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Infectious-inflammatory diseases methenolone acetate caused by susceptible to malaria infections: Lower respiratory tract infections caused by Staphylococcus aureus (penitsillinazoprodutsiruyuschie strains), Acinetobacter spp., Enterobacter spp., Escherichia coli, Haemophilus influenzae, Haemophilus parainfluenzae, Klebsiella spp., Serratia marcescens. Urinary tract infections (complicated and uncomplicated) caused by Enterococcus faecalis, Staphylococcus aureus (penitsillinazoprodutsiruyuschie strains), Enterobacter spp., Escherichia coli, Klebsiella spp., Morganella morganii, Proteus vulgaris, Providencia rettgeri, Pseudomonas aeruginosa. Intraabdominal infections caused by Enterococcus faecalis, Staphylococcus aureus (penitsillinazoprodutsiruyuschie strains), Staphylococcus epidermidis, Citrobacter spp., Enterobacter spp., Escherichia coli, Klebsiella spp., Morganella morganii, Proteus spp., Pseudomonas aeruginosa, Bifidobacterium spp., Clostridium spp., Peptococcus spp., Peptostreptococcus spp., Propionibacterium spp., Bacteroides spp., including B. fragilis, Fusobacterium spp.

  • Gynecological infections caused. Enterococcus faecalis, Staphylococcus aureus (strains penitsillinazoprodutsiruyuschie). Staphylococcus epidermidis, Escherichia coli, Streptococcus agalactiae (Streptococcus spp. Group B), Enterobacter spp., Gardnerella vaginalis, Klebsiella spp., Proteus spp., Bifidobacterium spp., Peptococcus spp., Peptostreptococcus spp., Propionibacterium spp., Bacteroides spp. including B. fragilis.
  • Septicaemia. caused by Enterococcus faecalis, Staphylococcus aureus (penitsillinazoprodutsiruyuschie strains), Enterobacter spp., Escherichia coli, Kiebsiella spp., Serratia Spp .; Bacteroides spp., Including B. fragilis., Pseudomonas aeruginosa.
  • Bone and joint infections caused by Enterococcus faecalis, Staphylococcus aureus (penitsillinazoprodutsiruyuschie strains), Staphylococcus epidermidis, Enterobacter spp., Pseudomonas aeruginosa.
  • Infections of skin and soft tissue caused by Enterococcus faecalis, Staphylococcus aureus (penitsillinazoprodutsiruyuschie strains), Staphylococcus epidermidis, Acinetobacter spp., Enterobacter spp., Citrobacter spp., Escherichia coli, Klebsiella spp., Morganella morganii, Proteus vulgaris, Providencia rettgeri, Pseudomonas aeruginosa ; Serratia spp., Peptococcus spp., Peptostreptococcus spp., Bacteroides spp., Including B. fragilis, Fusobacterium spp.
  • Infective endocarditis caused by Staphylococcus aureus (penitsillinazoprodutsiruyuschie strains).

Prevention of postoperative complications.

Contraindications:

Hypersensitivity methenolone acetate to imipenem and / or cilastatin (other carbapenems and beta-lactam antibiotics), early childhood (up to 3 months), chronic renal insufficiency (creatinine clearance of 5 ml / min without hemodialysis), chronic renal failure in children weighing less than 30 kg, central nervous system infections in children.

Precautions: Diseases of the central nervous system, convulsions history, high convulsive readiness, anticonvulsant therapy with valproic acid (reducing the effectiveness of therapy), chronic renal insufficiency (creatinine clearance less than 5 ml / min), patients on hemodialysis, old age.

 

Pregnancy and lactation:
Use of the drug during pregnancy is methenolone acetate only permissible if the potential benefit of treatment to the mother outweighs the potential risk to the fetus. Imipenem and cilastatin penetrate in small quantities in breast milk, therefore it is necessary to resolve the issue of termination of breastfeeding at the time of treatment with the drug.

 

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There may also be hepatic encephalopathy. Skin and skin appendages : alopecia often develops. Hair regrowth begins after the completion of drug treatment or even during long-term treatment; hair may vary in their structure and color. Sometimes during primobolan results the treatment of a rash on the skin, pigmentation of the skin and nail changes. From the urinary system : Hemorrhagic urethritis / cystitis, renal tubular necrosis (until death), fibrosis of the bladder (including common) with a concomitant cystitis or without him. The urine may be detected by atypical epithelial cells of the bladder. When high doses of cyclophosphamide in rare cases, there may be impairment of renal function, hyperuricemia, nephropathy associated with increased formation of uric acid. Infections : in patients with severe immunosuppression may develop serious infections. On the side cardiovascular system : cardiotoxicity is observed at high doses of primobolan results of the drug for several days, usually as part of an intensive antitumor combination drug therapy or during organ transplantation. It is noted severe and sometimes fatal episodes of congestive heart failure caused by hemorrhagic myocarditis. The respiratory system : interstitial pulmonary fibrosis (when administered at high doses for a long time). Reproductive system : violation of oogenesis and spermatogenesis. The drug can cause sterility in both men and women, which in some cases can be irreversible.

