primobolan steroid

This effect is reversible after discontinuation. At the initial stage of preparation , like other GnRH agonists, can cause a temporary increase in the concentration of testosterone primobolan steroid in serum in men and estradiol concentrations in the serum of women. In the early stages of therapy with , some women may experience vaginal bleeding of varying duration and intensity.
In men by around 21 days after the first capsule concentration of testosterone is reduced to castrate levels and continues to be reduced at a constant treatment, conducted every 28 days in the case of the drug   mg every 3 months, or when the drug  . This reduction in the concentration of testosterone during treatment with the drug  mg in most patients results in a regression of prostate tumors and symptomatic improvement.
In women, serum estradiol concentration is reduced also to about 21 days after the first capsule formulation , with regular administration of the drug every 28 days, is reduced to a level comparable to that seen in postmenopausal women. This reduction leads to a positive effect on hormone-dependent forms of breast cancer, endometriosis, uterine fibroids and suppressing the development of follicles in the ovaries. It also causes a thinning of the endometrium and cause amenorrhea in most patients.
After administration mg estradiol primobolan steroid concentration in serum decreases in women within 4 weeks after the first capsule and is reduced to a level comparable to that observed in menopausal women. When initial application of other GnRH analogues, and the transition to the drug  10.8 mg estradiol suppression is maintained. Estradiol suppression leads to a therapeutic effect in endometriosis and uterine fibroids.
It is shown that the drug  3.6 mg in combination with iron supplementation causes amenorrhea and increased hemoglobin and related haematological parameters in women with fibroids and associated anemia.
On receiving background GnRH agonists in women may occur menopause. Rarely, some women there is no recovery of menstruation after the end of therapy.

Pharmacokinetics
Introduction formulation  3.6 mg every four weeks or formulation Zoladex ® 10.8 mg every 12 weeks maintains effective concentrations. Accumulation in the tissues at the same time does not occur. Preparation  binds poorly to protein and its half-life from the blood serum is 2 – 4 hour front patients with normal renal function. The half-life is increased in patients with impaired renal function. When the monthly administration of the drug  3.6 mg or drug  10.8 mg of this change will have significant effects, so change the dose for these patients is not required. Patients with liver failure significant changes in the pharmacokinetics was observed.

INDICATIONS

For the drug Zoladex ® 3.6 mg

 

  • Prostate cancer
  • Mammary cancer
  • endometriosis
  • uterine fibroids
  • For thinning the endometrium during planned operations on the endometrium
  • In vitro fertilizationFor the drug Zoladex ® 10.8 mg
  • Prostate cancer
  • endometriosis
  • uterine fibroidsCONTRAINDICATIONS
    – Hypersensitivity to goserelin or other analogues of GnRH
    – Pregnancy and lactation
    – Children’s ageWITH CARE
    Persons male at special risk of ureteral obstruction or spinal cord compression. In extra-corporeal fertilization in patients with polycystic ovary syndrome.

    DOSAGE AND ADMINISTRATION The drug Zoladex ® 3.6 mg Adults drug Zoladex ® 3.6 mg injected subcutaneously into the anterior abdominal wall every 28 days. – In malignancies is long – in benign gynecological disorders are not more than 6 months – for thinning the endometrium do two injections at intervals of 4 weeks, with the uterus ablation recommended during the first two weeks after the second dose.

    In vitro fertilization
    drug Zoladex ® 3.6 mg used for pituitary desensitization. Desensitization is defined by the concentration of estradiol in the serum. As a rule, the required level of estradiol, which corresponds to that in the early follicular phase of the cycle (about 150 pmol / L), reached between 7 and 21 days. When the desensitization start superovulation (controlled ovarian stimulation) using gonadotropin. Pituitary desensitization caused when applying the depot GnRH agonist may be more stable, which may lead to an increased need for gonadotropins. At the appropriate stage of follicular gonadotropin administration stops further human chorionic gonadotrophin is administered to induce ovulation. Control of the performed treatment, the procedure primobolan steroid of oocyte retrieval and fertilization are carried out in accordance with the established practice of the medical establishment.

    The drug Zoladex ® 10.8 mg Adult men drug Zoladex ® 10.8 mg is administered subcutaneously in the abdominal wall every 3 months.

    Adult women
    drug Zoladex ® 10.8 mg is administered subcutaneously in the anterior abdominal wall every 12 weeks.

    Elderly patients, patients with renal or hepatic impairment: Dosage adjustment is not required.

    SIDE EFFECTS
    The frequency of adverse effects were as follows:
    often (> 1/100, <1/10); Uncommon (> 1/1000, <1/100); Rare (> 1/10 000, <1/1 000); Very rare (<1/10 000), including isolated reports.

    Neoplasms
    Very rare: pituitary tumor.
    Unspecified frequency: Degeneration fibromatous nodes in women with uterine fibroids.

    Immune system
    Uncommon:. Hypersensitivity reactions
    Rare: anaphylactic reactions.

    From endocrine system:
    Very rare: bleeding in the pituitary gland.

    Metabolic disorders:
    Common: impaired glucose tolerance. In men receiving GnRH agonists, there was a decrease in glucose tolerance. Impaired glucose tolerance was manifested the development or worsening of diabetes control blood glucose levels in patients with diabetes mellitus in anamnesis.
    Uncommon: hypercalcaemia (in women).

    From the nervous system and psychiatric:
    Very common: decreased libido associated with the pharmacological action of the drug and, in rare cases, lead primobolan steroid to its cancellation.
    Often: depressed mood, depression (in women), paresthesia, and compression of the spinal cord (in men) , headache (in women).
    Very rare: psychotic disorder.

