Synthetic steroid angigestagennoe means (blocks the action of progesterone at the receptor level) progestogenic activity is not. Marked antagonism with corticosteroids (due to competition on the level of communication with the receptors). Increases sustanon cycle contractility of the myometrium. stimulating the release of IL-8 in cells and horiodetsidualnyh myometrium increasing sensitivity to prostaglandins. As a result of the drug takes place decidua desquamation and removal of the ovum.
- Interruption of uterine pregnancy of early terms (up to 42 days of amenorrhea) in conjunction with misoprostol.
- Training and induction of labor.
- It has a history of hypersensitivity to mifepristone
- Adrenal insufficiency and prolonged therapy glkzhokortikosteroidnaya
- Acute or chronic renal and / or hepatic impairment
- Uterine fibroids (for a given dosage form)
- Anemia (hemoglobin level of less than 100 g / l)
- Disorders of hemostasis (including previous treatment with anticoagulants)
- Acute pelvic inflammatory disease
- The presence of heavy ekstragenitalyyuy pathology.
- Smoking women older than 35 years old without consulting a therapist.
For medical abortion:
a suspicion of an ectopic pregnancy,
pregnancy not confirmed by clinical studies; exceeding the deadline by 42 days of amenorrhea,
pregnancy, appeared at the background of intrauterine contraception, or after the cancellation of hormonal contraception.
For the training and induction of labor:
preeclampsia, severe preeclampsia, eclampsia, preterm or post-term pregnancy, the discrepancy pelvis maternal and fetal head, abnormal fetal position, spotting during pregnancy from the genital tract unknown etiology, premature rupture of membranes, severe hemolytic fetal disease.
To use caution in chronic obstructive pulmonary disease, asthma, hypertension, heart rhythm disturbances, heart failure.
Dosing and Administration
The drug should be used sustanon cycle only in hospitals that have a properly trained medical personnel and necessary equipment.
For the medical termination of early pregnancy.
600 mg of mifepristone (three 200 mg tablets) taken orally once in the presence of a doctor, after 1-1.5 hours after a meal (continental breakfast), washed down with 100 ml of water. Within 36-48 hours after mifepristone the patient should come to the hospital for receiving misoprostol 400 mcg. After administration of misoprostol must be dynamic medical supervision for 2 hours. After 10-14 days to re-conducted clinical examination and ultrasound control, if necessary, to determine the level of human chorionic gonadotropin to confirm that there was a miscarriage.
In the absence of effect of the drug on day 14 (incomplete abortion or ongoing pregnancy) conducted vakuumaspiratsiyu with subsequent histological examination of the aspirate.
For the training and induction of labor:
a single oral 200 mg of mifepristone (one tablet) in the presence of a doctor. After 24 hours, 200 mg of repeated reception. After 48-72 hours assesses the state of the birth canal and, if necessary, be appointed by prostaglandins or oxytocin.
associated with taking mifepristone. The feeling of discomfort in the abdomen, weakness, headache, nausea and vomiting, dizziness, pyrexia, rash.
Related medical abortion procedure. Bloody discharge from the genital tract. Pain in the lower abdomen. Exacerbation of inflammatory processes of the uterus and appendages.
mifepristone at doses up to 2 g does not cause unwanted reactions. In cases of overdose adrenal insufficiency may occur.
Interaction with other drugs
should be avoided nonsteroidal anti-inflammatory drugs (NSAIDs). At simultaneous reception of mifepristone and glucocorticosteroid medications need to increase the dose of the latter.
Patients using mifepristone for termination of early pregnancy should be informed that if the effect on the 10-14 day of the drug is not available (incomplete abortion or ongoing pregnancy), pregnancy, be sure to interrupt the other way, because it is possible the formation of congenital malformations in fetus.
Use of the drug requires prevention of Rh-alloimmunization and other general sustanon cycle activities related to abortion.
Breast-feeding should be discontinued 3 days after mifepristone medical abortion in the case.
The use of mifepristone for the preparation of the cervix for childbirth does not affect the subsequent lactation. buying anabolic steroids test e 250 where to buy anabolic steroids
Test sustanon induces a contraction of smooth muscle fibers of the myometrium and cervical extension. The ability of misoprostol to encourage uterine contractions and cervical ripening facilitates the removal of the uterus. The drug has a weak stimulating effect on the smooth muscles of the gastrointestinal tract. Large doses of misoprostol inhibit gastric acid secretion. Misoprostol has no clinically significant effect on prolactin levels of gonadotropins, thyrotropin, growth hormone, thyroxine, cortisol, creatinine, platelet aggregation, pulmonary function and cardiovascular system.
When administered orally is rapidly absorbed. Simultaneous reception with food – reduces the bioavailability of misoprostol (fatty foods significantly reduces the absorption without affecting the duration of absorption).
The walls of the gastrointestinal tract and the liver is metabolized to a pharmacologically active metabolite of diester – misoprostol acid.
Dose Increase misoprostol 200 mcg to 400 mcg leads to an increase in plasma concentrations of misoprostol acid in 2 times.
Write mainly through the intestine and kidney (less than 1%).
Termination of pregnancy of early terms (up to 42 days of amenorrhea) in combination with mifepristone.
- Hypersensitivity to the drug;
- Cardiovascular diseases;
- Diseases of the liver and kidneys;
- Diseases associated with prostaglandin-dependent, or contraindications to the use of prostaglandins: glaucoma, asthma, hypertension;
- Endocrinology and endocrine diseases, including diabetes mellitus, adrenal dysfunction;
- Gormonalnozavisimyh tumor;
- The use of intrauterine contraceptive (before application is necessary to remove the IUD;
- Suspected ectopic pregnancy.
Use during pregnancy and lactation
The drug can be used only for pregnant her interruption, otherwise it is contraindicated in pregnancy. In establishing pregnancy in patients taking Misoprostol, therapy with this drug should be discontinued.
It is necessary to inform patients about the potential dangers of misoprostol (teratogenic effects).
Breast-feeding should be stopped for 7 days after taking mifepristone in a method of medical abortion (up to 5 days after misoprostol Hour) .
Dosage and administration
for termination of pregnancy test sustanon in conjunction with mifepristone drug should be used in facilities that are appropriately trained medical staff.
Inside, 36-48 hours after ingestion of 600 mg (3 tablets) administered mifepristone 400 mg (2 tablets) of the drug Mirolyut ® .
Cramping abdominal pain, dizziness, headache, nausea, vomiting, flatulence, diarrhea, skin rash, pyrexia.
The recommended dose of misoprostol does not cause adverse reactions on the part of the cardiovascular system, liver or kidneys.
misoprostol toxicity was not found in humans. Clinical signs that may indicate excess dosages are drowsiness, tremor, cramps, abdominal pain, fever, tachycardia, hypotension or bradycardia.
The interaction with other drugs
reception for a long time of rifampicin, isoniazid, anticonvulsants, antidepressants, cimetidine, acetylsalicylic acid, indomethacin and barbiturates, smoking more than 10 cigarettes per day stimulates metabolism misoprostol, reducing its serum levels.
For 1 week after misoprostol should abandon admission of aspirin and other nonsteroidal anti-inflammatory drugs.
In applying for termination of early pregnancy, misoprostol should be used only in combination with mifepristone. In combination with mifepristone, misoprostol should be used only by prescription and under medical supervision and only in specialized hospitals, with capacity to provide emergency surgical gynecological and blood transfusion services.
Use of the drug requires prevention of Rh-conflict and other general activities related to abortion.
Before the appointment of misoprostol patient to be informed in detail about the action and the possible side effects of the drug. The patient should be observed in a medical institution for 4-6 hours prior to taking the drug. During and after taking the drug the patient should be given timely medical assistance in the event of massive bleeding or other complications.
After receiving the drug in patients, as a rule, there is a slight vaginal bleeding, some women have very long. At a very early stage of pregnancy can have an abortion after taking mifepristone, but in this case is also necessary reception of tablets of misoprostol for medical abortion optimization results. After receiving misoprostol in approximately 80% of women have an abortion occurs within 6 hours and approximately 10% of women -. 1 week
Patients should be retested in the same hospital after 8-15 days after taking the drug. If necessary, it should be carried out or ultrasound to determine the level of human chorionic gonadotropin in serum. If you suspect incomplete abortion test sustanon or continuation of the pregnancy is necessary to conduct a comprehensive medical examination in a timely manner.
In case of incomplete abortion or ongoing pregnancy, estimated at 10-14 days after mifepristone necessarily spend with subsequent histological examination of the aspirate, as an evaluation of the impact of the drug on the formation of congenital malformations the development of the fetus.
Simultaneous food intake does not modify absorption. When using the drug orally in doses of 7.5 and 15 mg doses are proportional to its concentration. Equilibrium concentration is achieved in 3-5 days. With long-term use (more than 1 year), the concentrations are similar to those that have been observed after the first reach a steady state pharmacokinetics. Plasma sustanon side effects protein binding is more than 99%. The range difference between the maximum and basal concentrations of the drug after administration once a day is relatively small. Meloxicam penetrates the blood-tissue barriers in the synovial fluid concentration reaches 50% of the maximum drug concentration in plasma.
Almost completely metabolized in the liver to form four pharmacologically inactive derivatives. The main metabolite, 5′-karboksimeloksikam (60% of the dose), formed by oxidation of an intermediate metabolite 5′-gidroksimetilmeloksikama which is also excreted, but to a lesser extent (9% of the dose).
Deduced equally with feces and urine, mainly as metabolites. Since feces in unchanged output of less than 5% of the daily dose in the urine as unchanged drug is found only in trace amounts. The half-life (T1 / 2) of meloxicam is 20 hours. Plasma clearance averages of 8 ml / min. Elderly persons drug clearance is reduced.The volume of distribution is low, with an average of 11 liters.
Hepatic or renal insufficiency of moderate severity substantially significant effect on the pharmacokinetics of meloxicam has not.
- Symptomatic treatment of osteoarthritis;
- Symptomatic treatment of rheumatoid arthritis;
- Symptomatic treatment of ankylosing spondylitis (ankylosing spondylitis).Contraindications
- hypersensitivity to any component of the drug;
- aspirin-induced asthma; aggravation of gastric ulcer and duodenal ulcer; severe renal failure (unless hemodialysis); severe hepatic impairment; Children under the age of 15 years;
The drug should be used with caution in elderly patients. Erosive and ulcerative lesions of the gastrointestinal tract in history.Dosing and Administration The drug is taken orally during a meal once a day. The recommended dosing regimen:
- Rheumatoid Arthritis: 15 mg. Depending on the therapeutic effect, the dose can be reduced to 7.5 mg per day.
- Osteoarthritis: 7.5 mg. With the ineffectiveness of the dose may be increased to 15 mg per day.
- Ankylosing spondylarthritis 15 mg per day. The maximum daily dose should not exceed 15 mg.
