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Tsilaspen consists of two components: imipenem, the representative of the class of beta-lactam antibiotics – carbapenems; cilastatin primobolan depot – specific inhibitor of renal dehydropeptidase, significantly increases the concentration of unchanged imipenem in the blood. Tsilastin has its own antibacterial activity, does not inhibit the beta-lactamase bacteria. Imipenem is a highly effective inhibitor of bacterial cell wall synthesis and is bactericidal against a wide spectrum of pathogenic gram-positive and gram-negative microorganisms, both aerobic and anaerobic. The stability of imipenem to cleavage by bacterial beta lactamases, including produced by Gram-positive and Gram-negative and penicillinase cephalosporinase ensures its effectiveness. it is active against Pseudomonas aeruginosa, Staphylococcus aureus, Streptococcus faecalis and Bacteroides fragilis. Resistant to bacterial destruction of beta-lactamase, which makes it effective against many microorganisms, such as Pseudomonas aeruginosa, Serratia spp. and Enterobacter spp oral testosterone, which are resistant to most of the beta-lactam antibiotics.. Antibacterial spectrum includes primobolan depot virtually all clinically important pathogens. Imipenem has a bactericidal effect in vivo primobolan depot on the following microorganisms: Gram-positive aerobes: Enterococcus faecalis, Staphylococcus aureus, including penitsillinazoprodutsiruyuschie strains, Staphylococcus epidermidis, including penitsillinazoprodutsiruyuschie strains, Streptococcus agalactiae (Streptococcus spp group in.), Streptococcus pneumoniae, Streptococcus pyogenes . Gram-negative aerobes: Acinetobacter spp, Citrobacter spp, Enterobacter spp, Escherichia coli, Gardnerella vaginalis, Haemophilus influenzae, Haemophilus parainfluenzae, Klebsiella spp…. , Morganella morganii, Proteus vulgaris, Providencia rettgeri, Pseudomonas aeruginosa oxymethalone, Serratia spp, including S. marcescens.. Gram-positive anaerobes: Bifidobacterium spp, Clostridium spp, Eubacterium spp, Peptococcus spp, Peptostreptococcus spp, Propionibacterium spp……

Gram negative anaerobes : .. Bacteroides spp, including B. fragilis, Fusobacterium spp Imipenem has a bactericidal effect in vitro on the following microorganisms: Gram-positive aerobes: Bacillus spp, Listeria monocytogenes, Nocardia spp, “Staphylococcus saprophyticus, Streptococcus spp… . Groups C, G and viridans Gram-negative aerobes: the Aeromonas hydrophila, of Alcaligenes spp, Capnocytophaga spp, of Haemophilus ducreyi, of Neisseria gonorrhoeae, including strains penitsillinazoprodutsiruyuschie, Pasteurella spp .., Providencia stuartii. ..Gram-negative anaerobes: Prevotella bivia, Prevotella disiens, Prevotella melaninogenica ., Veillonella spp Unaffected: .. Enterococcus faecium, methicillin-resistant anavar for sale uk spp Staphylococcus, Xanthomonas maltophilia, Pseudomonas cepacia in vitro acts synergistically with aminoglycosides against some strains of Pseudomonas aeruginosa. Imipenem quickly and well distributed in most tissues and body fluids. The highest concentrations are achieved in pleural fluid, peritoneal, and interstitial fluids and the reproductive organs (testes, prostate gland, vagina, uterus, ovaries). At low concentrations found in the cerebrospinal fluid. The volume of distribution in adults – 0.23-0.31 L / kg in children 2-12 years of age – 0.7 l / kg in the newborn – 0.4-0.5l / kg. Blocking kanaptsevoy imipenem cilastatin secretion leads to inhibition of its renal metabolism and accumulation in the urine in unchanged form. Cilastatin is metabolized to N-acetyl compounds. The on / in the introduction of the primobolan depot of imipenem and cilastatin in adults – 1 hour, children 2-12 years – 1-1.2 hours, in newborns the T ½ imipenem – 1.7-2.4 hours, cilastatin – 3.8-8.4 hours; with impaired renal function dinabol the T ½ . imipenem – 2.9-4 hours, cilastatin – 13.3-17.1 hours Report mostly kidneys (70-76% within 10 hours) through glomerular filtration rate (⅔) and active tubular secretion (⅓); 1-2% is excreted in the intestine and 20-25% – by extrarenal (mechanism unknown). Quickly and efficiently (73-90%) is derived by hemodialysis (as a result of a 3-hour session intermittent hemofiltration removes 75% of the administered dose).

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Inductors microsomal oxidation can induce liver microsomal metabolism of cyclophosphamide, which leads to increased formation of metabolites alikiliruyuschih, thereby reducing the half-life of and increasing its activity. Methenolone, causing significant and long lasting inhibition of cholinesterase activity enhances the action of suxamethonium, and reduces or slows the metabolism of cocaine, thereby enhancing and / or increasing the duration of its effect and increasing the risk of toxicity. While the use of allopurinol, in addition, a toxic effect on the bone marrow may be intensified. With simultaneous use anadrol cycle and allopurinol, colchicine, probenecid, sulfinpyrazone may require dose adjustment protivopodagricakih drugs for the treatment of hyperuricemia and gout; urikozuricheskih protivopodagricakih use of drugs may increase the risk of kidney disease associated with increased production of uric acid by using cyclophosphamide. Cyclophosphamide may increase the anticoagulant activity due to a decrease in the hepatic synthesis of coagulation factors and platelet disorders education, but can also reduce the anticoagulant activity through an unknown mechanism. As grapefruit methenolone contains a compound that may interfere with the activation of cyclophosphamide and thereby its effects, patients are not recommended to eat grapefruit or drink grapefruit juice from. Enhances the cardiotoxicity of doxorubicin and daunorubicin. Other immunosuppressants (azathioprine, chlorambucil, glucocorticoids, cyclosporine, mercaptopurine, etc.) Increase the risk of infections and secondary tumors. In an application of lovastatin in patients anastrozole with heart transplantation may increase the risk of rhabdomyolysis and acute renal failure. In combination with other myelosuppressive drugs or radiotherapy -. additive may bone marrow function oppression simultaneous use of high-dose cytarabine, cyclophosphamide in preparation for bone marrow transplantation led to increased incidence of cardiomyopathy followed fatal.

Cautions During treatment should regularly conduct blood tests (especially paying attention to the content of neutrophils and platelets) to assess the degree of myelosuppression as well as conduct regular urine test for the presence of red blood cells, the appearance of which may precede the development of hemorrhagic cystitis. If signs of cystitis with micro- – or gross hematuria treatment should be stopped. By reducing the number of leukocytes < 2500 / l and / or platelet count < 100,000 / ml treatment cyclophosphamide should be stopped. in the case of infection during therapy treatment should be either interrupted or should be reduced dose. Women and men during treatment with methenolone should use reliable methods anavar half life of contraception. In the period of treatment should refrain from drinking alcohol. If during the first ten days after the operation carried out under general anesthesia, the patient is prescribed cyclophosphamide, is necessary to put notify the anesthesiologist. The patient after adrenalectomy needs to adjust doses as the corticosteroids that are used for replacement therapy and drug Cyclophosphamide.

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