    Cardio-vascular system:
    Very common: hot flushes associated with the pharmacological action of the drug and, in rare cases, lead to its cancellation.
    Common: myocardial infarction (men); heart failure (for men), the risk of which is increased with concomitant administration of anti-androgen drugs. Changes in blood pressure, manifest as hypotension or hypertension. These changes are usually transient, and resolved either in the course of therapy with Zoladex ® , or after its termination. In rare cases, these changes require medical intervention, including the abolition of the drug Zoladex ® .

    Skin and subcutaneous tissue:
    Very common: sweating, associated with the pharmacological action of the drug and, in rare cases, lead to its cancellation.
    Common: alopecia (for women), as a rule, slightly expressed, including, in young patients with benign tumors; rash, mostly slightly pronounced, which is often resolved on the background of continued therapy.
    unspecified frequency: alopecia (males) which manifested itself as hair loss throughout the body due to the decline in androgen levels.

    From the musculoskeletal system:
    Common: arthralgia (in women), bone pain (in males). At the beginning of the treatment of patients with prostate cancer can often experience a temporary increase in bone pain, which is treated symptomatically.
    Uncommon: arthralgia (men).

    With the genitourinary system:
    Very common: erectile dysfunction (males), dryness of the vaginal mucosa and increasing the size of the breast (in women).
    Often: gynecomastia (male).
    Uncommon: painful breast (men), ureteral obstruction ( men)
    rare: ovarian cysts (women), ovarian hyperstimulation syndrome (in women when combined with gonadotropin).
    , unspecified frequency: vaginal bleeding (in women)

    Other:
    Very common: the reaction at the site of injection (in women)
    often: a reaction at the site of injection (for men); temporary increase of symptoms in patients with breast cancer in early therapy.

    Laboratory studies:
    Common: decrease in bone mineral density, increased body mass index

    Overdose
    of drug overdose experience in humans is limited. In case of accidental administration of the drug Zoladex ® first period or at a higher dose were observed clinically significant adverse events. Data concerning overdose in humans are not available. In case of overdose, the patient should appoint symptomatic treatment.

    INTERACTIONS WITH OTHER MEDICINES AND OTHER DRUG INTERACTIONS
    None known.

    SPECIAL INSTRUCTIONS

  • Caution should be prescribed the drug primobolan steroid to males at special risk of ureteral obstruction or spinal cord compression. These patients should be monitored closely during the first month of therapy. In that case, if the spinal cord compression or renal impairment due to ureteric obstruction are taking place or are developing, should be given the standard treatment for these complications.
  • In women, the drug  10.8 mg is shown only for the treatment of endometriosis and uterine fibroids. For women who need goserelin treatment for other indications, use the drug Zoladex ® 3.6 mg.
  • When using the drug  women to restore menstruation should be used non-hormonal methods of contraception.
  • As with other GnRH analogues, when using the drug 3.6 mg in combination with gonadotrophin, reported rare cases of ovarian hyperstimulation syndrome (OHSS). It is assumed that desensitization caused by the use of the drug mg may in some cases lead to an increase in the required dose of gonadotropin. It is necessary to carefully monitor the stimulation cycle to identify patients at risk for OHSS, since the frequency and severity of the manifestations of the syndrome may be dependent on the dose of gonadotropin mode. Introduction of human chorionic gonadotropin should be stopped, if necessary.
  • The use of GnRH agonists in women may cause a reduction in bone mineral density. After treatment, most women occurs in bone mineral density recovery. Patients receiving the drug Zoladex ® 3.6 mg for the treatment of endometriosis, the addition of hormone replacement therapy (estrogen and progestogen drugs daily) reduced the loss of bone mineral density and vasomotor symptoms. There is currently no experience of the use of hormone-replacement therapy in the treatment of drug Zoladex ® 10.8 mg.
  • Resumption of menstruation after the end of treatment with Zoladex ® some patients may be delayed. In rare cases, some women during treatment with GnRH analogues may occur menopause without the restoration of menstruation after the end of therapy.
  • The use of the drug Zoladex ® may lead to an increase in cervical resistance, care must be taken when cervical dilatation.
  • No data on the efficacy and safety of therapy with Zoladex ® benign gynecological disease lasting more than 6 months.
  • The drug Zoladex ® 3.6 mg should be used only in vitro fertilization under the supervision of a specialist who has experience in this field.
  • It is recommended to use the drug with caution Zoladex ® 3.6 mg at ekstra¬korporalnom fertilization in patients with polycystic ovary syndrome, as there may be stimulation of a large number of follicles.
  • According to preliminary data of the primobolan steroid use of a bisphosphonate in combination with GnRH agonists in men reduces the loss of bone mineral density.In connection with the possibility of reducing the tolerance of glucose in patients receiving GnRH agonists in men, it is recommended to periodically monitor blood glucose.Effects on ability to drive and use other mechanisms
    do not have information about how the drug Zoladex ® leads to deterioration of these activities.PACKAGING
    capsule to subcutaneous depot 3.6 mg or 10 mg 8-syringe applicator with a protective mechanism (Safety Glide secure delivery system).
    One syringe applicator is placed in an aluminum laminate envelope. Envelope with attached movable flag-annotation is placed in a cardboard box with instructions for use.

    STORAGE
    Store at a temperature below 25 o C. The Keep out of the reach of children.

    SHELF LIFE
    3 years. Do not use beyond the expiration date printed on the package.