In patients with an increased risk of side effects, as well as in patients with severe renal impairment on hemodialysis, the dose should not exceed 7.5 mg per day.Pregnancy and lactation
The drug is not recommended for use during pregnancy and lactation.Side effects Bodies of the digestive system: nausea, vomiting, abdominal pain, diarrhea, constipation, flatulence, erosive and ulcerative lesions of the gastrointestinal tract, perforation of the stomach or intestines, gastrointestinal bleeding (implicit or explicit), increased activity of “liver” enzymes, hepatitis, colitis, stomatitis, dry mouth, esophagitis. Cardiovascular system: tachycardia, increased blood pressure, feeling “tides”. Respiratory system: exacerbation of asthma, cough. Central sustanon side effects nervous system: headache, dizziness, tinnitus, disorientation, confusion, sleep disturbance. Urogenital System: edema , interstitial nephritis, renal medullary necrosis, urinary infection, proteinurniya, haematuria, renal failure. The bodies of: conjunctivitis, blurred vision skin: itching, skin rash, urticaria, erythema multiforme exudative (including Stevens-Johnson syndrome) toxic epidermal necrolysis (Lyell’s syndrome), increased photosensitivity. hemopoietic system: anemia, leukopenia, thrombocytopenia. allergic reactions:anaphylactoid reactions (including anaphylaxis), swelling of the lips and tongue, allergic vasculitis. Other: feverInteraction with other drugs
When applied simultaneously with other nonsteroidal anti-inflammatory drugs (as well as acetylsalicylic acid) increases the risk of erosive and ulcerative lesions and gastrointestinal bleeding; -When The simultaneous use of antihypertensive drugs may decrease the effectiveness of the latter;
In an application with lithium therapy may develop lithium accumulation and increase its toxic effect (recommended monitoring the concentration of lithium in the blood);
In an application with methotrexate increases the side effects of the latter on the hematopoietic system (risk of anemia and leukopenia, shows periodic blood count control); -When The simultaneous use of diuretics and cyclosporine increases the risk of renal failure,
the simultaneous use of intrauterine contraceptive devices may reduce the effectiveness of the latter,
the simultaneous use of anticoagulants (heparin, ticlopidine warfarin), as well as with thrombolytic drugs (streptokinase, fibrinolizin ) increases the risk of bleeding (requires periodic monitoring of indicators of coagulation).
in an application with kolestiraminom, as a result of binding of meloxicam, enhanced its excretion via the gastrointestinal tract.
Management vehicles, maintenance vehicles and machinery
use of the drug can cause undesired effects in the form of headaches and dizziness, drowsiness. If you have the above phenomenon it is necessary to abandon the vehicle management and maintenance of machines and mechanisms.
Overdose Symptoms: . Impaired consciousness, nausea, vomiting, epigastric pain, gastrointestinal-bleeding, acute renal failure, liver failure, respiratory arrest, asystole Treatment: No specific antidote; an overdose of the drug should carry out gastric lavage, activated charcoal (within the hour), symptomatic therapy. Cholestyramine accelerates the excretion of the drug. Forced diuresis, alkalization of urine, hemodialysis – are ineffective because of the high regard of the drug to blood proteins.
Caution must be exercised when using the drug in patients with a history in which the gastric ulcer and duodenal ulcers, as well as in patients on anticoagulant therapy. These patients are at increased risk of occurrence of erosive ulcerous diseases of the gastrointestinal tract. -Follow Caution and monitor renal function when using the drug in elderly patients, patients with chronic heart failure with signs of circulatory failure in patients with cirrhosis, and in patients with hypovolemia due to surgical interventions.
Patients with renal insufficiency, if creatinine clearance greater than 25 ml / min do not require a correction mode.
in patients undergoing dialysis, medication dosage should not exceed 7.5 mg / day.
patients taking both diuretics sustanon side effects and meloxicam, should take plenty of fluids.
If during treatment having an allergic reaction (itching, skin rash, urticaria, sensitization to light), consult a doctor in order to address the issue of termination of dosing.
Sustanon steroid medication from the group of tetracyclic antidepressants, an antagonist of presynaptic and postsynaptic α 2 receptors in the central nervous system and enhances central noradrenergic and serotonergic. Mirtazapine sedative properties due to its antagonistic activity against H 1 histamine receptors. Mirtazapine generally well tolerated. At therapeutic doses, has practically no anticholinergic action and almost no effect on the cardiovascular system.In clinical conditions also appear anxiolytic and hypnotic properties, therefore mirtazapine is most effective in anxiety depressions of different genesis. The antidepressant effect appears after 1 to 2 weeks of treatment.
Following oral administration of the drug mirtazapine is rapidly absorbed (bioavailability of about 50%), reaching a maximum concentration in plasma after about 2 hours. About 85% of the mirtazapine is bound to plasma proteins. The average half-life of 20 to 40 hours (of 65 hour rarely). The shorter half-lives observed in young people. The equilibrium concentration is established in 3-5 days. The recommended dose range pharmacokinetic mirtazapine have a linear dependence on the dose administered. Food intake has no effect on the pharmacokinetics of the drug.
Mirtazapine is extensively metabolised and excreted in the urine and faeces within a few days. The main ways of its metabolism in the body are demethylation and oxidation followed by conjugation.Cytochrome R450- dependent enzymes CYP2D6 and CYP1A2 are involved in the formation of 8-hydroxy metabolite of mirtazapine, while as CYP3A4 presumably determines the formation and the N-demethylated metabolites N-oxidized. The clearance of mirtazapine is reduced in patients with renal or hepatic insufficiency.
Depressive of different etiology.
. Hypersensitivity to mirtazapine or any other components of the preparation
. Simultaneous treatment with monoamine oxidase inhibitors (MAOIs)
Age 18 years (effectiveness and safety have not been established). Precautions:
- epilepsy and organic brain damage (on the background of therapy with Mirzaten in rare cases may develop convulsions);
- hepatic or renal failure;
- heart disease (conduction disturbances, angina or recent myocardial infarction).
- cerebrovascular disease (including a history of ischemic attack..);
- hypotension, and conditions that predispose to hypotension (including degidrotatsii and hypovolemia..);
- patients who abuse drugs, drug addiction, mania, hypomania.
- impaired urination in t h, prostatic hyperplasia..;
- Acute angle-closure glaucoma, and increased intraocular pressure;
Pregnancy and lactation
The safety of the drug Mirzatena during pregnancy has not been established, so it can be used during pregnancy only when the benefits to the mother outweighs the potential risk to the fetus and under medical supervision.
The use during lactation and breast feeding is not recommended (no data for the withdrawal of the drug in breast milk).
Dosing and Administration
The inside is not liquid, squeezed small amounts of water.
Adults: initial dose – 15 mg per day, 4 days it can be increased up to 30 mg / day, 10 days later, with no effect – up to 45 mg per day.
Elderly patients: the recommended dose is the same as that for adults.
In order to achieve a satisfactory effect and safety, increasing the dose should be under close medical supervision.
In renal and hepatic insufficiency:. daily dose should be reduced by about 1/3 of the
daily dose should preferably be taken at a time at night. It is also possible to receive fractional doses equally spaced throughout the day.
The course of treatment – 4-6 months. Treatment canceled gradually.
From the nervous system: drowsiness, impaired concentration, is more common in the first weeks of treatment (dose reduction generally does not lead to a reduction in sedation, but may reduce the antidepressant effect); in rare cases: psychomotor retardation, anxiety, hyperkinesia, myoclonus, hypokinesia, lethargy, hypersensitivity, tremors, convulsions, fatigue, mania, nightmares / vivid dreams.
From the side of hematopoiesis: rarely oppression blood (graiulotsitopeniya, neutropenia, eosinophilia , agranulocytosis, aplastic anemia and thrombocytopenia); increased activity of transaminases in the blood plasma.
From sustanon steroid the digestive system: nausea, vomiting, constipation, abdominal pain.
From the urogenital system:. dysmenorrhea
Cardio vascular system: seldom possible orthostatic hypotension, decreased blood pressure.
Other: increased appetite and increased body weight, dizziness, headache, edema syndrome; rare: urticaria, back pain, arthralgia, myalgia, dysuria, “cancellation” syndrome, dry mouth, thirst.
depression of the central nervous system with disorientation, prolonged sedation, tachycardia, hallucinations, a moderate increase or decrease in blood pressure.
Treatment: gastric lavage, activated charcoal, symptomatic therapy.
Interaction with other medicines
Mirtazapine may potentiate the inhibitory effect of alcohol on the central nervous system. In connection with these patients during treatment to abstain from alcohol.
Mirtazapine should not be used concurrently with MAO inhibitors or within 2 weeks after cessation of use.
Mirtazapine may potentiate the sedative effects of benzodiazepines.
Caution is required in cases where such strong inhibitors of CYP3A4 such as HIV protease inhibitors, azole antifungals, erythromycin and nefazodone, mirtazapine used simultaneously.
mirtazapine dosage may be reduced from the beginning or cimetidine concurrent treatment increased when cimetidine treatment is completed.
- the appointment of antidepressants in patients with schizophrenia or other psychotic disorders, psychotic disorders may potentiate or of aggravated; depressive phase can be replaced by a manic;
- since there is a risk of suicide, especially at the beginning of treatment, patients should be given only a small amount of pellets;
- despite the fact that atidepressanty not addictive, abrupt withdrawal of therapy can cause nausea, headache and malaise;
- elderly patients often more sensitive, especially in relation to adverse events antidepressants.
- when the signs of jaundice, treatment should be interrupted.
- suppression of bone marrow function, manifested as granulocytopenia or agranulocytosis is rare and usually occurs after 4-6 weeks of treatment and recovered after discontinuation of treatment. The physician should inform the patient that the appearance of symptoms such as fever, sore throat, stomatitis, and other signs of influenza-like syndrome; it is necessary sustanon steroid to stop treatment, consult a doctor do a blood test.
Effects on ability to drive and use machines
During treatment Mirzatenom should avoid the performance of potentially hazardous activities that require high speed of psychomotor reactions, such as driving a car or operating machinery.
Sustanon 250 for saletherapeutic intrauterine system (IUS) releasing levonorgestrel, has a mainly local gestagenic action. Progestogen (levonorgestrel) is released directly into the uterine cavity, it can be used in extremely low daily dose. High concentrations of levonorgestrel endometrial help to reduce the sensitivity of its estrogen and progesterone receptors, making the endometrium insensitive to estradiol and providing strong antiproliferativnos action. When using Mirena observed morphological changes of the endometrium and a weak local reaction to the presence of a foreign body in the uterus. The thickening of the mucous membrane of the cervical canal prevents the penetration of sperm into the uterus. Prevents fertilization, due to oppression and mobility of sperm function in the uterus and fallopian tubes. In some women, ovulation occurs and depression.
Prior use of does not affect the reproductive function. Approximately 80% of women who want to have children, pregnancy occurs within 12 months after the removal of the IUD.
In the first months, due to inhibition of proliferation of the endometrium of the process, there may be an initial increase in spotting. Following this, a pronounced suppression of the endometrium leading to a reduction in the duration and volume of menstrual bleeding in women using. Scarce bleeding is often transformed into oligo- or amenorrhea. At the same time ovarian function and the level of estradiol in the blood are normal.By the end of the third month from the date of installation in women with menorrhagia, the volume of menstrual bleeding was reduced by 88%. When menorrragii caused by submucosal fibroid, treatment effect is less pronounced. The decrease menstrual blood loss reduces the risk of iron deficiency anemia.Mirena also reduces the severity of dysmenorrhea.
Sustanon 250 for sale in preventing endometrial hyperplasia during continuous estrogen therapy was equally high in both oral and transdermal application of an estrogen. Observed at moioterapii estrogen incidence of endometrial hyperplasia was 20%. In a clinical study in used perimsnoiauze women and 259 postmenopausal women; during the observation period up to 5 years in the group of women who were postmenopausal, no cases of endometrial hyperplasia. Pharmacokinetics
Taken internally levonorgestrel is rapidly and completely absorbed; its absolute bioavailability is close to 90%. Levonorgeetrel binds to serum albumin and binding globulin sex steroids (SHBG). Relative distribution (free, bound to albumin, linked to GTN) GTN is dependent on the concentration in the blood serum. Only about 2.5% of levonorgestrel serum in free form, while 47.5% and 50% bound to SHBG and albumin, respectively. The mean volume of distribution of levonorgestrel is about 137 L, and the rate of metabolic clearance of serum – about 5.7 l / h. The terminal half-life of levonorgestrel in serum after a single reception is within 14-20 hours. Lsvonorgsstrel as metabolites released in about equal proportions with urine and feces. Metabolites have weak or no pharmacological activity have generally shu. The main metabolite in urine – tetragidronorgestrel, which accounts for 10% of the radioactivity was detected in urine after administration of radiolabeled levonorgestrel with.
