Nice to meet you how many cytotec used for abortion MCK's significant cash generating ability could afford the company the opportunity to rapidly repay acquisition debt, possibly limiting a downgrade of the ratings to one notch. However, a two-notch downgrade could result from Fitch's expectation for debt-to-EBITDA to be sustained around 2x or above 18-24 months following a potential deal's consummation. Fitch believes that even in the event of a two-notch downgrade of the long-term IDR, MCK's strong liquidity profile will support a short-term IDR maintained at 'F2'.