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oral primobolan

After oral administration of simvastatin, which is an inactive lactone, is hydrolyzed to give the corresponding beta-hydroxy-acid derivative, which is the major metabolite and possesses high inhibitory activity against  reductase, the enzyme that oral primobolan  catalyzes the initial and most significant step of cholesterol biosynthesis. Clinical studies have demonstrated the effectiveness of Zocor in reducing the levels of total cholesterol in the blood plasma, low density lipoprotein.

The 5-year multicenter, randomized, double-blind, placebo-controlled study to protect the heart (Heart Protection Study – HPS) the effectiveness of Zocor therapy has been demonstrated in 20 536 patients with hyperlipidemia or not, are at high risk of coronary heart disease due to the presence of diabetes mellitus , stroke and other vascular diseases.

In this study, Zocor 40 mg per day reduced total mortality by 13% compared with placebo, the risk of death associated with coronary artery disease by 18%, the risk of major coronary events (nonfatal myocardial infarction or death associated with coronary heart disease) 27 %, the risk of the need for surgical procedures to restore coronary blood flow (aorto-coronary bypass and percutaneous transluminal angioplasty) by 30%, the risk of the need for recovery of peripheral blood flow and other non-coronary revascularization by 16%, the risk of stroke by 25%. The frequency of hospitalizations for heart failure was reduced by 17%. The risk of major coronary and vascular events was reduced by 25% in patients with CHD or without, including patients with diabetes, peripheral vascular disease and cerebrovascular disease. In patients with diabetes, Zocor to 21% reduced risk of developing cardiovascular complications, including operations to restore the peripheral blood flow, amputation of the lower extremities and the occurrence of venous ulcers.

In another multicentre, placebo-controlled study involving 404 patients. Zokora according to coronary angiography slowed the progression of coronary atherosclerosis and the emergence of new sectors like atherosclerosis and new total occlusion, whereas in patients treated with standard therapy, there was a steady progression of coronary artery atherosclerosis.

Pharmacokinetics

Metabolism. The major active metabolites of simvastatin in the blood plasma are betagidroksiatsid oral primobolan and 6 “hydroxy, 6” hydroxymethyl and 6 “-eksometilen derivatives. The maximum concentration of metabolites of simvastatin in plasma achieved through 1,3-2,4 hours after a single dose. There information about reaching the maximum concentration of simvastatin and its metabolites in the period up to 4 hours and its slow decline over 12 hours at about 10%. upon receipt of simvastatin in recommended therapeutic doses (5-80 mg per day) remains linear profile AUG (area under the curve concentration – time) of the active metabolite in the general circulation.

The linear dependence is maintained with increasing dose up to 120 mg. Simvastatin is an inactive lactone, which is readily hydrolyzed in developing B-hydroxy acid, L-654,969, a potent inhibitor of HMG-CoA reductase. The plasma metabolite represented by L-654,969 and 4 active metabolite. Inhibition of HMG-CoA reductase is the basis of all the metabolites in pharmacokinetic studies hydroxy acids (active inhibitors). Both are determined in plasma when assigning simvastatin.

Suction is exposed for about 85% of an oral dose of simvastatin.

Distribution. After intake in the liver determined simvastatin higher concentration than in other tissues. The content of the active form of simvastatin L-654,969 in the systemic circulation is less than 5% of an oral dose, 95% of this amount is bound to proteins condition. Simvastatin resulted active in liver metabolism (more than 60% in men) is its low content in the general circulation. The ability to penetrate the blood-brain barrier is simvastatin and the blood-barrier has not been studied.

Withdrawal. The first passage through the liver blood flow simvastatin is metabolized, followed by excretion of the drug and its metabolites in the bile. In a study of 100 mg of drug administered in capsules (5 x 20 mg) simvastatin labeled C14 accumulates in the blood, urine and feces. About 60% of the labeled product was detected in the stool and about 13% of all – in urine. AUC coefficient of variation in the general circulation does not depend on the dose of simvastatin. In this study, patients received oral doses of simvastatin tablets in 5, 10, 20, 60, 90 and 120 mg. Eating (within a standard hypolipidemic diet) immediately after receiving simvastatin does not violate the pharmacokinetic profile of the drug. Pharmacokinetic parameters when receiving a single dose and long-term treatment with simvastatin suggest that simvastatin does not accumulate in the tissues with prolonged treatment. Maximum plasma concentration achieved within inhibitors 1,3-2,4 hours after ingestion. In a study of patients with severe renal failure (kratinina clearance less than 30 mL / min) after administration of a single dose plasma HMG-CoA reductase inhibitor drug concentration was approximately 2-fold higher than in healthy volunteers.

INDICATIONS

Coronary heart disease (CHD) or at high risk for coronary heart disease:
In patients with a high risk of CHD (in the presence of hyperlipidemia or without it), for example, in patients with diabetes, patients with stroke or other cerebrovascular disease in history, in patients with peripheral vascular disease, or in patients with coronary artery disease or predisposition to coronary artery oral primobolan disease Zokora FORTE is indicated for:

  • Reducing the risk of total mortality by reducing CHD deaths as a result;
  • Reduce the risk of serious cardiovascular and coronary events
    • nonfatal myocardial infarction
    • coronary death
    • stroke
    • revascularization surgery;
  • Reduce the risk of the need for operations to restore coronary blood flow (such as coronary artery bypass grafting and percutaneous transluminal coronary angioplasty);
  • Reduce the risk of the need for surgery to restore blood flow in peripheral and other non-coronary revascularization;
  • Reduce the risk of hospitalization due to angina.

hypercholesterolemia:

  • If the use of diet and other non-drug treatment is not enough, Zokora FORTE assigned together with diet to:
    • reducing elevated total cholesterol, LDL cholesterol, triglycerides, apolipoprotein B (apo B);
    • increase HDL cholesterol in patients with primary hypercholesterolaemia, including heterozygous
    • familial hypercholesterolaemia (Pa type hyperlipidemia Fredrickson classification) hypercholesterolemia or mixed (type lib hyperlipidemia Fredrickson classification);

    decrease LDL cholesterol / HDL cholesterol and total cholesterol / HDL cholesterol.