Approximately 0.1% of the dose received by the mother of levonorgestrel can pass through breast milk to the baby.
- Idiopathic menorrhagia.
- Prevention of endometrial hyperplasia during estrogen replacement therapy.
- Pregnancy or suspected it.
- Existing or recurrent inflammatory diseases of the pelvic organs.
- Infections of the lower genital tract.
- Postpartum endometritis.
- Septic abortion during the last three months. Cervicitis.
- Diseases accompanied by increased susceptibility to infections.
- Cervical Dysplasia.
- Malignant tumors of the uterus or cervix.
- Progestogen-dependent tumors, including breast cancer.
- Abnormal uterine bleeding of unknown etiology.
- Congenital or acquired abnormalities of the uterus, including fibroids, leading to deformation of the uterine cavity.
- Acute liver disease or a tumor.
- Hypersensitivity to the drug.
Application with caution
under the following conditions MIRENA should be used with caution, after consultation with a specialist. It discuss whether removal system in the presence of nerve or any of the conditions listed below:
- migraine, focal migraine with asymmetrical visual loss or other symptoms indicating transient cerebral ischemia,
- unusually severe headache;
- severe hypertension;
- severe circulatory disorders, including stroke and myocardial infarction
Pregnancy and lactation
Should not be used during pregnancy or suspected it. If pregnancy occurs in women during Mirena use, it is recommended to remove the IUD, since any intrauterine contraceptive left in situ, increases the risk of miscarriage and premature birth. Removal of sustanon 250 for sale or probing of the uterus may result in spontaneous abortion. If you carefully remove the intrauterine contraceptive can not be, it should discuss the appropriateness of abortion. If a woman wants to keep the pregnancy and IUD can not be removed, the patient should be informed about the risks and possible consequences of premature birth to the child. In such cases of pregnancy should be carefully monitored. It is necessary to exclude ectopic pregnancy. A woman should explain that she should report any symptoms suggestive of complications of pregnancy, particularly the colicky abdominal pain, accompanied by fever.
Due to the use of intrauterine and local action of the hormone can not completely exclude its teratogenic effects (especially virilization). Due to the high contraceptive efficacy of Mirena clinical experience relating to the outcomes of pregnancy in its application is limited. However, women should be informed that to date evidence of birth defects caused by the use Mirena if they continue the pregnancy until delivery without removing the IUD, no.
Levonorgestrel has been found in hrudnom milk, but it is unlikely to represent a risk for the child if doses released Mirren, located in the uterine cavity.
It is believed that the use of any progestogen-only contraceptive method six weeks after childbirth has no adverse effect on the growth and development of the child. Progestogen-only methods do not affect the quantity and quality of breast milk. It was reported about rare cases of uterine bleeding in women using MIRENA during lactation.
Dosage and administration
Mirena is inserted into the uterine cavity and is effective for five years. Lsvonorgesgrela release rate in vivo in the beginning is about 20 micrograms per day and after five years reduced to about 11 micrograms per day. The average release rate of levonorgestrel – about 14 micrograms per day for up to five years. MIRENA may be used in women receiving hormone replacement therapy, in combination with oral estrogen or tranedermalnymi preparations containing no progestogen.
When properly installed, Mirena, carried out in accordance with the instructions for use, the Pearl index (an indicator of the number of pregnancies in 100 women using a contraceptive during the year) is approximately 0.1% per year. 11ri expulsion or perforation Pearl Index may increase.
Instructions on the use of IUDs and handling of
Mirena is supplied in a sterile package which is opened only immediately prior to installation of the intrauterine system. You must abide by the rules of aseptic handling with opening system. If the sterility of the package seems to be impaired, the IUD should be destroyed as medical waste. The same should apply to the Navy, and removed from the uterus, because it contains hormone residues.
Installation, removal and replacement of the intrauterine system
is recommended that MIRENA installed only by a doctor who has experience working with this Navy or well trained for this procedure.
Before installing Mirena woman should be informed about the effectiveness, risks and side effects of the IUD. It is necessary to hold a general and gynecological examination, including a pelvic examination and breast, as well as the smear from the cervix. It is necessary to exclude pregnancy and diseases, sexually transmitted infections, and genital infections have to be completely cured. Determine the position of the uterus and the size of its cavity. Especially important to the correct location of Mirena in the bottom of the uterus, which provides uniform exposure to the progestogen on the endometrium, IUD prevents expulsion and create conditions for its maximum effectiveness. Therefore, you should carefully fulfill the requirements of the installation instructions Mirena. Since the installation of equipment in the uterus various Navy is different, special attention should be paid to practicing proper technique specific installation system.
The woman should be reevaluated in 4-12 weeks after installation, and then 1 time per year, or more frequently if clinically indicated.
Women of childbearing age MIRENA be installed into the uterus within seven days from the onset of menses. IUDs can also be installed immediately after the abortion in the first trimester of pregnancy.
Postpartum IUD insertion should be delayed until involution of the uterus does not happen, but at least 6 weeks after delivery. If involution is significantly delayed, you can postpone the procedure until the completion of involution. If you have trouble installing the Navy and / or very severe pain or bleeding during or after the procedure, you should immediately conduct a physical and ultrasonography (US) to avoid perforation.
It can be set at any time to protect the endometrium during estrogen replacement therapy in women with amenorrhea Mirena; in women with preserved menstrual installation is carried out in the last days of menstruation or withdrawal bleeding.
MIRENA should not be used for emergency contraception.
Prior to installation, Mirena should be excluded pathological processes in the endometrium, as in the first months of its application are often marked by irregular bleeding / spotting. You should also exclude the pathological processes in the endometrium when bleeding occurs after the onset of estrogen replacement therapy in women, which continues to use MIRENA, previously set for contraception. Appropriate diagnostic measures should be taken and when irregular bleeding occur during long-term treatment.
MIRENA is removed by gently pulling the strings captured forceps. If the thread is not visible, and the system is in the uterine cavity, it can be removed with the traction hook for extraction of the IUD. The extension of the cervical canal may be required.
The system should be removed after five years after installation. If a woman wants to continue using the same method, a new system can be installed immediately after the removal of the previous one.
If desirable pregnancy, women of childbearing age must perform removal of the IUD during menstruation, provided that the menstrual cycle is saved. If the system is removed in the middle of the cycle, and the woman in the previous week had sexual intercourse, she is at risk of getting pregnant, except in cases where the new system was installed immediately after removing the old one. Installing and removing the IUD may be accompanied by a certain pain and bleeding. The procedure can cause fainting due to a vasovagal reaction, or a seizure in epileptic patients.
Side effects are more likely to develop in the first months after the introduction of Mirena in the uterus; with prolonged use they will gradually disappear.
It is very common side effects (observed in more than 10% of women using MIRENA) include uterine / vaginal bleeding, spotting, and oligo-amenorrhea, benign ovarian cysts. The average number of days during which spotting in women of childbearing age is gradually reduced from nine to four days per month during the first six months after IUD insertion. The number of women with prolonged (more than eight days), bleeding is reduced from 20 to 3% in the first three months of use of Mirena. In clinical studies, it sustanon 250 for sale has been found that in the first year of Mirena 17% of women had amenorrhea duration of at least three months. When MIRENA is used in combination with estrogen replacement therapy in the first months of treatment in the majority of women in the peri- and post-menopausal observed spotting and irregular bleeding. In the future, their frequency decreases, and approximately 40% of women treated with this therapy in the last three months of the first year of treatment of bleeding in general disappear.Changes in the nature of bleeding are more common in the perimenopausal period than in postmenopausal. The frequency of benign ovarian cysts depends on the diagnostic method used. According to clinical trials enlarged follicles have been diagnosed in 12% of women using MIRENA. In most cases, the increase in the follicles are asymptomatic and disappear within three months. The table presents side effects that are classified by body system, according to MedDRA. The frequency corresponds to clinical studies.
Dopamine receptor agonist with high selectivity and specificity associated with dopamine receptor subgroups D2, has a strong affinity for D3 receptors. It reduces sustanon the deficit of motor activity in Parkinson’s disease due to the stimulation of dopamine receptors in the striatum. Pramipexole inhibits the synthesis, release and metabolism of dopamine, protects dopamine neurons from degeneration that occurs in response to ischemia or methamphetamine neurotoxicity.
Reduces prolactin secretion (dose-dependent).
With prolonged use (more than 3 years) signs of declining efficacy not established.
Pramipexole after ingestion rapidly and completely absorbed. The absolute bioavailability is greater than 90% and the maximum plasma concentration observed 1-3 hours. The rate of absorption is reduced when having a meal, but at the total absorption does not affect food intake. For pramipexole characteristic linear kinetics and a relatively small variation in concentrations between individual patients.
Treatment of Parkinson’s disease symptoms (monotherapy or in combination with levodopa).
: Hypersensitivity to pramipexole or to any component of the formulation.
Kidney failure, hypotension.
In the study of carcinogenicity in animals showed degeneration and loss of photoreceptor cells in the retina of albino rats. The potential significance of this effect in humans has not been established, but it can not be ignored due to a possible violation of the mechanism (blurring of the disc), universal for all vertebrates.
The individual dose should be in the range from 0.375 mg to 4.5 mg per day. Both early and late stages of the disease the drug was effective, starting with a daily dose of 1.5 mg. It is not ruled out that in some patients doses above 1.5 mg per day may provide an additional therapeutic effect, especially at the late stage of the disease when levodopa dose reductions shown.
Pramipexole should be withdrawn gradually over several days.
Doses for patients receiving concomitant therapy with levodopa:
If concurrent therapy with levodopa, it is recommended as the dose, as well as during maintenance therapy with pramipexole reduce the dose of levodopa. This is necessary to avoid excessive dopaminergic stimulation.
Doses for patients with renal failure: For the initial therapy: patients with a creatinine clearance greater than 50 mL / min does not require reduction of the daily dose. If creatinine clearance 20 – 50 mg / ml initial drug dose administered daily in two steps, starting with 0.125 mg 2 times per day (0.25 mg daily). When creatinine clearance less than 20 ml / min the daily dose of the drug is prescribed once a day, starting at 0.125 mg.
If, during maintenance therapy of renal function decreases, the daily dose reduced by the same percentage by which the creatinine clearance decreased, i.e. If creatinine clearance is reduced by 30%, the daily dose should be reduced by 30%. The daily dose can be divided into two stages, if creatinine clearance is in the range of 20 – 50 ml / min, or taken once a day, if creatinine clearance less than 20 mL / min.
Doses for patients with hepatic insufficiency: there is no need to reduce the dose in patients with hepatic insufficiency.
Side effects of
the early stages of the disease more common adverse events were somnolence and constipation, and at a later stage of the disease when treatment in combination with levodopa were more common dyskinesia and hallucinations. These adverse events decreased with continued therapy; constipation, nausea and dyskinesia tended to disappear.
From the nervous system: confusion, neuroleptic malignant syndrome (hyperthermia, muscle rigidity, altered mental status, akathisia, vegetative lability, abnormal thinking), insomnia, extrapyramidal syndrome, dizziness, fatigue, amnesia, hypoesthesia, dystonia, myoclonus, tremor, depression, anxiety, ataxia, hypokinesia, delusions, suicidal thoughts.
From the musculoskeletal system: hypertonus muscles, cramps in the leg muscles, muscle twitching, arthritis, bursitis, male, pain in the lumbosacral spine, chest pain, pain in the neck.
From the digestive system: loss of appetite, dysphagia, dyspepsia, abdominal pain, flatulence, diarrhea, dry mouth, vomiting.
The respiratory system: pharyngitis, sinusitis, rhinitis, flu-like symptoms, shortness of breath, increased cough, voice alteration.
With the genitourinary system: urinary tract infection, increased frequency of urination.
Since the cardiovascular system: orthostatic hypotension, tachycardia, increased creatine sustanon kinase activity, angina, arrhythmia.
