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 exemestane pct 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 buy sustanon 250 uk 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 halotestin results 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.

To remove the regression of symptoms is recommended dose of cyclosporin 2.5 mg / kg, divided into 2 doses. If a month no improvement of skin condition can gradually increase the dose to 1 mg / kg to a maximum of 5 mg / kg, divided into two separate reception. At primobolan cycle repeat treatment dose is to be minimally effective.
If at a dose of 5 mg / kg every 6 weeks, no significant improvement occurs, it is necessary to cancel the drug.

Nephrotic syndrome:
For removal of regressive symptoms of nephrotic syndrome is recommended to use a dose of not more than 5 mg / kg for adults and no greater than 6 mg / kg in children older than 1 year, divided into 2 separate reception under normal kidney function. For patients with impaired renal function (creatinine level in blood serum above 200 mmol / l in adults and 140 umol / L in children are contraindications), the initial dose of cyclosporine should not exceed 2.5 mg / kg.
The level of a therapeutically effective concentrations of cyclosporine in the blood is from 60 to 160 ng / ml. Check the level of concentration must first, as far as possible, every day, and then -. Every 2 weeks
during the first 3 months of treatment should regularly monitor the level of serum creatinine (normal renal function – every primobolan cycle 2 weeks, when broken – weekly). With a stable level of creatinine can control this value with an interval of 2 months.
If a patient has severe liver dysfunction should be reduced starting dose of cyclosporine by 25 -. 50%
for patients resistant to glucocorticosteroids nephrotic syndrome, if the effectiveness of cyclosporine is not enough, we recommend the combination of cyclosporine with low doses of corticosteroids.
If after 3 months of treatment with cyclosporine is symptoms of nephrotic syndrome, the drug should be discontinued therapy.

Severe Rheumatoid Arthritis:
The first 6 weeks of therapy recommended dose of cyclosporine 2.5 mg / kg divided into 2 doses. In that case, if the drug is poorly tolerated, the dose can be reduced. Further dosage is determined individually depending on the clinical primobolan cycle course of the disease and tolerability and should be minimally effective. Do not exceed a daily dose of 4 mg / kg. In extreme cases, may increase the dose of cyclosporin to 5 mg / kg.
Cyclosporin may be administered in combination with low-dose corticosteroids and / or with non-steroidal anti-inflammatory drugs.
The treatment up to 12 weeks.

Severe form of atopic dermatitis:
To remove the picture of acute disease, a dose of cyclosporine 2.5 mg / kg, divided into 2 separate reception. If after 2 weeks there is no significant improvement, it is necessary to increase the dose of cyclosporine to a maximum of 5 mg / kg.
In a few extreme cases require the use of an initial dose of cyclosporine 5 mg / kg. When the need to improve the gradual reduction in dose.
The course of treatment duration of 8 weeks may be sufficient to cleanse the skin, but it has been shown that treatment for up to 1 year primobolan cycle, effective and well tolerated, provided the compulsory monitoring of all necessary parameters.

How to use:
The capsules primobolan cycle hexane should be always one and the same time of the day during a meal.
The daily dose should always be divided into 2 separate reception.
The capsules should be taken without chewing, washing down with water.
Do not take the capsules with grapefruit juice.

Hypersensitivity to cyclosporin and to other components of the drug. Pregnancy and feeding: The drug for pregnant women is possible only if the expected benefit justifies the potential risk to the fetus.During primobolan dosage breastfeeding should stop taking the drug, since it is possible the penetration of cyclosporin parent milk.

Dosage and administration:

Dosage in organ transplantation: Adults: In this case, as a rule, tacrolimus administered in conjunction with other immunosuppressive agents. The initial dose is 10 – 14 mg / kg per day, divided into 2 separate reception 12 hours apart. This dose is applied for 1 – 2 weeks after surgery. Thereafter, by conducting control of the level of cyclosporine in the blood, primobolan dosage the dose was gradually reduced to 2 – 6 mg / kg per day, as divided into 2 doses. The therapeutic range of blood levels in the subsequent application is from 100 to 400 ng / ml. Shown In renal transplantation, that the recommended dose at the lower limit, i.e. below 3 – 4 mg / kg and the blood concentration of about 100 ng / mL result in risk of rejection reactions. Some patients month after transplantation, while receiving corticosteroids recommended dose is less than 5 mg / kg.