  • Hypertriglyceridemia (type IV hyperlipidemia Fredrickson classification).
  • An adjunct to diet and other methods of treating patients with homozygous familial hypercholesterolemia to reduce elevated total cholesterol, LDL cholesterol, and apolipoprotein B.
  • Primary disbetalipoproteinemiya (type III hyperlipidemia Fredrickson classification).

In patients with diabetes, Zocor FORTE reduces the risk of peripheral vascular complications (revascularization operations, lower limb amputations, occurrence of venous ulcers).
In patients with coronary artery disease and hypercholesterolemia Zokora Forte slows the progression of coronary atherosclerosis, including reducing the incidence of new complications.

CONTRAINDICATIONS

Hypersensitivity to any component of the drug.
Liver disease in the active phase or persistent elevation of transaminases in the blood plasma of unknown etiology.
Pregnancy and lactation.

CAREFULLY

Simvastatin, like other inhibitors oral primobolan of HMG-CoA reductase can sometimes cause myopathy.
Many of the patients who underwent treatment during rhabdomyolysis simvastatin had a complicated medical history, including suffered renal failure, usually due to diabetes. Such patients require more careful observation. Therapy with simvastatin should be temporarily discontinued in these patients a few days before the big surgical interventions and in the postoperative period.

Patients with sustained elevated levels of serum transaminases exceeding 3 times the upper limit of normal, the drug should be discontinued.

In severe renal insufficiency (creatinine clearance less than 30 ml / min), should carefully weigh the advisability of the appointment of the drug in doses exceeding 10 mg per day. If such dosages are deemed necessary, they should be administered with caution.

Alcohol abuse before treatment.

Pregnancy and lactation

Zokora FORTE is contraindicated in pregnant women. Since safety in pregnant women has not been proven, and there is no evidence that treatment with the drug during pregnancy brings obvious benefits, the drug should be discontinued if pregnancy occurs. Simvastatin should be administered to women of childbearing age only when the probability of pregnancy is very small.

If during treatment with Zocor FORTE pregnancy occurs, the drug should be discontinued, and the woman warned of the possible danger to the fetus. Data on the allocation of simvastatin and its metabolites in breast milk are not available. The appointment Zokora FORTE women during lactation should be borne in mind that many drugs are excreted in breast milk, and there is a threat of serious adverse reactions, so breast-feeding is not recommended.

APPLICATION IN PEDIATRIC PRACTICE

Data on the efficacy and safety of children is not enough, therefore the use in children is not recommended.

DOSAGE AND ADMINISTRATION

BEFORE treatment with drugs Zocor FORTE Patients should be given a standard hypolipidemic diet, which must be observed during the entire course of treatment.

The recommended dose of Zocor – from 5 to 80 mg should be taken once daily in the evening. When selecting a dose of Zocor its change should be made at intervals of not less than 4 weeks, to a maximum daily dose of 80 mg once daily in the evening.

Patients with coronary heart disease (CHD) or at high risk of developing coronary heart disease
Standard starting Zocor dose for patients at high risk for coronary heart disease in combination with hyperlipidemia or without it (if you have diabetes, stroke or other cerebrovascular disease in the history of peripheral diseases vascular, ischemic heart disease) is 40 mg once a day in the evening. Drug therapy can be administered simultaneously with diet and exercise therapy.

Patients with hypercholesterolemia, without the above risk factors
Standard Zocor initial dose is 20 mg once a day in the evening. For patients who need a significant (more than 45%) reduction in LDL cholesterol level, the initial dose may be 40 mg once a day in the evening. Patients with mild to moderate hypercholesterolemia Zocor therapy can be initiated with a dose of 10 mg once daily. If necessary, the selection of doses should be carried out in accordance with the above scheme (see. “DOSAGE AND ADMINISTRATION / coronary heart disease” section).

Patients with homozygous familial hypercholesterolemia
recommended dose Zocor is 40 mg once a day in the evening, or 80 mg per day in 3 doses: 20 mg in the morning, afternoon, and 20 mg to 40 mg in the evening. In such patients, Zocor is used in combination with other treatments that reduce the level of cholesterol (e.g., LDL apheresis) or without them, if they are unavailable.

Concomitant therapy
Zocor FORTE may be administered as a monotherapy, or in combination with bile acid sequestrants. In patients taking cyclosporine, danazol, gemfibrozil or other fibrates (except fenofibrate) or lipid-lowering doses of niacin (> 1 g / day) in combination with simvastatin, the maximum recommended dose is 10 mg of Zocor per day. For patients taking amiodarone or verapamil together with Zocor, the daily dose of Zocor should not exceed 20 mg (see. Sections “SPECIAL INSTRUCTIONS / myopathy / rhabdomyolysis” and “Interaction with other medicines”).