From the senses: conjunctivitis, paralysis of accommodation, diplopia, cataract, increased intraocular pressure, impaired hearing.
Allergic reactions. Other: hyperthermia, retroperitoneal fibrosis, pulmonary infiltrates, pleural effusion, weight loss. increased sweating.
Hypotension in the treatment of drug mirapex did not develop more frequently than with placebo. For some patients hypotension may occur at the beginning of the treatment, especially if the dose is increased too quickly.
Cases of Insomnia and peripheral edema.
Reported cases of sleep during daily activities (including while driving), which sometimes resulted in accidents.
Application mirapex drug can cause a change (increase or decrease) libido.
The literature describes cases of pathological craving for gambling in patients receiving pramipexole (especially in high doses), which was stopped after discontinuation of the drug.
Cases of severe overdose not described. Expected symptoms: nausea, vomiting, hyperkinesia, hallucinations, agitation, and decreased blood pressure.
Treatment: gastric lavage, symptomatic therapy. Assigned antidote does not exist. If there are indications of stimulation of the nervous system, it may be recommended by neuroleptics. The effectiveness of hemodialysis has not been established.
Pramipexole a small extent (<20%) is bound to plasma proteins and undergoes biotransformation. Therefore, interactions with other medications affecting plasma protein binding or elimination due to biotransformation are unlikely.
Drugs that inhibit the secretion of cationic active agents through the renal tubules (e.g., cimetidine) or which themselves are derived by an active secretion by the renal tubules, may interact with pramipexole, resulting in reduction of clearance of one or both drugs. In the case of simultaneous use of these drugs (including amantadine) and pramipexole is necessary to pay attention to such sustanon signs of excessive dopamine stimulation as dyskinesias, agitation or hallucinations. In such cases it is necessary to reduce the dose. Diltiazem, triamterene, verapamil, quinidine, quinine, reduce the clearance of 20%.
Selegelin and levodopa do not influence the pharmacokinetics of pramipexole. Pramipexole increases levodopa concentration and reduces TSmax from 2.5 to 0.5 hours. Interaction with anticholinergic drugs and amantadine has not been studied. However, interaction with amantadine is possible because drugs have a similar mechanism of excretion. Anticholinergic drugs mainly output pathway, so interactions with pramipexole unlikely.
With increasing doses of pramipexole recommended dose reduction of levodopa dosage while other antiparkinsonian drugs should be maintained at a constant level. Dopamine antagonists (phenothiazines, butyrophenone, thioxanthenes, metoclopramide) decrease the effectiveness of treatment.
Because of the potential cumulative effects, patients should be advised to exercise caution when taking other sedating medicinal products or alcohol in combination with the drug mirapex, as well as while the reception of medicines, increasing the concentration of the pramipexole plasma (eg, cimetidine).
hallucinations and confusion – known side effects in the treatment of dopamine agonists and levodopa. When applying mirapex drug in combination with levodopa in the later stages of the disease hallucinations were observed more frequently than pramipexole monotherapy in patients at early stages of the disease. Patients should be informed of the possibility of hallucinations (mostly visual), which may affect the ability to drive a car.
Care should be taken if the patient of severe cardiovascular disease. Because of the risk of orthostatic hypotension during dopaminergic therapy to control blood pressure, especially at the beginning of treatment.
Patients should be warned of the possible sedative effect of the drug. Reported cases of sleep during daily activities (including while driving), which sometimes resulted in accidents. In some cases, falling asleep was not preceded by a state of drowsiness, which are often observed in patients taking pramipexole doses higher than 1.5 mg / day, and that, in accordance with the latest knowledge in the field of sleep physiology, is always preceded by a sleep.
A clear relationship between the severity of sleepiness and duration of treatment was not traced. Some patients received both drugs with other potentially sedative properties. In most cases (according to available data) after dose reduction or discontinuation of treatment in the future episodes of falling asleep was not observed.
It was reported that the sudden cessation of therapy was observed symptom, which allows to assume neuroleptic malignant syndrome.
Effects on ability to drive and use machinery
Patients should be informed of the possibility of hallucinations (mostly visual), which may affect the ability to drive a car.
In applying the drug may develop sedative effects, including drowsiness and falling asleep during daily activities. Since drowsiness is a common adverse event with potentially serious consequences, patients should not drive a car or operate other complex machinery until such time until they gain sufficient experience of treatment mirapex to assess affects whether it is negative or not their mental and / or locomotor activity. Patients should be advised that if during the treatment they experience increased sleepiness or episodes of falling asleep during daily activities (ie during conversation, food, etc.), they have to give up driving, working with machinery, and sustanon seek medical advice. http://test-propionate.com/tag/bradley-martyn-steroids/ online anabolic steroids pharmacy
Miramistin has a strong bactericidal effect on nonpositive and non-negative, aerobic and anaerobic bacteria in the form of monocultures and microbial associations, including hospital strains with multidrug-resistant to antibiotics. Has expressed hyperosmolar activity, thereby relieves wound and perifocal inflammation, absorbs the purulent exudate, contributing to the formation of dry scab. Do not damage the granulation and viable skin cells, it does not inhibit testosterone sustanon the edge epithelialization. There has locally irritating and allergenic properties.
When applied topically miramistin does not have the ability to be absorbed through the skin and mucous membranes.
Indications for use:
Surgery, Traumatology: suppurations prophylaxis and treatment of purulent wounds. Treatment of inflammatory processes of the musculoskeletal system. Obstetrics, gynecology: prevention and treatment of suppuration of puerperal trauma, wounds of the perineum and vagina, postpartum infections, inflammatory diseases (vulvovaginitis, endometritis). Combustiology: the treatment of superficial and deep burns II and IIIA degree training burn wounds to dermatoplastike. Dermatology, venereology: treatment and prevention of pyoderma and ringworm, candidiasis of the skin and mucous membranes, foot mycoses.Individual prevention of diseases, sexually transmitted diseases (syphilis, gonorrhea, chlamydia, trichomoniasis, genital herpes, genital candidiasis, etc.). Urology: complex treatment of acute and chronic urethritis and uretroprostatitis specific (chlamydia, trichomoniasis, gonorrhea) and non-specific nature. Dental treatment and prevention of infectious and inflammatory diseases of the oral cavity: stomatitis, gingivitis, periodontitis, periodontitis. Hygiene treatment for dentures. Otolaryngology – complex treatment of acute and chronic otitis, sinusitis, tonsillitis, laryngitis.
Dosage and administration:
The product is ready for use. For instructions on using the package with a nozzle spray:
- Remove the cap from the vial.
- Extract the attached nozzle spray from its protective packaging.
- Attach the nozzle to the spray testosterone sustanon bottle.
- Activate spray nozzle by pressing.
Surgery, traumatology, combustiology. With the prophylactic and therapeutic purposes irrigate the surface of wounds and burns, loosely tamponiruyut wounds and fistulous passages, fix gauze pads soaked in the drug. Treatment procedure is repeated 2-3 times a day for 3-5 days. Highly effective method of active drainage of wounds and cavities with a daily consumption of up to 1 liter of the drug.
Obstetrics, Gynecology. In order to prevent post-partum infection is used as a vaginal irrigations before delivery (5-7 days), after each delivery vaginal examination and postpartum 50 ml of the drug in the form of a tampon with an exposure for 2 hours, for 5 days. Women during delivery by caesarean section, immediately before surgery treated vagina during surgery – uterine cavity and the incision therein and postoperatively administered swabs soaked drug into the vagina with an exposure for 2 hours to 7 days. Treatment of inflammatory diseases of the course is conducted within 2 weeks of administration by intravaginal tampons with the drug, as well as by iontophoresis.
Venereology. For the prevention of sexually transmitted diseases drug is effective if it is applied not later than 2 hours after intercourse. The contents of the vial with an applicator urological enter into the urethra for 2-3 min: men (2-3 mL), women (1-2 ml) and the vagina (5-10 ml). Treat skin inner surfaces of the thighs, pubic area, genitals. After the procedure, it is recommended not to urinate for 2 hours.
Urology. In the complex treatment of urethritis and spend uretroprostatitis injection into the urethra of 2-3 ml of the drug 1-2 times a day, the course -10 days.
Otorhinolaryngology. In purulent sinusitis – when puncture maxillary sinus is washed with a sufficient amount of the drug. Tonsillitis, pharyngitis and laryngitis testosterone sustanon treated gargling and / or irrigation using a spray nozzle, 3-4-fold pressing, 3-4 times a day. The amount of drug per ml of rinsing 10-15.
Some of the following microorganisms showed resistance to minocycline, so it is advisable to conduct laboratory susceptibility testing prior to use. Antibiotics tetracycline is not recommended for the treatment of streptococcal and staphylococcal sustanon 250 side effects infections, if not shown the sensitivity of microorganisms to minocycline.
- Bacillus anthracis
- Listeria monocytogenes
- Staphylococcus aureus
- Streptococcus pneumoniae
- Bartonella bacilliformis
- Brucella species
- Calymmatobacterium granulomatis
- Campylobacter fetus
- Francisella tularensis
- Haemophilus ducreyi
- Vibrio cholerae
- Yersinia pestis
For the following microorganisms is strongly recommended that a sensitivity study to minocycline:
- Acinetobacter species
- Enterobacter aerogenes
- Escherichia coli
- Haemophilus influenzae
- Klebsiella species
- Neisseria gonorrhoeae *
- Neisseria meningitidis *
- Shigella species
- Actinomyces species
- Borrelia recurrentis
- Chlamydia psittaci
- Chlamydia trachomatis
- Clostridium species
- Entamoeba species
- Fusobacterium nucleatum subspecies fusiforme
- Mycobacterium marinum
- Mycoplasma pneumoniae
- Propionibacterium acnes
- Treponema pallidum subspecies pallidum
- Treponema pallidum subspecies pertenue
- Ureaplasma urealyticum
The volume of distribution is 0.7 l / kg. Minocycline is well into the organs and tissues: 30 – 45 minutes after ingestion found in therapeutic concentrations in the kidneys, spleen, eye tissues, pleural and ascites fluid, synovial exudate, exudate maxillary and frontal sinuses, in the liquid sulcus. It penetrates sustanon 250 side effects into cerebrospinal fluid (20 – 25% of the level determined in plasma). It passes through the placenta, enters the mother’s milk.
Repeated administration of the drug may accumulate. It is accumulating in the reticuloendothelial system and bone. The bones and teeth forms insoluble complexes with Ca 2+ . Treated kishechnopechёnochnoy recycling 30-60% of the dose is excreted in the intestinal contents; 30% excreted by the kidneys within 72 hours (of which 20-30% – in an unmodified form), with severe chronic renal failure – only 1-5%. The half-life (the T 1/2 ) Minocycline is approximately 16 hours.
Indications for use:
Minocycline hydrochloride is used to treat the following diseases sensitivity provided pathogens:
- skin Infections
- Spotted fever, typhoid fever, typhoid fever, Q fever (koksiellёz), rickettsial disease and vesicular tick fever
- Respiratory Tract Infections
- lymphogranuloma venereum
- parrot disease
- Trachoma (infectious keratoconjunctivitis)
- Conjunctivitis with inclusions (paratrahoma)
- NGU, an infection of the cervical canal and the anus in adults
- Cyclic fever
- Inguinal granuloma
- Yaws (tropical sustanon 250 side effects granuloma, non-venereal syphilis)
- Vincent’s infection
In the case of acute intestinal amebiasis allowed the use of minocycline as an adjunct to amebitsidnym drugs.
In severe acne, minocycline may be used as adjunctive therapy.
Oral administration of minocycline is indicated for asymptomatic carriers of Neisseria meningitidis to eradicate meningococci from the nasopharynx.
To prevent the emergence of resistance it is recommended the use of minocycline in accordance with the results of laboratory tests, including serotyping and susceptibility of pathogens. For the same reason it is not recommended the use of minocycline as a preventive measure in case of high risk of meningococcal meningitis.