Bone marrow transplantation: It is generally recommended short-term combination of cyclosporine and methotrexate. Dose picked individually. Mainly for 1 – 2 days before surgery recommended intravenous cyclosporine at 2.5 – 5 mg / kg per day. As will be possible only oral medication, move to the capsules at a dose of 12.5 mg / kg per day (divided into 2 doses) for 3 – 6 months. Further the dose was gradually reduced to complete expiration treatment.

Therapy of acute graft – versus -. Host starting dose of 12.5 – 15 mg / kg of cyclosporin per day, divided into 2 doses. After 50 days of starting to lower the dose weekly by 5% to the complete abolition of the drug after 20 weeks. If the cancel receiving cyclosporine again develops acute reaction should again conduct therapy drug. When receiving primobolan dosage hexane in organ transplantation, bone marrow and acute graft – versus – host observed transient complaints of gastro – intestinal tract, can be 1/3 of the recommended daily dose administered nolvadex once intravenously with the infusion solution.

Heavy endogenous uveitis: The initial dose of cyclosporine is 5 – 10 mg / kg per day divided in 2 doses until remission of inflammation and improvement in visual acuity In severe cases, you can assign an additional 0.2 – 0.6 mg / kg per day of prednisone or other similar glucocorticosteroid. during maintenance therapy dose should be reduced slowly until the minimum effective dose is in remission of the disease should not exceed 5 mg / kg / day. The therapeutic level of cyclosporin blood concentration is from 100 to 150 ng / ml. There are individual data on the use of cyclosporine in children older than 5 years experience in the use of the drug according to the indications primobolan dosage in children under 5 years are available.

Upon receiving Cyclosporine hexane stable absorption observed and almost no influence food intake, which ensures low variability expressed pharmacokinetics and effect relationship between the drug and the highest dose. Absorption: After primo steroid oral administration, the maximum concentration of cyclosporine in the blood plasma is achieved in the time interval 95.0 . ± 42,1 minutes distribution: Cyclosporine is primarily distributed in the bloodstream to the magnitude steroids types of the apparent volume of distribution of 3 – 5 l / kg. The plasma is determined by 33 to 47%, in granulocytes – from 5 to 12% in the lymphocytes – 4 to 9% of the erythrocytes and – from 41 to 58% of the injected drug. Plasma protein binding is approximately 90%.

Metabolism: The biotransformation process produces up to 15 metabolites.Major metabolic pathways are mono- and dihydroxylation t bol steroid in different parts of the molecule. Active metabolites of either one does not exceed by more than 10% of the activity of “parent” substance.Excretion: The primo steroid elimination of the organism occurs mainly in the bile, only about 6% of the administered dose excreted in urine as metabolites, and approximately 0.1% – in the form of unchanged substance.Half-life values are significant fluctuations and make up about 6.3 hours in healthy volunteers, approximately 20.4 hours in patients with severe liver diseases and an average 11 hours (from 2 to 25 hours) in renal transplantation. The magnitude of clearance of cyclosporine in children is about 2 times higher than in adults. Capsules and solution for internal use bioequivalent.

Indications for use:

Transplantation:

  • Immune suppression and prevention of transplant rejection tamoxifen side effects bodybuilding after kidney, liver, heart, combined heart-lung transplant, lung, or pancreas.
  • Prevention of graft rejection after bone marrow transplantation.
  • Prevention and treatment primo steroid of graft – versus – host.

Other diseases:

  • Endogenous uveitis (after exclusion of infectious etiology): active, sight-threatening uveitis middle or rear portion of the eye; Behçet uveitis with recurrent attacks of inflammation affecting the retina.
  • Severe psoriasis is usually in cases of resistance to prior treatment.
  • Nephrotic syndrome, dependent on corticosteroids and resistant to them (impaired renal function with a pronounced loss of protein) caused by disorders of the vascular glomerulus (diseases such as minimal change nephropathy, focal and segmental glomerulonephritis).
  • Severe forms of rheumatoid primo steroid arthritis of the active current (in those cases where the classical slow-acting antirheumatic drugs are ineffective npp cycle, or their application is impossible).
  • Severe form of atopic dermatitis when systemic therapy is shown.