In renal insufficiency
Since Zocor FORTE excreted by the kidneys in a small amount, no need to change the dose in patients with moderate renal failure. In patients with severe renal impairment (creatinine clearance less than 30 mL / min) should carefully weigh the desirability drug administration at doses exceeding 10 mg per day. If such dosages are deemed necessary, the drug should be used with caution. (see. “With cautious” section) Buy muscle labs usa online

primobolan depot for sale

Hypersensitivity to zofenopril and other ACE inhibitors, a history of angioedema associated with primobolan depot for sale treatment with ACE inhibitors, porphyria, expressed human liver, pregnancy, lactation, at the age of 18 years (effectiveness and safety have not been established), severe renal insufficiency.

The caution should be applied  7.5 with primary peraldosteronizme, bilateral renal artery stenosis, stenosis of the artery to a solitary kidney, hyperkalemia, condition after kidney transplantation;aortic stenosis, mitral stenosis (with impaired hemodynamics), idiopathic hypertrophic subaortic stenosis, connective tissue diseases, cerebrovascular diseases, diabetes, renal disease (proteinuria greater than 1 g / day), liver failure, patients on a diet with restriction of salt or under on hemodialysis, at simultaneous reception with immunosuppressants and saluretikami in the elderly (over 75 years), psoriasis.
caution should be exercised when administered to patients with reduced volume of circulating blood (as a result of diuretic therapy, while limiting salt intake, dialysis, diarrhea and vomiting) – are at primobolan depot for sale increased risk of sudden and pronounced reduction in blood pressure after the application of even the initial dose of the ACE inhibitor.

Pregnancy and breast-feeding

The drug 7.5 can not be used during pregnancy and should not be used in women of childbearing age in the absence of effective contraception. Because zofenopril calcium is released in breast milk, the drug should not be used nursing Meter.

Dosage and administration:

Zokardis ® 7.5 administered orally, regardless of meal times (before, during or after a meal), drinking plenty of fluids.

Hypertension Patients with normal renal and hepatic function to achieve optimal blood pressure treatment should start with the two tablets of the drug Zokardis ® 7.5, I received once a day, and gradually, with the lack of severity of the hypotensive effect, increase the dose at intervals of 4 weeks. Generally effective dose of 4 tablets of the preparation Zokardis ® 7.5 1 taken once per day. The maximum primobolan depot for sale daily dose of eight tablets Zokardis preparation ® 7.5 per day taken once or divided into two doses every 4 tablets. Patients with impaired water – salt balance Initial therapy with ACE inhibitors requires correction of salt and / or water scarcity, stopping ongoing diuretic therapy for 2-3 days prior to initiation of an ACE inhibitor and begins with a dose of 2 tablets of the drug Zokardis ® 7.5 1 times a day. If this is not possible, you should start with a dose of 1 tablet of the drug Zokardis ® 7.5 a day. Patients with impaired renal function or are on hemodialysis in patients with mild renal impairment (creatinine clearance (CC)> 45 ml / min) no dose reduction is required. Patients with moderate to severe renal impairment (creatinine clearance <45 ml / min) should be given a therapeutic dose of 1 1/2 times a day. The starting dose for patients on dialysis, is 1/4 the dose used for patients with normal renal function. dosage in elderly patients in elderly patients with normal QC does not require dose adjustments. In elderly patients with creatinine clearance <45 ml / min is recommended to take half the daily dose. Dosage in hepatic dysfunction in patients with mild to moderate impaired liver function the initial dose of the drug Zokardis ®7.5 is half the dose used in patients with normal liver function. in patients with severe hepatic dysfunction Zokardis ® 7.5 should not be used. Acute myocardial infarction (in combination therapy).

Overdose:

Symptoms: marked reduction of blood pressure until the development of collapse, myocardial infarction, acute stroke or thromboembolic complications, convulsions, stupor. Treatment: the patient is transferred to a horizontal position with a low headboard. In mild cases shows gastric lavage and ingestion of saline, in more severe cases – measures aimed at stabilizing the blood pressure: intravenous infusion of 0.9% sodium chloride solution, plasma substitutes, if necessary, in a nutshell angiotensin II. hemodialysis (elimination rate enalaprilata- 62 ml / min).

Interaction with other drugs

The antihypertensive effect of ACE inhibitors may be enhanced by other antihypertensives, diuretics. . general anesthetics, analgesics and antipyretics, ethanol
When concomitant administration of zofenopril with nonsteroidal anti-inflammatory drugs may reduce the hypotensive effect of zofenopril; potassium-sparing diuretics – hyperkalemia; with lithium salts -. slowdown lithium excretion
immunodepressants, allopurinol, cytostatics reinforce haematotoxicity.
Hypoglycemic agents – increase the risk of hypoglycemia.