Oral administration of minocycline is not recommended for the treatment of meningococcal infections.
Experience of clinical application of minocycline shows efficacy in the treatment of infections of sustanon 250 side effects marinum, however, currently this data is not confirmed by the results of controlled clinical trials.
- Hypersensitivity to minocycline, tetracycline and other ingredients
- Severe hepatic and renal failure
- Systemic lupus erythematosus
- Children under 8 years (the period of tooth development)
- Simultaneous treatment with isotretinoin
- Lactase deficiency, lactose intolerance, glucose-galactose malabsorption
Violations of the liver and kidney, the simultaneous application of hepatotoxic drugs.
Dosage and administration:
Inside, after a meal. It is recommended to drink plenty of fluids (milk can) to reduce the risk of irritation and ulceration of the esophagus.
Initial dose sustanon 250 side effects mg (2 capsules of 100 mg or 4 capsules of 50 mg), after taking 100 mg (1 capsule of 100 mg or 2 capsules of 50 mg) every 12 hours (twice daily) .
The maximum daily dose should not exceed 400 mg.
Infections of the urinary and anogenital caused by Chlamydia and Ureaplasma: 100 mg (one 100 mg capsule or two capsules of 50 mg) every 12 hours for 7-10 days.
Inflammatory diseases of the pelvic organs in women in the acute stage of 100 mg (one 100 mg capsule or two capsules of 50 mg) every 12 hours, sometimes in combination with cephalosporins.
Primary syphilis in patients hypersensitive to penicillin 100 mg (one 100 mg capsule or two capsules of 50 mg) twice a day for 10-15 days.
Gonorrhea: 100 mg (one 100 mg capsule or two capsules of 50 mg) twice a day for 4-5 days, or 300 mg single dose.
Uncomplicated gonococcal infections (excluding urethritis and anorectal infection) in man: an initial dose – 200 mg (2 capsules of 100 mg or 4 capsules of 50 mg), which supports – 100 mg (1 capsule of 100 mg or 2 capsules of 50 mg) by every 12 hours for at least 4 days, followed by microbiological assessment of recovery after 2-3 days after discontinuation of the drug.
Uncomplicated gonococcal urethritis in men: 100 mg (one 100 mg capsule or two capsules of 50 mg) every 12 hours for 5 days.
Acne: 50 mg (1 capsule 50 mg) per day, duration of the course of 6-12 weeks.
On the background of the drug, due antianabolicheskogo effect inherent drugs tetracycline group, increase urea levels in the blood plasma can occur. In patients with normal renal function, it does not require discontinuation of therapy. In patients with severe renal impairment may occur azotemia develop, hyperphosphatemia, and acidosis. In this situation it is necessary to monitor the level of urea and creatinine in the blood plasma, and the maximum daily dose of minocycline should not exceed 200 mg.
Pharmacokinetics of minocycline in patients with renal failure (creatinine clearance less than 80 mL / min) at present poorly understood, in order to infer the need for dose adjustment.
If hepatic dysfunction sustanon 250 side effects drug be used with caution. Children older than 8 years in infections caused by pathogens sensitive to minocycline: initial dose – 4 mg / kg followed by 2 mg / kg every 12 hours.
Desmopressin is a structural analog of arginine vasopressin, human pituitary hormone. The difference is the substitution of cysteine and deamination of L-arginine, D-arginine. This leads to a significant prolongation of period and complete lack vasoconstrictor effect. Desmopressin increases the permeability of epithelia of distal convoluted tubules and increases the reabsorption of water, which leads to a reduction in urine output, increased urine osmolarity while reducing plasma osmolarity, decrease in urinary frequency and reducing nocturia (nocturia). PharmacokineticsBioavailability of desmopressin in a sublingual form in doses of 200, 400 and 800 micrograms is about 0.25%. The maximum concentration (C max ) of desmopressin plasma levels achieved for 0.5-2 hours after drug administration and directly proportional to the applied dose: after receiving the 200, 400 and 800 ug C max was 14, 30 and 65 pg / ml, respectively. Desmopressin not penetrate the blood-brain barrier. Desmopressin is excreted by the kidneys, the half-life is 2.8 hours.
Indications for use:
- Central diabetes insipidus;
- Primary nocturnal enuresis in children older than 6 years old;
- Nocturia (nocturnal polyuria) as symptomatic therapy.
- Hypersensitivity to desmopressin or other ingredients;
- Habitual or psychogenic polydipsia (with a volume of urine formation 40 ml / kg / 24 hours);
- Heart failure and other conditions requiring the appointment of diuretic drugs;
- Renal insufficiency moderate and severe (creatinine clearance below 50 ml / min);
- Children under 6 years of age;
- Syndrome of inappropriate antidiuretic hormone products. If you have one of these diseases, before taking this medication, you should consult with your doctor.Precautions: . Renal insufficiency (creatinine clearance greater than 50 mL / min), fibrosis of the bladder, disorders of water and electrolyte balance, the potential risk of increased intracranial pressure, pregnancy, advanced age (65 years and older) Pregnancy and lactation There were no side effects on during pregnancy, the health of the pregnant woman, the fetus and the newborn when receiving sustanon 350 . However, caution should be exercised when administering the pregnant. The dose, which desmopressin may enter the body of the newborn with breast milk of women receiving the higher dose (approx. 300 mg) desmopressin is not able to influence the child’s urine output. The decision to continue breastfeeding is accepted, if the benefit to the mother outweighs the potential risk to the child. Sustanon 350 must be taken some time after the meal, as the food intake reduces the absorption of the drug and its effectiveness. Central diabetes insipidus: The recommended starting dose Minirin ® 60 mg 3 times a day. Subsequently the dose varies depending on the therapeutic effect. The recommended daily dose is in the range 120-720 mg. The optimal maintenance dose is 60-120 mg 3 times per day sublingually. The primary nocturnal enuresis: The recommended starting dose of 120 mg at night. In the absence of the effect of the dose can be increased to 240 mg. During treatment it is necessary to restrict fluid intake in the evening. Recommended continuous course of treatment is 3 months. The decision to continue treatment is made based on clinical data sustanon 350, which will be observed after discontinuation of the drug for 1 week. Nocturia: The recommended starting dose is 60 mg sublingually for the night. If no effect in 1 week dose increased to 120 mg sublingual and subsequently to 240 g by increasing the dose with a frequency of less than one time per week. If after 4 weeks of treatment and dose adjustment adequate clinical response is observed, it is not recommended to continue taking the drug .
The most common side effects observed in cases where treatment is not limited fluid intake, and there are fluid retention and / or hyponatremia, which can be asymptomatic or manifested by the following symptoms: headache, dizziness, nausea, vomiting, dry mouth, peripheral edema, body weight, in severe cases -. cramp If any of these instructions side effects are compounded, or if you notice any other side effects not mentioned in the instructions, inform your doctor.
Overdosing increases the duration of action of the drug and increase the risk of fluid retention and hyponatremia. In case of overdose, seek medical advice. Treatment of hyponatremia should be individualized, it is obligatory to discontinuation of the drug and the abolition of restrictions on fluid intake. If you have symptoms of overdose possible infusion of isotonic or hypertonic sodium chloride solution. In the case of severe fluid retention (convulsions and unconsciousness) treatment should be added to furosemide.
Interaction with other drugs:
Tricyclic antidepressants, selective serotonin reuptake inhibitors, chlorpromazine and carbamazepine, may cause a syndrome of inappropriate secretion of antidiuretic hormone, may increase the antidiuretic effect and increase fluid retention risk and hyponatremia. Simultaneous use of nonsteroidal anti-inflammatory agents also increases the risk of side effects. The combination with loperamide It can lead to a threefold increase in plasma concentration of desmopressin and increase the risk of side effects (fluid retention, hyponatremia). It is likely that other drugs that lower the tone and motility of the smooth muscles of the intestine, may have a similar effect. When concomitant administration sustanon 350 with the above drugs for the prevention of hyponatremia need regular determination of sodium concentration in the blood plasma.
It is mandatory to minimize the restriction for the reception of fluid 1 hour before receiving and for 8 hours after drug administration in patients with primary nocturnal enuresis. Failure to do so can lead to side effects. A high risk of side effects, patients are older than 65 years with initially low concentration of sodium in the blood plasma and polyuria 2.8-3.0 liters per day. In the case of occurrence of acute urinary incontinence, dysuria and / or nocturia, urinary tract infection sustanol 300, in cases of suspected tumor of the bladder or prostate, in the presence of polydipsia and decompensated diabetes, it is necessary to make a diagnosis and treatment of these conditions and diseases prior to treatment . when acute arisen related diseases, such as systemic infections, fever, gastroenteritis, accompanied by an imbalance of fluids and electrolytes, the drug should be discontinued. with the utmost care prescribers elderly patients (65 years and older) in connection with a high risk of side effects (water retention and hyponatremia). When assigning in these cases it is necessary to determine plasma sodium concentration prior to drug administration, 3 days after the beginning of the reception and for each dose is increased. It is necessary to monitor the patient’s condition during the period of receiving.
Levonorgestrel, ingested, absorbed quickly and completely. Biotransformation occurs on common pathways of metabolism of steroids. Biologically active substances are not found among the metabolites. Levonorgestrel binds to serum albumin and globulin, sex hormone binding (SHBG). Value product fractions (free, albumin-linked and associated GSM) depends on the blood levels of SHBG. Following induction of protein binding, the fraction associated with SHBG increases, while the free and bound albumin fraction decreases. The sustanon 250 gains accumulation in the body when levonorgestrel daily intake occurs almost entirely in the second elimination phase. State of the equilibrium concentration is reached on the 3-4th day. Pharmacokinetics of levonorgestrel dependent on the concentration of SHBG in plasma. When receiving 20 Miniziston FEM concentration of SHBG increases by about 70% due to the fact that the preparation contains ethinylestradiol. The total concentration levonorgestrel serum increases linearly with its specific binding capacity. Levonorgestrel level in serum does not undergo further changes after one to three courses of regular reception because the induction of the activity of SHBG ends. Upon reaching equilibrium concentration of state level levonorgestrel in serum in three to four times higher than after a single dose. The absolute bioavailability of levonorgestrel is close to 100%. Approximately 0.1% of the dose of levonorgestrel obtained mother passed the child with milk. Ethinylestradioladopted into ethinylestradiol It absorbed quickly and completely. Upon receiving the FEM 20 Miniziston maximum drug concentration in serum is approximately 60-70 pg / l is achieved in one to two hours.Then, the serum concentration of ethinyl estradiol is reduced, and the reduction is biphasic; the first phase is characterized by a half-life of the drug within 1-2 hours, The second one is within 10-20 hours. For technical reasons these parameters can only be calculated while taking the drug at high doses. It has been established that the apparent volume of distribution of ethinyl estradiol is about 5 liters / kg, and its metabolic clearance rate from plasma is about 5 ml / min / kg. Ethinylestradiol highly (98%), albeit nonspecifically binds albumin. Ethinyl estradiol is metabolized in the suction phase and the first passage through the liver, resulting in reduced individual variations and its bioavailability when administered orally. Ethinyl estradiol is not eliminated in a free form; its metabolites are eliminated, the half-life is equal to about one day. The ratio of the proportion of metabolites excreted in urine to the fraction released in the bile, corresponding to 40: 60. Due to the relatively large half-life of the drug in the terminal elimination phase, when the equilibrium concentration by 30-40% above the content of the drug in the plasma than after application for five or six days. The absolute bioavailability of ethinyl estradiol is subject to considerable individual variations. After receiving Miniziston 20 Fem inside it is about 40-60% of the dose. In nursing mothers about 0.02% of the daily dose of ethinyl estradiol can enter the body of the child with breast milk. The reception of other drugs may affect the systemic bioavailability of ethinyl estradiol. However, interaction with high doses of vitamin C have been identified. Chronic administration of ethinyl estradiol induces an increase in the synthesis of corticosteroid-binding globulin (CBG) and GSM, and the degree of induction of SHBG synthesis depends on the type and dose of progestogen is used at the same time.