A significant portion of women develop amenorrhea, regular menstruation is usually recovered within a few months after stopping treatment. In girls, as a result of treatment with cyclophosphamide during the prepubertal period, the secondary sexual characteristics develop normally and menstruation were normal; later they were able to conceive. In men, as a result of treatment, may develop oligospermia or azoospermia associated with increased gonadotropin levels in normal secretion of testosterone. Sexual desire and potency in these patients is not violated. In boys, during drug treatment in prepubertal, secondary sex, symptoms develop normally, however, can primobolan results be marked oligospermia or azoospermia, and increased secretion of gonadotropins. There may be varying degrees of testicular atrophy. Some patients with azoospermia due to a drug is reversible, but the restoration of impaired function may occur only a few years after stopping treatment. Allergic reactions : skin rash, hives, itchy skin, rarely -anafilakticheskie reaction; possible cross-sensitivity with other alkylating compounds. Other : a syndrome similar to the syndrome of inappropriate secretion of antidiuretic hormone (ADH); rush of blood to the skin of the face or facial flushing, headache, increased sweating; development of secondary malignancies.

Overdose
A specific antidote to an overdose of the drug is unknown. In cases of overdose should be used to support measures including appropriate primobolan results treatment of infections, manifestations of myelosuppression and / or cardiotoxicity.

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Cyclophosphamide metabolized mainly in the liver by the action of microsomal oxidase system, forming active alkylating metabolites methenolone enanthate), part of which is subjected to further transformation to inactive metabolites, some are transported into cells, where under the influence phosphatases are converted into metabolites possess cytotoxic action. The concentration of metabolites in the plasma reaches a maximum 2-3 hours after intravenous administration. Communication unchanged drug to plasma proteins is negligible (12-14%), but some metabolites bind more than 60%. Penetrates through the blood-brain barrier to a limited extent.
Cyclophosphamide is excreted mainly by the kidneys in the form of a metabolite, but 5 to 25% of the administered dose is excreted in the urine in an unmodified form as well as in the bile. The half-life is 3-12 hours.

Indications
Acute lymphoblastic and chronic lymphocytic leukemia, Hodgkin’s disease, non-Hodgkin’s lymphoma, multiple myeloma, breast cancer, ovarian, neuroblastoma, retinoblastoma, mycosis fungoides. Cyclophosphamide is also used in combination with other anticancer drugs for the treatment of lung cancer, germ cell tumors, cancer, cervical methenolone enanthate cancer, bladder cancer, soft tissue sarcoma, reticulosarcoma, Ewing’s sarcoma, Wilms tumor, prostatic cancer.
As immunosuppressive agents cyclophosphamide used in progressive autoimmune diseases (rheumatoid arthritis, psoriatic arthritis, collagen diseases, autoimmune hemolytic anemia, nephrotic syndrome) and for the suppression of transplant rejection reactions.

Contraindications

  • Hypersensitivity to cyclophosphamide or any other component of the formulation.
  • Severe violation of bone marrow function.
  • Cystitis.
  • Urinary retention.
  • Pregnancy and lactation.
  • Active infection.

Precautions : in severe diseases of the heart, liver and kidneys, adrenalectomy, gout (in history), nefrourolitiaze, methenolone enanthate suppression of bone marrow function, bone marrow infiltration by tumor cells prior to radiation or chemotherapy.

Dosing and Administration
Is administered intravenously or as an infusion, intramuscular injection.
Is part of many chemotherapy regimens, and therefore, the choice of a particular route of administration, regime and doses in each methenolone enanthate individual case should be guided by the data of literature.
The most common applied doses and regimens for adults and children:

When using cyclophosphamide in combination with other anticancer drugs may require dose reduction of both cyclophosphamide and other .

After addition of the solvent vial is shaken vigorously in order to completely dissolve the drug. If rapid and complete dissolution is not reached, the vial should be left to stand for several minutes.
To. solution for infusion of the drug to the resulting solution was added Cyclophosphamide Ringer’s, 0.9% sodium chloride solution or dextrose solution, so that the total liquid volume was approximately 500 ml.