special instructions

Transient pronounced reduction in blood pressure is not a contraindication for continuation of treatment after stabilization of blood pressure. In the case of re-pronounced reduction in blood pressure, reduce the dose or stop the drug.
With the development of excessive blood pressure lowering the patient is transferred to a horizontal position with a low headboard, if necessary, introduce 0.9% chloride and plasma substituting drugs sodium solution.
The use of vysokoprotochnyh dialysis membranes increases the risk of an anaphylactic reaction. Correction of the dosing regimen on the days free from dialysis should be performed depending on the level of blood pressure. Before and after treatment with ACE inhibitors is necessary to monitor blood pressure, blood parameters (hemoglobin, potassium, urea, creatinine, activity of “liver” enzymes), protein in the urine.
It should be carefully observed for patients with severe heart failure, coronary heart disease and diseases of the brain vessels, in where a sharp decrease in blood pressure can lead to heart attack, stroke, or renal dysfunction. The sudden cancellation of treatment does not lead to the syndrome of “lifting” (a sharp rise in blood pressure).
In patients with an indication for the development of angioedema in history, there is an increased risk of developing cancer while taking ACE inhibitors.
For newborns and babies who were in utero effects of ACE inhibitors. should be closely monitored for timely detection of significant decrease in blood pressure, oliguria, hyperkalemia, and neurological disorders, possible due to the decrease in renal and cerebral blood flow while reducing blood pressure, called ACE inhibitors, If oliguria need to maintain blood pressure and renal primobolan depot for sale perfusion through the introduction of appropriate fluids and vasoconstrictor.
In patients with reduced kidney function should be to reduce the single dose or increase the interval between doses of the drug.
during the selection of a therapeutic dose should refrain from driving motor vehicles and activities potentially hazardous activities that require high concentration and speed of psychomotor reactions, becausedizziness, especially after the initial dose of ACE inhibitor in patients taking diuretics.
Use caution when exercising in hot weather (risk of development of dehydration and excessive reduction of blood pressure due to a decrease in blood volume). Before surgery (including dental) must notify the surgeon / anesthetist on the use of ACE inhibitors.
During treatment is not recommended to drink alcoholic beverages, as Alcohol enhances the hypotensive effect of the drug.
The simultaneous use of hypoglycemic agents, increases the risk of hypoglycemia.

Product form:

Tablets coated on 7.5mg.
At 7 or 14 tablets in a blister made of PVC / aluminum foil.
According to the blister 1 or 2 together with instructions for use placed in a cardboard box.

Storage conditions:

List B.
The temperature is not above 25 ° C, store vnedostupnom children! eminence labs

primobolan

This reduces the total peripheral vascular resistance, systolic and diastolic blood pressure (BP), fasting -. And preload on the myocardium
Extends the artery to a greater extent than the veins, with the reflex increase of heart rate frequency is not marked. Reduces degradation of bradykinin, prostaglandin synthesis increases.
Hypotensive effect is more pronounced at high plasma renin concentration than under normal or reduced concentrations. Lowering blood pressure in the therapeutic primobolan range has no effect on cerebral blood flow, cerebral blood flow in the vessels is maintained at a sufficient level and on the background of decreased blood pressure. Enhances coronary and renal blood flow.
With prolonged use reduces hypertrophy of the left ventricle myocytes and resistive walls of arteries, preventing the progression of heart failure and slowing the development of left ventricular dilatation. It improves blood flow to ischemic myocardium. Reduces platelet aggregation.
Calcium Zofenopril is a prodrug as an active inhibitor is the Link-free sulfhydryl zofenoprilat- thioether which primobolan result from hydrolysis.
Onset of the antihypertensive effect vnutr- reception time is 1 hour, reaching a maximum after 4-6 hours and lasts up to 24 hrs. some patients to achieve optimal blood pressure therapy is required for several weeks. In heart failure, a significant clinical benefit observed with long-term treatment – 6 months or more.

Pharmacokinetics
calcium Zofenopril is rapidly and completely absorbed from the gastrointestinal tract after oral administration and undergoes nearly complete conversion to zofenoprilat, whose maximum concentration is achieved in the blood at 1.5 hours after receiving the oral dose Zokardisa ®
Approximately 88% of zofenopril calcium is bound to plasma proteins. Zofenopril is rapidly metabolized in the liver to the active metabolite zofenoprilata.
The half-life is 5.5 hours zofenoprilata, and its total body clearance is 1300 ml / min following oral zofenopril calcium. Zofenoprilat Displayed mostly kidneys – 69% -26% through the intestines.

Indications for use:

 

  • Hypertension mild to moderate moderate.
  • Acute myocardial infarction with signs or symptoms of heart failure in patients with stable hemodynamics and not receiving thrombolytic therapy.

    Contraindications:

    Hypersensitivity to zofenopril and other ACE inhibitors, a history of angioedema associated with treatment with ACE inhibitors, porphyria, age 18 years (effectiveness and safety have not installed), severe hepatic impairment.
    Caution should be used Zokardis ® 30 with primary hyperaldosteronism, bilateral renal artery stenosis, stenosis of the artery to a solitary kidney, hyperkalemia, condition after kidney transplantation; aortic stenosis, mitral stenosis (with impaired hemodynamics), idiopathic hypertrophic subaortic stenosis, connective tissue diseases, cerebrovascular diseases, diabetes, renal disease (proteinuria greater than 1 g / day), liver failure, patients on a diet with restriction of salt or under on hemodialysis, at simultaneous reception with immunosuppressants and saluretikami in the elderly (over 75 years), psoriasis.
    caution should be exercised when administered to patients with reduced volume of circulating blood (as a result of diuretic therapy, while limiting intake of salt, hemodialysis, diarrhea and vomiting) – are at increased risk of sudden and pronounced reduction in blood pressure after the application of even the initial dose of the ACE inhibitor.

    Pregnancy and breast-feeding

    The drug Zokardis ® 30 should not be used during pregnancy and should not be used in women of childbearing age in the absence of effective contraception.Because zofenopril calcium is released in breast milk, the drug should not be used to nursing mothers.