Miniziston FEM 20 must not be used if any of the conditions listed below. If any of these conditions develop for the first time in patients receiving the drug should be immediately repealed.
- The presence of thrombosis (venous and arterial) present or in history (eg deep vein thrombosis, pulmonary embolism, myocardial infarction, cerebrovascular accident).
- Available now or in the history of the state prior to thrombosis (eg, transient ischemic attack, angina pectoris)
- Diabetes mellitus with vascular complications.
- The presence of serious or multiple risk factors for venous or arterial thrombosis may also be regarded as a contraindication
- The presence of current or a history of severe liver disease (as long as liver function tests have not come back to normal).
- Available now or history of liver tumors (benign or malignant).
- Identified hormone malignant diseases (eg genital or mammary glands) or are suspected.
- Vaginal bleeding of unknown origin.
- Pregnancy or suspected it.
- Hypersensitivity to any component of Miniziston 20 FemDosing and Administration
Drops should be taken in the order indicated on the package, every day at about the same time, if necessary with a small amount of liquid. Take one tablet a day continuously for 21 days. Drops of each subsequent packaging are beginning to take after a seven-day break, during which withdrawal bleeding usually occurs. It usually begins in the second or third day after the last pills, and can not end before you start taking a new package.
How to start admission Miniziston 20 Fem
- Without taking any hormonal contraceptive use in the preceding month.
Admission Miniziston 20 Fem begins on the first day of the menstrual cycle (ie the first day of menstrual bleeding). Shall start receiving 2-5 days of the menstrual cycle, but in this case it is recommended to additionally use a barrier method of contraception during the first 7 days of tablet-taking from the first package.
- When switching from other combined oral contraceptives. Preferably start taking Miniziston 20 Fem next day after taking the last active pills from the previous package, but in any case not later than the day after the usual 7-day break in the reception (for products containing 21 pills) or after the last inactive pills ( for preparations containing 28 pills in the package).
- When switching from contraceptives containing only progestin ( “mini-pill”, an injectable form, implant)
The woman may switch from the mini-pill to Miniziston 20 Fem any day (without a break), with the implant – the date of its removal from the injection mold – from the day sustanon 250 gains when the next injection should have to be made. In all cases, you must use an additional barrier method of contraception during the first 7 days of tablet-taking.
- After an abortion in the first trimester
The woman may start taking immediately. Subject to this condition the woman does not need additional contraceptive protection.
- After delivery or abortion in the second trimester of pregnancy,
women should be advised to start taking the drug at 21-28 days after delivery or abortion in the second trimester of pregnancy. If the reception is started later, you must use an additional barrier method of contraception during the first 7 days of tablet-taking. However, if a woman has been sexually active, before you start taking Miniziston 20 Fem pregnancy should be excluded or must wait for the first menstrual period. Receiving Missed Pills If the delay in taking pills is less than 12 hours, contraceptive protection is not reduced. The woman should take pills as soon as possible, should be taken at the usual time. If the delay in taking pills made more than 12 hours, contraceptive protection may be reduced. It is possible to be guided by the following two basic rules:
- The drug should never be interrupted for more than 7 days
- For an adequate suppression of the hypothalamic-pituitary-ovarian system requires several days of continuous tablet-taking.
Accordingly, we can give the following practical tips.
- The first week of taking the drug
should take the last missed pills as soon as possible, as soon as you remember (even if this means taking two pills at once). Next take the pills at the usual time. In addition to be used a barrier method (condom) for the next 7 days. If intercourse took place during the week before skipping pills, you need to take into account the chance of pregnancy. The more pills missed, and the closer to the period of the pass, do not provide for their admission, the higher the risk of pregnancy.
- The second week of
woman should take the last missed pills as soon as possible, as soon as you remember (even if this means taking two pills at once). Next take the pills at the usual time.
Provided that the woman has taken pills correctly in the 7 days preceding the first missed pills, there is no need to use additional contraceptive measures. However, if this is not so, or woman misses more than 1 tablet, you should use extra precautions for 7 days.
- The third week
The risk of reduced reliability is imminent because of the approaching scheduled break in receiving pills.
However, by adjusting the tablet-taking mode, you can still prevent a decrease contraceptive protection. If you adhere to any of the following two elections, there is no need to use extra contraceptive precautions, provided that in the 7 days preceding the first missed pills woman took all the pills correctly.
1. The woman should take the last missed pills as soon as possible, as soon as you remember (even if this means taking two pills at once). Next take the pills at the usual time. Admission pills of the next pack should be started as soon as the end of the current package of pills, ie without the usual break. Withdrawal bleeding is unlikely, but may experience spotting or breakthrough bleeding during the tablet-taking.
2. A woman can also interrupt the reception of pills from the current package. Then sustanon 250 gains she should take a break from taking pills continuously for up to seven days, including the day of skipping pills, and then start receiving new packaging.
If the woman misses pills and then while taking pills she had no withdrawal bleeding, it is necessary to exclude pregnancy. Advice in case gastrointestinal disorders (vomiting) If she vomited within 3 to 4 hours after ingestion of pills, absorption may not be complete, it is necessary to focus on advice on the pellets pass. If a woman does not want to change the normal dose, it must take, if necessary, additional pills (or more pellets) from a new package. How do I change the first day of the menstrual cycle or delay the onset of menstruation To delay the onset of menstruation, the woman should continue receiving new packaging Miniziston 20 Fem without interruption. Drops of this new packaging can be accepted as long as they do not run out. Against the background of the drug from the second package, women may experience spotting from the vagina or breakthrough uterine bleeding. Then make the seven-day break, and then resume the regular intake of medication. In order to move the first day of menstruation to another day of the week, a woman should shorten her next break in taking pills for as many days, as much as she wants. The shorter the interval, the higher the risk that she will have spotting and breakthrough bleeding while taking second pack (just as when she wanted to delay the onset of menses).Side effects
The following undesirable effects have been reported in women taking Miniziston 20 Fem, and their relationship with the drug has neither been confirmed nor refuted: pain and tension of the mammary glands, breast enlargement, discharge from the breast; headache; migraine; changes in libido; reduction / mood changes; poor tolerance of contact lenses; nausea; vomiting; other gastrointestinal disorders; changes in vaginal secretion; various skin disorders); fluid retention; change in body weight; hypersensitivity reaction.
Sometimes it can develop chloasma, especially in women with a history of chloasma during pregnancy.
See. Warnings also. Overdose
No serious side effects have been reported in overdose. Symptoms that may occur with overdose include nausea, vomiting and, in young girls, slight vaginal bleeding. There is no specific antidote; should be symptomatic treatment.
Cautions and Warnings
If any of the conditions / risk factors mentioned below are currently available, you should carefully weigh the potential risks and expected benefits of treatment Miniziston 20 of themes in each individual case and discussed with the woman before she decides start taking the drug. In the case of aggravation, or amplification of the first manifestations of any of these conditions or risk factors, the woman should consult with your doctor, who can decide whether to cancel the drug.
- Diseases of the cardiovascular system
A number of epidemiological studies have revealed a slight increase in the incidence of venous and arterial thrombosis and thromboembolism while taking the combined oral contraceptive.
Venous thromboembolism, manifested in the form of deep vein thrombosis and / or pulmonary embolism, may occur during the use of combined oral contraceptives. Approximate frequency of venous thrombosis and thromboembolism in women taking oral contraceptives with low estrogen dose (less than 50 micrograms ethinylestradiol) is up to 4 to 10 women a year in the company compared to 0.5-3 per 10 women LLC a year to women not use of oral contraceptives. However, the incidence of venous thromboembolism while taking combined oral contraceptives, is less than the rate associated with pregnancy (6 to 10 OOO pregnant women per year).
In women taking combined oral contraceptives are described in extremely rare cases, thrombosis in other blood vessels, eg, hepatic, mesenteric, renal arteries and veins, central retinal vein and its branches.Contact receiving combined oral contraceptive has not been proved.
Symptoms of venous and arterial thrombosis include pain in one leg, its swelling or a combination thereof; sudden onset of severe pain in the chest (regardless of whether it radiates to the left arm); sudden shortness of breath; suddenly starts teasing cough; severe prolonged dull headache; sudden partial or complete loss of vision; diplopia; violation of articulation or aphasia; collapse, sometimes accompanied by local spasms; weakness or very severe paresthesia, suddenly appearing on one side or in one part of the body; motor disturbances; . “acute” abdomen
risk of thrombosis (venous and / or arterial) and thromboembolism is increased:
y smoking (with the number of cigarettes or increasing age the risk further increases, especially in women older than 35 years),
in the presence of:
-Family history (ie venous or arterial thromboembolism ever in close relatives or parents at a relatively young age); if the supposed hereditary predisposition, the woman should be assessed and the appropriate specialist to resolve the question of the possibility of using combined oral contraceptives;
-ozhireniya (body mass index over 30 kg / m2);
-zabolevany heart valves;
-Duration immobilization, major surgery, any surgery to the legs, or major trauma. In these situations it is desirable to discontinue the use of combined oral contraceptives (in the case of the planned operation, at least four weeks prior to her) and not to renew the appointment within two weeks after the immobilization.
It is necessary to take into account the increased risk of thromboembolism during the postpartum period.
Circulatory disorders may also celebrated in diabetes mellitus, systemic lupus erythematosus, hemolytic uremic syndrome, chronic inflammatory bowel disease (Crohn’s disease or ulcerative colitis) and sickle cell disease.
The increase in the frequency and severity of migraine during use of combined oral contraceptives (which may be preceded by cerebrovascular disorders) may be grounds for immediate discontinuation of these drugs.
Biochemical parameters which can be indicative of hereditary or acquired predisposition to venous or arterial thrombosis include resistance to activated protein C, hyperhomocysteinemia, deficiency of antithrombin-III, deficiency of protein C, protein deficit S, antiphospholipid antibody (cardiolipin antibodies, lupus anticoagulant). it should be borne in mind that the risk of thrombosis during pregnancy is higher than when taking combined oral contraceptives.
of the increased risk of cervical cancer in long-term use of combined oral contraceptives has been reported in some epidemiological studies. His connection with the intake of combined oral contraceptives has not been proved. Saved controversy as to the extent to which these findings relate to the characteristics of sexual behavior and other factors such as human papilloma virus.
Meta-analysis of epidemiological studies have demonstrated that there is a slightly increased relative risk (RR = 1.24) of developing breast cancer diagnosed in women who at the time of the study were used combined oral contraceptives. His connection with the intake of combined oral contraceptives has not been proved. The observed increase in risk may be due to an earlier diagnosis of breast cancer in women using combined oral contraceptives. Breast cancers in women who had ever used combined oral contraceptives were clinically less severe than in women, never did not use them
in rare cases during treatment with combined oral contraceptives was observed the development of liver tumors. In case of severe pain in the abdomen, liver enlargement or signs of intra-abdominal bleeding it should be considered in the differential diagnosis.
- Other conditions
Women with hypertriglyceridemia, or a family history of it, we can not exclude an increased risk of developing pancreatitis while taking combined oral contraceptives.
Although a slight increase in blood pressure have been reported in many women taking COCs, clinically relevant increases were rare. However, if while taking combined oral contraceptives develops persistent, clinically significant hypertension, a doctor is prudent for the cancellation of these drugs and the treatment of hypertension. Acceptance of combined oral contraceptives may be continued if using antihypertensive treatment achieved normal blood pressure values.
The following conditions have been reported to develop or worsen both during pregnancy and while taking combined oral contraceptives, but their relationship with the intake of combined oral contraceptives It has not been proven: jaundice and / or pruritus related to cholestasis; the formation of gallstones; porphyria; systemic lupus erythematosus; hemolytic uremic syndrome; chorea; herpes gestationis; hearing loss associated with otosclerosis. Cases of Crohn’s disease and ulcerative colitis during treatment with combined oral contraceptives have also been described.