Side effects Hematopoietic system : leukopenia, neutropenia; rarely, thrombocytopenia, anemia. The largest decrease in the number of white blood cells and platelets usually occurs 7-14 days of treatment.Recovery leukopenia usually begins 7-10 days after discontinuation of treatment. On the part of the digestive system : nausea, vomiting, anorexia, stomatitis, less often, discomfort or pain in the abdomen, diarrhea or constipation, there are isolated reports of the development of hemorrhagic colitis, jaundice. Rarely, abnormal liver function, manifested an increase in transaminases, alkaline phosphatase and bilirubin in blood serum. In 15-50% of patients receiving high, dose cyclophosphamide in combination with busulfan and. total irradiation during allogeneic bone marrow transplantation develop veno-occlusive disease of the liver. A similar reaction in very rare cases are also observed in patients receiving high doses of cyclophosphamide methenolone enanthate in patients with aplastic anemia. The syndrome usually develops within 1-3 weeks after transplantation of the bone marrow and is characterized by rapid weight gain, hepatomegaly, ascites and hyperbilirubinaemia.

If you can not avoid the combined use, the careful selection of individual doses of cyclosporine.
At simultaneous application of tacrolimus may develop nephrotoxic effect of cyclosporin and increase the period of its half-life.
Tacrolimus reduces clearance and increases the primobolan side effects toxicity of digoxin, colchicine, lovastatin, and prednisolone.
In connection with the immunosuppressive effect of cyclosporine we can not exclude the development of potentially dangerous atypical reactions after vaccination, so you should avoid the use of live attenuated vaccines. flavonoid substances found in grapefruit juice , affect the cytochrome , and therefore may increase the level of cyclosporine in the blood. Therefore it is not recommended to drink grapefruit juice in the range of 1 hour before administration of the drug.

 

Special instructions:

Cyclosporine hexane can be used by physicians experienced in immunosuppressive therapy and of treatment in patients after organ transplantation. Use primobolan side effects of the drug is possible only in specialized hospitals.
During treatment, the need for continuous monitoring of laboratory parameters, blood pressure values, a condition of the liver and kidneys, as well as the determination of the concentration of lipids in the blood serum (before treatment and after the first month of treatment). Recommended strengthening of antihypertensive therapy for high blood pressure.
Cyclosporine can cause hyperkalemia or magnesium deficiency, therefore, first of all, with severe impaired renal function, it is necessary to monitor the level of potassium and magnesium in the blood plasma, avoid excessive potassium intake of (food, potassium-containing drugs ).
When using cyclosporin together with other immunosuppressive drugs there is a risk of excessive immunosuppression, which may lead to infection and the formation of lymphomas (especially Hodgkin and reticular sarcoma).
When receiving the drug to regular skin examination and histological inspection of suspicious sites.
since cyclosporin can primobolan side effects affect kidney function, during the treatment necessary to conduct at least two measurements of the initial values of creatinine in blood serum. The measurements are repeated on a weekly basis during the month, and then for 3 months – from a two-week intervals. Then, at a stable level of creatinine measurement is performed on a monthly basis. More frequent creatinine monitoring is required when the need to increase the dose of cyclosporine, or while the application of non-steroidal anti-inflammatory drugs. In that case the creatinine level rose by more than 30% of the initial value (normal range), it is necessary to reduce the dose of cyclosporin to 25 – 50%. If the serum creatinine level rose by more than 50%, it is necessary to lower the dose of cyclosporine at least 50%. When endogenous uveitis therapy should be under constant ophthalmic control, as well as determining the level of concentration of cyclosporine in the blood. In nephrotic syndrome: It is necessary to determine the initial values and conduct regular monitoring of serum creatinine. Dose correcting this case, taking into account dynamics values creatinine concentration in blood plasma. In the treatment of systemic control creatinine performed at intervals of 2 weeks during the first 3 months of therapy in the future – 1 time in 1 – 2 months.

In the case of long-term (over 1 year) receiving cyclosporine is recommended kidney biopsy. Patients should not receive cyclosporine with uncontrolled high blood pressure. It is possible primobolan side effects worsening of renal function in elderly patients. In patients with psoriasis skin lesions not typical for psoriasis should be biopsied before treatment. Patients with cancer or precancerous changes in the skin should be treated with medication only after appropriate treatment of such changes in the absence of alternative forms of effective therapy. Avoid prolonged sun exposure. Patients on therapy, Cyclosporin Geksalom should avoid direct exposure to sunlight and ultraviolet radiation or  therapy. Prior to treatment, as well as in the first 3 months of therapy necessary to control the levels of uric acid in the blood and urine. . allowed to increase the quantities of “liver” enzymes and bilirubin in the blood of most 2 times the treatment of rheumatoid arthritis for safety and efficacy, control measurements should be carried out the following indicators:

 

  • regular monitoring of creatinine levels in the blood;
  • hematology profile (the number of erythrocytes, leukocytes, platelets) prior to treatment and every 4 weeks;
  • liver counts: at baseline and every 4 weeks;
  • urine analysis before treatment and every 4 weeks;
  • measuring a blood pressure value: before treatment and every 2 weeks for 3 months, then – once every 4 weeks;
  • potassium levels of blood lipids: before treatment and every 4 weeks.

