The patient is a 47-year-old white male who presented to our clinic for medication refills. His medical history was significant for type 2 diabetes, hypertension, hyperlipidemia, and chronic back and joint pain. His medications included rosuvastatin (Crestor), valsartan (Diovan), folic acid, metformin, pentoxifylline (Trental), amitriptyline,carbamazepine (Tegretol), and methotrexate.