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The FDA issued a warning letter to an Indian API manufacturer after inspectors found that the company knowingly accepted deliberately mislabeled raw materials to bypass licensing requirements, failed to perform required identity testing, and relied on unverified supplier documentation before using the materials to manufacture APIs shipped to the United States

In fact, its pretty uneven

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Drugs like Cytoxan (cyclophosphamide) and Rheumatrex (methotrexate) suppress inflammation by reducing the bodys own ability to fight off infection