The medicament comprises about 25.5. % primobolan side effects. When observing the recommended dosage for each receiving cyclosporine (24 capsules of 25 mg, 12 capsules of 50 mg and 6 mg capsules, 100) to the body receives 1.2 g of alcohol. Thus there is a risk to the health of liver diseases, alcoholism, epilepsy, brain injuries, pregnancy and for young children. The effect of other medicines may thus weaken or strengthen.

Side effects of cyclosporin depending on the dose and are reduced with a decrease in dose. Kidneys: The most common, especially in the first weeks of treatment – complications associated with increased levels of creatinine and urea in serum. These primobolan enanthate phenomena are associated with functional changes in the kidney, they depend on the dose and decrease at lower doses.

Hematopoietic system:
Perhaps the development of anemia, rarely – leukopenia. In rare cases – thrombocytopenia and microangiopathic hemolytic anemia.

Skin:
Primobolan enanthate – excessive hairiness of the skin, rarely – rash, hair loss, allergic skin reactions, skin redness, itching.

Cardio – vascular system:
Common: hypertension, at least – ischemic heart disease.

The immune system:
There are malignant and lymphoproliferative disorders. In the treatment of psoriasis may be benign lymphoproliferative disorders, as well as B and T cell lymphomas, which may disappear with the abolition of the drug.

The digestive system:
Common: anorexia, nausea, vomiting, abdominal pain, diarrhea, gingival hyperplasia, hepatic dysfunction (accompanied by increased levels of bilirubin and “liver” enzymes in the serum); rarely – pancreatitis.

Muscular system:
Rare: muscle cramps, muscle pain, muscle weakness.

The nervous system and sensory organs:
Common: tremor, fatigue, paresthesia – mainly in the first weeks of therapy.
Rare: motor neuropathy, symptoms primobolan enanthate of encephalopathy (convulsions, confusion, disorientation, slowness of reactions, agitation, insomnia, visual disturbances, cortical blindness, coma, paresis, cerebellar ataxia).

Laboratory tests, metabolism:
Common: reversible slight increase in the lipid content in the blood serum, as well as weight gain, hyperglycemia, hyperuricemia, hyperkalemia, hypomagnesemia.

 

Overdose:

Data on drug overdose is limited. In the presence of appropriate indications (disturbance of consciousness, headache, tachycardia, and in some cases – reversible kidney failure), symptomatic therapy.Tacrolimus is not excreted from the body by hemodialysis and hemoperfusion using activated carbon. Showing nonspecific methods of elimination such as gastric lavage.

 

Interaction with other drugs:

Cyclosporine in combination with potassium-sparing diuretics can cause hyperkalemia or magnesium deficiency, therefore, necessary to control the levels of potassium and magnesium and potassium to avoid excessive intake of food.

With simultaneous application of Tacrolimus hexane with other immunosuppressive drugs increases the risk of infections, and lymphoproliferative disorders.
The risk of nephrotoxicity with concomitant administration of cyclosporin hexane and drugs such as aminoglycosides (gentamicin and tobramycin), amphotericin B, ciprofloxacin, melphalan, trimethoprim, vancomycin, non-steroidal anti-inflammatory drugs (diclofenac, naproxen).
in simultaneous reception with nifedipine may primobolan enanthate develop damage to the gums (hyperplasia).
in organ transplantation in the case of simultaneous use of fibrates (eg bezafibrate, fenofibrate), sometimes there is a more pronounced and persistent deterioration of renal function.
Drugs that increase the concentration cyclosporine in the blood: the ketoconazole, fluconazole, itraconazole, some macrolide antibiotics (e.g. erythromycin, clarithromycin, josamycin, pozinomitsin and pristinamycin), doxycycline, oral contraceptives, propafenone, methylprednisolone (high dose) metokolopramid, danazol, amiodarone, holievaya acid and its derivatives, and calcium channel blockers (e.g., diltiazem, nicardipine, verapamil, mibefradil).
Drugs that lower the concentration of cyclosporine in the blood: barbiturates, carbamazepine, phenytoin, metamizole, rifampicin, nafcillin, orlistat, octreotide, probucol, troglitazone and sulfadimidine and trimethoprim when administered intravenously, as well as preparations containing St. John’s wort grass.