Acute or chronic disturbances of liver function may require the elimination of the use of combined oral contraceptives, as long as liver function tests have not returned to normal. Recurrent cholestatic jaundice, which develops for the first time during pregnancy or previous use of sex hormones, requires discontinuation of combined oral contraceptives.
Although combined oral contraceptives may have an effect on insulin resistance and glucose tolerance, there is no need to change the therapeutic regimen in diabetics using low-dose COCs (<0.05 mg ethinylestradiol). However, women with diabetes should be carefully observed while taking combined oral contraceptives.
Women with a tendency to chloasma while taking combined oral contraceptives should avoid prolonged exposure to sunlight and ultraviolet radiation.
- Laboratory tests
using combined oral contraceptives can affect the results of certain lab tests, including liver function, kidney, thyroid, adrenal, levels of transport proteins in the plasma, carbohydrate metabolism, coagulation and fibrinolysis parameters.Changes do not usually go beyond the normal range.Interaction with other drugs
Drug interactions that result in increased clearance of sex hormones can lead to breakthrough bleeding and / or reduce the contraceptive reliability.
This has been established with respect to phenytoin, barbiturates, primidone, carbamazepine and rifampicin; also have assumptions about oxcarbamazapine, topiramate, felbamate and griseofulvin. The mechanism of this interaction sustanon 250 gains is based on the change in the work of liver enzymes.
The contraceptive protection is reduced when taking antibiotics (such as ampicillin and tetracycline). This mechanism of action has not been elucidated.
Women treated with any of the above classes of drugs, short-course, in addition to the 20 Miniziston FEM should temporarily use a barrier method of contraception at the time of concomitant drug administration and for 7 days after their cancellation. While receiving rifampicin and for 28 days after its cancellation in addition to 20 Miniziston of themes to be used a barrier method of contraception (eg, condoms). If the use of the following drugs launched in the end of the reception package Miniziston 20 Fem, the next pack should be started without the usual break at the reception.
The women receiving these drugs long course, should be encouraged to other (non-hormonal) method of contraception (eg, condoms).
While taking combined oral contraceptives may experience irregular bleeding (spotting or breakthrough bleeding), especially during the first months of use. Therefore, the evaluation of any irregular bleeding should be performed only after a period of adaptation of approximately three cycles.
If the irregular bleeding recur or develop after previous regular cycles, it should be considered non-hormonal causes and implemented adequate diagnostic measures to exclude malignancy or pregnancy.These may include diagnostic curettage.
In some women withdrawal bleeding may not develop during a break in taking pills. If the drug is taken according to directions, it is unlikely that the woman is pregnant. However, if before the pills are taken regularly or if there are no two consecutive menstrualopodobnyh bleeding, to continue receiving the drug should be excluded pregnancy.
Pregnancy and lactation
Miniziston 20 Fem is not appointed during pregnancy. If pregnancy is detected during the reception Miniziston 20 Fem, the drug immediately canceled. However, extensive epidemiological studies have revealed no increased risk of defects in children born to women treated with hormones prior to pregnancy or teratogenic effects when sex hormones were taken inadvertently in early pregnancy.
Receiving combined oral contraceptives can reduce the amount of breast milk and change its composition, therefore, their use is not recommended during lactation. Small amounts of sex steroids and / or their metabolites may be excreted with the milk but there is no confirmation of their negative impact on the health of the newborn.
Before you start the application Miniziston 20 Fem she will need to undergo a thorough general medical and gynecological examination (including breast examination and cytological examination of cervical mucus), exclude unusual, severe or prolonged headache or migraine attack; partial or complete loss of vision or double vision; slurred speech; sudden changes in hearing, smell or taste; dizziness or fainting;weakness or numbness in any part of the body; severe abdominal pain; severe pain in the leg, or sudden swelling caused any of the legs.
Receptors located on the main surface of parathyroid cells, are the main regulators of secretion of parathyroid hormone (PTH). Tsinakaltset has calcimimetic activity, reducing the concentration of PTH directly, increasing the sensitivity of the receptor to the extracellular calcium.
Reduction of PTH concentration buy sustanon 250 is accompanied by a decrease in calcium content in the blood serum. Reduction of PTH concentration correlates with the concentration tsinakaltseta. After reaching equilibrium state in serum calcium concentration remains at a constant level throughout the dosing interval of the drug.
Three clinical trials of six months (double-blind, placebo-controlled) included patients with end-stage renal disease on dialysis with uncontrolled form of secondary hyperparathyroidism (1136 patients). Patients taking tsinakaltset, there was a significant reduction in the concentration of intact PTH, calcium, phosphorus and serum calcium-phosphate product (Ca × R) compared to placebo in patients who received conventional therapy.
Reduced concentration iGTTG and Ca × P maintained throughout 12 months of therapy. Tsinakaltset reduced concentration iPTH, calcium and phosphorus and Ca × P, regardless of the initial concentrations iPTH or Ca × P dialysis mode (peritoneal dialysis as compared to hemodialysis), duration of dialysis, and whether or not the applied vitamin D.
Reducing the concentration of PTH associated with insignificant decrease bone turnover markers concentrations (bone specific alkaline phosphatase, N-telopeptides of bone turnover and bone fibrosis). A retrospective analysis of the data pool collected for the 6 and 12-month clinical trials, using buy sustanon 250 Kaplan-Meier method. parameters of bone fractures and parathyroidectomy were lower in the group tsinakaltseta comparison with the control group.
Preliminary studies in patients with chronic kidney disease (CKD) and secondary hyperparathyroidism. not on dialysis indicate that PTH concentration tsinakaltset reduced similarly as in patients diagnosed with end-stage renal failure (TSPN) and secondary hyperparathyroidism. on dialysis.
However, for patients with renal failure in the pre-dialysis step were not established the efficacy, safety, dosage and optimum therapy targets. These studies have shown that patients with CKD not on dialysis and receiving tsinakaltset, there is a greater risk of developing hypocalcemia compared to dialysis patients with end-stage renal disease receiving tsinakaltset that may be due to a lower initial concentration of calcium and / or residual renal function.
Mimpara after oral administration of the drug. the maximum concentration (C max ) tsinakaltseta plasma levels achieved after approximately 2-6 hours. Tsinakaltseta absolute bioavailability in the fasting state, established on the basis of comparing the results of different studies was approximately 20-25%. When taken with food tsinakaltseta, its bioavailability is increased by about 50-80%. Such an increase tsinakaltseta plasma concentration was observed regardless of the fat content in food. At dosages of 200 mg saturation absorption is observed, probably due to poor solubility.
There is a high volume of distribution (approximately 1000 liters), which indicates a broad distribution. Tsinakaltset approximately 97% bound to plasma proteins and is distributed at the minimum level in the erythrocytes.
After absorption, decreased tsinakaltseta concentration occurs in two steps with an initial half-life of about 6 hours and final half-life of 30 to 40 hours. The equilibrium state tsinakaltseta concentration is achieved within 7 days with minimal cumulation.
Pharmacokinetic parameters tsinakaltseta not change with time.
Tsinakaltset buy sustanon 250 metabolized by a group of clinical methods). The main circulating metabolites are inactive. According to studies in vitro, , tsinakaltset is a potent inhibitor of CYP2D6, but at concentrations reached in the clinical setting, tsinakaltset does not inhibit the activity of other enzymes CYP. including CYP1A2, CYP2C8, CYP2C9, CYP2C19, and CYP3A4, and also is not an inducer of CYP1A2, CYP2C19H, CYP3A4.
After the introduction of healthy volunteers 75 mg labeled dose radioisotope method tsinakaltset subjected to rapid and substantial oxidative metabolism, followed by conjugation. Excretion of radioactivity was mainly due to renal excretion of metabolites.
Approximately 80% of the injected dose detected in the urine and 15% in feces.
Linearity / non-linearity
Increasing the area under the curve “concentration-time» (AUC) and C max tsinakaltseta occurs almost linearly with dosage range 30-180 mg once a day.
Pharmacokinetic / pharmacodynamic interaction
Soon after the introduction of tsinakaltseta, PTH begins to decrease; wherein the maximum decrease occurs after about 2-6 hours after administration, which corresponds tsinakaltseta maximum concentration (C max ). Thereafter tsinakaltseta concentration starts to decrease and the concentration of PTH increases within 12 hours after dosing, and then PTH suppression remains approximately the same level until the end of the daily dosing regimen while the interval once a day. Concentration of PTH in clinical drug trials Mimpara measured at the end of the dosing interval.
Elderly: pharmacokinetics tsinakaltseta no clinically significant differences related to patient age.
pharmacokinetic profile tsinakaltseta in renal failure mild, moderate and severe, and hemodialysis or peritoneal dialysis is comparable to the pharmacokinetic profile of the drug in healthy volunteers.
– Hepatic impairment: pechenochnayanedostatochnost mild has no significant effect on the pharmacokinetics tsinakaltseta. Compared with the group with normal hepatic function tsinakaltseta average AUC were approximately twice as high in the group with moderate hepatic impairment, and approximately 4-fold higher with severe liver failure. The average half-life tsinakaltseta in patients with moderate and severe hepatic insufficiency, prolonged by 33% and 70%. Liver failure does not affect the binding of proteins tsinakaltseta. Since the selection of doses is carried out on the basis of the parameters of efficacy and safety in patients with hepatic impairment is not required to conduct additional dose adjustment (see. Sections “Dosage and administration”, “Special instructions and precautions”).
Gender: tsinakaltseta clearance may be lower in women than in men. Since the selection of doses are individually not required additional dose correction according to the sex of the patient.
Children: the pharmacokinetics tsinakaltseta has been studied in 12 children (6-17 years) with CKD who are on dialysis, after a single oral dose of 15 mg. The average values of AUC and C max (23.5 (range 7.22 to 77.2) ng * hr / mL and 7.26 (range 1.80 to 17.4) ng / mL, respectively) were within approximately 30 % mean values AUC and C max observed in one study in healthy adults after a single oral dose of 30 mg (33.6 (range 4.75 to 66.9) ng * h / mL and 5.42 (range 1.41 to 12.7) ng / ml, respectively). Due to limited data in children does not exclude potentially more severe exposure tsinakaltseta certain dose in young children, with less weight compared to older children, having more body weight. The pharmacokinetics of repeated doses in children has not been studied.
Smoking: tsinakaltseta clearance is higher in smokers than in metabolism, passing with the participation of CYP1A2. If a patient stops or starts smoking during therapy, tsinakaltseta concentration in plasma may change and may require dose adjustment.
Preclinical safety studies
Preclinical studies did not reveal any genotoxic. no carcinogenic potential tsinakaltseta. Safe range. According to toxicological studies it is quite narrow since in experiments on animals was dose-limiting factor gipokaltsiemnya. The development of cataracts and cataract were observed during the toxicological and carcinogenicity studies in rodents with repeated dosing. However, such phenomena have been observed in experiments on dogs or monkeys or in clinical trials where the monitoring was conducted in relation to cataract formation. It is known that rodents cataracts can occur as a result of hypocalcaemia.
Indications for use:
- Treatment of secondary hyperparathyroidism in patients with end-stage renal disease on dialysis. Mimpara may also be administered as part of combination therapy including agents that bind phosphate and / or vitamin D.
- Reduction of hypercalcemia in patients with parathyroid carcinoma.
- Hypersensitivity to the active component or any other components of the preparation.
- Children under 18 years old.