    Dosage and administration:

    Zokardis ® 30 appointed interior regardless of meal times (before, during or after a meal), drinking plenty of fluids. Hypertension Patients with normal renal and hepatic function to achieve optimal blood pressure treatment should start with the 1/2 tablet formulation Zokardis ® 30 , 1 time a day, and gradually, with the lack of severity of the hypotensive effect, increase the dose at intervals of 4 weeks.Typically, the effective dose is 1 tablet of the drug Zokardis ® 30, 1 time per day. The maximum daily dose is 2 tablets of the drug Zokardis ® 30 per day taken once or divided into two doses (1 tablet).Patients with impaired water – salt balance Initial ACE inhibitor therapy requires adjusting salt and / or water deficit termination ongoing diuretic therapy for 2-3 days prior to initiation of an ACE inhibitor and begins with a dose of 1/2 tablet formulation Zokardis ® January 30 times per day. If this is not possible, you should start treatment with 1/4 tablet Zokardis ® 30 per day. Patients with impaired renal function or are on hemodialysis in patients with impaired renal function (creatinine clearance (CC) more than 45 ml / min) no dose reduction is required . Patients with moderate to severe renal impairment (creatinine clearance less than 45 ml / min) should be given a therapeutic dose of 1 1/2 times a day. The starting dose for patients on hemodialysis, is 1/4 of the dose used for patients with normal renal function. dosage in elderly patients in elderly patients with normal CK does not require dose adjustment. In elderly patients with CC less than 45 ml / min is recommended to take half the daily dose.Dosage in hepatic dysfunction in patients with mild to moderate dysfunction of the liver initial dose of the drug Zokardis ® 30 is half the dose used for patients with normal liver function . In patients with severe liver dysfunction Zokardis ® 30 should not be used.

     

    Acute myocardial infarction (as part of combination therapy)
    Treatment should be started within 24 hours after the first symptoms of myocardial infarction and continued for 6 weeks.

    In case of abnormal decrease in blood pressure at the beginning of treatment or during the first 3 days after myocardial infarction, the initial dose does not increase or cancel.
    To correct for left ventricular failure or congestive heart failure, and hypertension treatment can be continued for a long time.
    After 6 weeks of therapy may be discontinued in patients without signs of left ventricular failure or congestive heart failure. Dosage in elderly patients Zokardis ® 30 should be used with caution in myocardial infarction patients who are older than 75 years.

    Side effect:

    Since the cardiovascular system: an excessive fall in blood pressure, orthostatic collapse, rarely – chest pain angina, myocardial infarction (usually associated with a marked reduction of blood pressure), arrhythmia (atrial or bradi- tachycardia, atrial fibrillation), palpitations, thromboembolism of pulmonary artery branches , pain in the heart, faint. On the part of the central nervous system: dizziness, headache, fatigue, insomnia, anxiety, depression, confusion, fatigue, somnolence (2 – 3%), is very rare in the application of high doses of -nervoznost, depression, paresthesia. From the sensory organs: rarely disorders of the vestibular apparatus, hearing and visual impairment, tinnitus. on the part of the digestive tract: dry mouth, anorexia, dyspepsia (nausea, diarrhea or constipation, vomiting, abdominal pain ), very rare: ileus, pancreatitis, liver dysfunction and biliary excretion, hepatitis, jaundice. The respiratory system: nonproductive cough, very rare: interstitial pneumonitis, bronchospasm, dyspnea, rhinorrhea, sore throat.Allergic reactions: rare: skin rash , angioedema face, extremities, lips, tongue, glottis and / or larynx, hoarseness, erythema multiforme, exfoliative dermatitis, very rare: Stevens-Johnson syndrome, toxic epidermal necrolysis, pemphigus, pruritus, urticaria, photosensitivity, serositis, vasculitis, myositis, arthralgia, arthritis, stomatitis, glossitis. From the laboratory parameters: giperkreatinemiya, increased urea, increased activity of “liver” transaminases, hyperbilirubinemia, hyperkalemia, hyponatremia. There have been, in some cases, decrease in hematocrit and hemoglobin, increased erythrocyte sedimentation rate, thrombocytopenia, neutropenia, agranulocytosis (in patients with autoimmune diseases), eosinophilia. From the urinary system: renal dysfunction, proteinuria.

     

    Overdose:

    Symptoms: marked reduction of blood pressure until the development of collapse, myocardial infarction, acute stroke or thromboembolic complications, convulsions, stupor. Treatment: the patient is transferred to a horizontal position with a low headboard. In mild cases shows gastric lavage and ingestion of saline, in more severe cases – measures aimed at stabilizing the blood pressure: intravenous infusion of 0.9% sodium chloride solution, plasma substitutes, at necessity administration of angiotensin II of, hemodialysis.

    Interaction with other drugs

    The antihypertensive effect may be enhanced when taken with other antihypertensive agents, diuretics, general anesthetics, analgesics and antipyretics, ethanol.
    When concomitant administration of zofenopril with nonsteroidal anti-inflammatory drugs may reduce the hypotensive effect of zofenopril; kalisberegatmi diuretikami- hyperkalemia; with lithium salts -. slowdown lithium excretion
    immunosuppressants, allopurinol, cytostatics reinforce haematotoxicity.
    Hypoglycemic agents – increase the risk of hypoglycemia.

