantoloc. Below are some of the drugs that can interact with Pantoprazole:

• Acalabrutinib
• Atazanavir
• Belumosudil
• Dacomitinib
• Dasatinib
• Erlotinib
• Gefitinib
• Infigratinib
• Methotrexate
• Nelfinavir
• Neratinib
• Nirogacestat
• Pazopanib
• Pexidartinib
• Rilpivirine
• Selpercatinib
• Sotorasib
• Amikacin liposome
• Amphetamine
• Bacampicillin
• Bendroflumethiazide
• Chlorothiazide
• Chlorthalidone
• Dicumarol
• Digoxin
• Enzalutamide
• Ethacrynic acid
• Foscarnet
• Fostamatinib
• Gentamicin
• Glycerol phenylbutyrate
• Warfarin
• Voriconazole
• Tobramycin
• Torsemide
• Simvastatin
• Repotrectinib
• Pentamidine
• Omaveloxolone
• Neomycin
• Mitapivat
• Lovastatin
• Ketoconazole
• Hydroflumethiazide
• Indinavir

What Are the Other Pantoloc Interactions?

Besides the above-mentioned drug interactions, Pantoloc can have some other interactions. These can be food, lifestyle, alcohol, or disease interactions.

• C. diff
• Liver disease
• Bone fractures
• Hypomagnesemia

[Note: This isn’t a complete list, and there could be other drugs that interact with Pantoloc. Make sure to tell your doctor about any prescription, over-the-counter medicines, and herbal products you’re taking.]

People usually take alternative drugs for several reasons. In some cases, the prescribed medication may not be a suitable treatment option for them due to their medical conditions. On the other hand, they may not achieve the results they are aiming for. Therefore, patients should talk to a medical practitioner before starting a particular treatment or changing their medication. These experts may help them decide which medication is best suited for them. Some of the alternatives to Pantoloc (Pantoprazole) are as follows:

For GERD

• Protonix
• Prilosec
• Dexilant
• Prilosec OTC
• Aciphex

For Erosive Esophagitis

• Famotidine
• Dexilant
• Prevacid
• Esomeprazole

For Helicobacter Pylori Infection

• Clarithromycin
• Amoxicillin
• Metronidazole
• Pylera
• Amoxicillin/clarithromycin/lansoprazole

Others

• Omeprazole
• Nexium (esomeprazole)

[Note: Your doctor will choose what’s best for you. Don’t use any of these alternative medications without consulting your healthcare provider. Taking them by yourself may cause serious side effects.]

It is important to note that Pantoloc medication costs are not the same everywhere. The actual price of obtaining affordable Pantoloc for heartburn relief depends on various factors, including your insurance plan, location, and the pharmacies you use. Pantoloc, with its effective healing qualities, can be expensive for certain patients. Here, insurance coverage plays a significant role. With an insurance coverage plan, you can buy your medication at affordable rates. However, not all drugs/medications are covered under the insurance plan. To manage these costs, you can buy from reputed and licensed pharmacies like Polar Bear Meds, where you can buy Pantoloc from Canada in the USA at affordable prices. Moreover, first-time buyers can buy Pantoloc with coupon code WELCOMEPB10 to receive a 10% discount on their first order.

AtPolarBearMeds.com, we assure you the most affordable price to buy Pantoloc from Canada. Rest easy knowing that your order will be dispatched from a reputable Licensed Canada Pharmacy Online, adhering to the highest standards of quality and authenticity. Our discounted medications are shipped directly from Canada to your doorstep, ensuring a swift and secure delivery experience. To conveniently buy Pantoloc online to treat acid-related stomach & intestine problems at a substantial cost, call us at 1-888-779-2193 toll-free.