    special instructions

    Transient marked reduction of blood pressure is not a contraindication for continuation of treatment after stabilization of blood pressure (BP). In the case of re-pronounced reduction in blood pressure, reduce the dose or stop the drug.
    With the development of excessive blood pressure lowering the patient is transferred to a horizontal position with a low headboard, if necessary, introduce 0.9% chloride and plasma substituting drugs sodium solution.
    The use of vysokoprotochnyh dialysis membranes increases the risk of an anaphylactic reaction. Correction of the dosing regimen on the days free from dialysis should be performed depending on the level of blood pressure. Before and after treatment with ACE inhibitors is necessary to monitor blood pressure, blood parameters (hemoglobin, potassium, creatinine, urea), the activity of “liver” enzymes), protein in the urine.
    It is necessary to carefully monitor the bolnmi with severe heart failure, coronary heart disease and diseases of the brain vessels in which a sharp decrease in blood pressure can lead to heart attack, stroke, or renal dysfunction. The sudden cancellation of treatment does not lead to the syndrome of “lifting” (a sharp rise in blood pressure).
    In patients with an indication for the development of angioedema in history, there is an increased risk of developing cancer while taking ACE inhibitors.
    For newborns and babies who were in utero effects of ACE inhibitors, should be closely monitored for timely detection of significant decrease in blood pressure, oliguria, hyperkalemia, and neurological disorders, possible due to the decrease in renal and cerebral blood flow while reducing blood pressure, called ACE inhibitors. If oliguria need to maintain blood pressure and renal perfusion through the introduction of appropriate fluids and vasoconstrictor.
    In patients with impaired renal function should be to reduce the single dose or increase the interval between doses of the drug.
    During the selection of a therapeutic dose should refrain from driving motor vehicles and activities potentially hazardous activities, require high concentration and speed of psychomotor reactions, becausedizziness, especially after the initial dose of ACE inhibitor in patients taking diuretics.
    Use caution when exercising in hot weather (risk of development of dehydration and excessive reduction of blood pressure due to a decrease in blood volume). Before surgery (including dental) must notify the surgeon / anesthetist on the use of ACE inhibitors.
    During treatment is not recommended to drink alcoholic beverages, as Alcohol enhances the hypotensive effect of the drug.
    The simultaneous use of hypoglycemic agents, increases the risk of hypoglycemia.

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buy primobolan

Absorption: After oral cetirizine rapidly and well absorbed from the gastrointestinal tract. Maximum concentration level is determined after about 30 -60 minutes.
Food intake has no significant effect buy primobolan on the amount of absorption, but in this case, the rate of absorption is significantly reduced.The drug does not penetrate through gemagoentsefalichesky barrier.Metabolism. Cetirizine poorly metabolized in the liver with the formation of the inactive metabolite
At 10 days of administration at a dose of 10 mg of drug accumulation is observed.After a single administration of a single dose of the value of half-life is about 10 hours. In children aged 2 to 12 years the value of half-life is reduced to 5 to 6 hours.

If the kidney function (creatinine clearance below 11-31 ml / min) and in patients on hemodialysis (creatinine clearance less than 7 ml / min), the value of half-life increased by 3 times, the clearance is reduced by 70%.

Against the background of chronic diseases and elderly patients have an increase in the value of the half-life by 50% and a decrease in clearance of 40%.

Hemodialysis is ineffective.

Indications for use:

 

  • Seasonal and perennial allergic rhinitis and conjunctivitis;
  • Itchy allergic dermatitis;
  • Hay fever (hay fever);
  • Urticaria (including chronic idiopathic);
  • Angioedema.

 

Contraindications for use:

 

  • Hypersensitivity to the drug.
  • End-stage renal failure (creatinine clearance <10 mL / min).
  • Hereditary galactose intolerance, the lack of lactase, or syndrome of glucose-galactose malabsorption.
  • Children under 6 years of age.
  • Pregnancy, lactation.

 

With care.
Chronic renal failure secondary to buy primobolan severe (requires correction mode), advanced age (perhaps decreased glomerular filtration).

Dosing and Administration

The drug Zodak used by a physician to prevent complications.

Inside, regardless of meals.

Adults and children over the age of 12 years,
drug Zodak usually prescribed to 1 coated tablet (= 10 mg of cetirizine), once a day.

Children aged 6 to 12 years of
drug Zodak usually prescribed to 1 coated tablet (= 10 mg of cetirizine), once a day or 1/2 coated tablet (= 5 mg of cetirizine), twice a day, in the morning and in the evening.

Patients with renal insufficiency dose reduced according to creatinine clearance (CC): with CC 30-49 ml / min – 5 mg once daily; at 10-29 ml / min – 5 mg every other day.

When administering the drug to patients with renal failure and patients older dose should be adjusted depending on the value of KK.

Overdose

Symptoms of
possible confusion, dizziness, drowsiness, confusion, stupor, weakness, anxiety, irritability, sedation, fatigue, headache, mydriasis, pruritus, tachycardia, tremor, urinary retention, dry mouth, diarrhea, constipation (often with receiving daily 50 mg of cetirizine), malaise.

Treatment of
symptomatic therapy. A specific antidote is not revealed.

Hemodialysis is ineffective. Perform gastric lavage. activated charcoal.

Interaction with other drugs

Not established clinically significant interactions of cetirizine with other drugs.

Co-administration with theophylline (400 mg / d) reduces the total clearance of cetirizine (kinetics of theophylline is not changed).

special instructions

In the period of treatment should refrain from activities potentially hazardous activities that require high concentration and psychomotor speed reactions.

Caution should be exercised in patients with impaired liver and / or kidney disease, and the elderly.

Not recommended simultaneous buy primobolan use of drugs which depress the central nervous system, alcohol.

Product form:

Tablets, film-coated, 10 mg.
At 7 or 10 tablets in PVC / PVDC / A1 blister. Each blister 7 tablets; 1, 3, 6, 9, or 10 blister packs of 10 tablets, together with instructions for use in a cardboard box.

Storage conditions

Store at 10-25 ° C in a dry place.
Keep out of reach of children!

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