Use during pregnancy and breast-feeding
Clinical data on the use tsinakaltseta in pregnancy. As shown preclinical studies on rabbits, tsinakaltset crosses the placental barrier. In animal experiments found no direct negative impact on the course of pregnancy, childbirth or postnatal development. There was also revealed no embryotoxic or teratogenic effects in experiments on pregnant female rats and rabbits, except for the germ reduction in body weight in rats using toxic doses in pregnant females. In pregnancy, the drug Mimpara should be used only in cases where the potential benefit justifies the potential risk to the fetus.
is not explored tsinakaltseta excretion in breast milk Until now. Tsinakaltset appears in the breast milk of lactating rats, while there is a high concentration ratio of milk to plasma concentrations. After careful evaluation of risk / benefit ratio should decide to discontinue breastfeeding or receiving Mimpara preparation.
Dosage and administration:
For oral administration. The drug is recommended Mimpara be taken with food or shortly after ingestion of food, since during the study showed that increases bioavailability tsinakaltseta while taking the drug with meals (see., “Pharmacokinetic Properties”).
The tablets should be taken as a whole, without dividing them.
In the treatment of patients with hepatic impairment, the starting dose is not required to change. The drug Mimpara should be taken with caution to patients suffering from liver failure in the moderate and severe forms. It should be carefully monitored for treatment during dose titration and long-term therapy (see. “Special instructions and precautions”, “Pharmacokinetic properties”).
Adults and elderly (> 65 years)
The recommended starting dose for adults Mimpara drug is 30 mg once a day. Mimpara dose titration should be performed every 2-4 weeks to a maximum dose of 180 mg (once per day), in which in dialysis patients achieved the required level of PTH in the range of 150-300 pg / ml (15.9-31.8 pmol / L) defined the content of iPTH. PTH level analysis should be conducted no earlier than 12 hours after taking the drug Mimpara. In assessing the level of PTH should adhere to current guidelines.
Measurement of PTH levels should be performed 1-4 weeks after initiation of therapy and dose adjustment I Mimpara preparation When receiving a maintenance dose, monitoring ^ PTH levels should be carried out approximately every 1-3 months. For PTH level measurement, you can use the content of iPTH or biointaktnogo PTH (biPTG); therapy with Mimpara does not alter the relation between iPTH and biPTG. Information about famakokineticheskom / pharmacodynamic (PK / PD) profile tsinakaltseta see Pharmacodynamic properties.
During titration often necessary to carry out monitoring of the level of calcium in blood serum, including 1 week after initiating therapy or dose adjustments buy sustanon 250 drug. Upon reaching a maintenance dose, serum calcium levels should be measured about once a month. If serum calcium levels decrease below the normal range, appropriate steps should be taken (see. “Special instructions and precautions”).Concomitant therapy using drugs bind phosphate and / or Vitamin D, should be adjusted as needed.
Carcinoma of the parathyroid glands
Adults and elderly (> 65 years)
The recommended starting dose of Mimpara preparation for adults is 30 mg, the multiplicity of reception: twice a day. Mimpara dose titration should be performed every 2-4 weeks following sequence changes dosage: 30 mg twice daily, 60 mg twice daily, 90 mg twice daily and 90 mg three or four times daily as needed to reduce calcium concentration in the serum to an upper limit of the normal range or below this level. The maximum dose is used in clinical studies was 90 mg for the multiplicity of receiving four times a day. calcium levels in serum should be measured within 1 week after initiation of therapy and dose adjustment of Mimpara preparation. Upon reaching a maintenance dose, serum calcium levels should be measured every 2-3 months. After titration to the maximum dose of the drug dosage Mimpara, periodic monitoring of calcium levels in serum should be carried out; if you can not maintain a clinically significant reduction in the level of calcium in the blood serum, should decide on the termination of therapy with Mimpara ( “Pharmacodynamic properties” see.).
Metabolic disorders and eating
Disorders of the nervous system
Common: dizziness, paraesthesia.
Disorders of the gastrointestinal tract
Very common: nausea, vomiting.
Sometimes: dyspepsia, diarrhea.
Disorders of the skin and subcutaneous tissue disorders
Violations of the skeletal muscle, connective tissue and bone
General disorders and reactions to the drug
Common: hypocalcaemia (see section “Special instructions and precautions.”), Reduced testosterone levels (see section “Special instructions and precautions.”).
Carcinoma of the parathyroid glands
The safety profile of Mimpara in this patient population is generally consistent with the picture, ^ observed in patients suffering from chronic kidney disease. In this population of patients with the most common side effects were nausea and vomiting.
In patients with heart failure and receiving tsinakaltset during post-marketing studies, individual recorded idiosyncratic cases of hypotension and / or worsening heart failure.
Doses were titrated to a level of 300 mg (once a day), safe for patients who are on dialysis.
Overdose drug Mimpara may lead to hypocalcaemia. In case of overdose, patients should be monitored signs and symptoms of hypocalcemia. There should be symptomatic and supportive therapy. Since the degree of binding with proteins tsinakaltseta high, hemodialysis is not an effective therapeutic approach in overdose.
Interaction with other drugs
Effect of other drugs on tsinakaltset
Tsinakaltset partly metabolized by CYP3A4 enzyme. Simultaneous administration of ketoconazole 200 mg twice daily (expressed inhibitor of CYP3A4) resulted in increased levels tsinakaltseta about 2 times.You may need a dose adjustment drug Mimpara if the patient during therapy starts or stops taking a potent inhibitor (eg, ketoconazole, itraconazole, telithromycin, voriconazole, ritonavir) or inducer activity of this enzyme (eg rifampicin) (see. “Special instructions and precautions “)
The data obtained in the experiments in vitro suggest that tsinakaltset partially metabolized CYP1A2 enzyme.
Smoking stimuliruetaktivnost CYP1A2; it was noted that tsinakaltseta clearance at 36-38% higher in smokers than non-smokers. The effect of CYP1A2 inhibitors (fluvoxamine, ciprofloxacin) on tsinakaltseta levels has not been studied in plasma. You may need a dosage adjustment if during therapy with Mimpara patient starts or stops smoking or begins, or ceases to simultaneous reception of powerful SYP1A2 inhibitors.
Calcium carbonate: Concomitant use of calcium carbonate (1500 mg single dose) did not alter the pharmacokinetics of tsinakaltseta.
Sevelamer: Concomitant use of sevelamer (2400 mg three times daily) had no effect on the pharmacokinetics of tsinakaltseta.
Pantoprazole: Concomitant use of pantoprazole (80 mg once daily) did not alter the pharmacokinetics of tsinakaltseta.
tsinakaltseta effect on other drugs
Medicinal products metabolised by the enzyme P450 2D6 (CYP2D6): Tsinakaltset is a potent inhibitor of CYP2D6. You may need a dose adjustment of drugs while taking a drug Mimpara if such funds are predominantly metabolized of CYP2D6, have a narrow therapeutic index and require individual selection of doses (eg, flecainide, propafenone, metoprolol (appointed in heart failure), desipramine, nortriptyline, clomipramine ). (See. “Special instructions and precautions”)
Desipramine: Simultaneous administration dose of 90 mg tsinakaltseta once daily with 50 i desipramine, tricyclic antidepressants, predominantly metabolising CYP2D6, significantly increased the level of exposure to desipramine (3.6 times) (90% CI 3, 4.4) in patients with active metabolism of CYP2D6.
Warfarin: Multiple oral tsinakaltseta did not affect the pharmacokinetics or pharmacodynamics of warfarin (measured by prothrombin time and factor VII clotting).
Tsinakaltseta no effect on the pharmacokinetics of R- and S- warfarin and lack of autoinduction enzymes in patients following multiple dosing indicates that the inducer is not tsinakaltset CYP3A4, CYP1A2 or CYP2C9 in humans.
Special instructions and precautions
In clinical studies seizures were observed in 1.4% of patients receiving Mimpara preparation and in 0.7% of patients in the placebo group. Although the reasons for the reported difference in the appearance of seizures is unclear, the seizure threshold is lowered with a significant decrease in the concentration of calcium in the blood serum.
Hypotension and / or worsening heart failure
in patients with heart failure, taking tsinakaltset during postmarketing observations, recorded some idiosyncratic cases of hypotension and / or worsening of heart failure, in which a causal relationship to tsinakaltsetom can not be completely excluded and may be due to a decrease in calcium concentration in the serum. Data from clinical studies showed that hypotension occurred in 7% of patients treated with tsinakaltset and 12% of placebo-treated patients, and heart failure – in 2% of patients receiving placebo or tsinakaltset.
Treatment with Mimpara should not be carried out at a calcium concentration in serum (corrected for albumin) below the lower limit of the normal range. Since tsinakaltset lowers calcium concentration in the serum, you must be closely monitored with regard to the development of hypocalcemia (see. “Dosage and Administration” section). Patients diagnosed with CKD who are on dialysis, Mimpara when taking the drug. calcium concentration in the serum was 4% less than 7.5 mg / dL (1.875 mmol / L). In the case of hypocalcemia, increase of calcium concentration in the serum can be used fosfagevyazyvayuschie calcium-containing drugs, vitamin D and / or carry out the correction of calcium concentration in the dialysis solution.
When stable hypocalcemia should reduce the dose or stop taking Mimpara. Potential symptoms of hypocalcemia may be paresthesia, myalgia, cramps and tetany. Tsinakaltset not indicated for patients diagnosed with CKD not on dialysis.
Preliminary studies have shown that patients diagnosed with CKD not on dialysis increases the risk of hypocalcemia (concentration of serum calcium <8.4 mg / dL [2.1 mmol / L]) as compared with patients on dialysis, which can be due to the lower initial concentration of calcium and / or presence of residual renal function.
In chronic suppression of PTH concentration below the concentration of about 1.5 on the upper limit of normal for the results of the analysis of iPTH, adynamic bone disease. If PTH concentration falls below the recommended range, you should reduce the dose of Mimpara and / or of vitamin D, or to discontinue therapy.
testosterone concentration is often below the normal range in patients with end-stage renal failure. Data from clinical trials, which included patients with and those on TSPN diatize showed that free testosterone concentration was reduced by an average of 31.3% in patients taking the drug buy sustanon 250 and 16.3% of patients in the placebo group at 6 months after initiation of therapy. Open prolonged phase of this study showed no further decrease in the concentration of free and total testosterone in patients over a 3-year period of treatment with Mimpara. The clinical significance of reducing serum testosterone concentrations has not been established.
The drug should be used with caution in patients with hepatic insufficiency, moderate and severe (for the Child-Pugh classification). tsinakaltseta as plasma concentrations may be 2-4 times higher, should be closely monitored during treatment (see. sections “Dosage and administration”, “Pharmacokinetic properties”).
Clinical evidence tsinakaltseta exposure on fertility are not available. Animal experiments showed no effect on fertility.
Mimpara contains lactose as excipient (each tablet contains 30 mg of lactose 2.74 mg, each tablet contains 60 mg of lactose 5.47 mg, each tablet contains 90 mg 8.21 mg Lactose). Patients with rare hereditary galactose intolerance, Lapp lactase deficiency or malabsorption glyukogalaktozy should not take the drug.
Effects on ability to drive vehicles, machinery
Studies on the effect of the drug on the ability to drive or work not carried out with complex mechanisms. However, certain adverse reactions may affect the ability to drive or operate complex mechanisms (see. “Side effects” section).
Sustanon 250 reviews have a beneficial effect on inflammatory and degenerative diseases of the nerves and the skeletal system. Contribute to increased blood flow, and improve the functioning of the nervous system. Thiamine plays a key role in the metabolism of carbohydrates, and in the Krebs cycle with subsequent participation in the synthesis of TPP (thiamine pyrophosphate), and ATP (adenosine triphosphate). Pyridoxine is involved in the metabolism of protein, and in part in the metabolism of carbohydrates and fats. The physiological function of both vitamins is a potentiation of each other, which manifests itself in a positive impact on the nervous, neuromuscular and cardiovascular systems. At deficiency of vitamin Wb widespread deficiency state quickly cease after the introduction of these vitamins. Cyanocobalamin is involved in the synthesis of the myelin sheath, it stimulates hematopoiesis, reduces the pain associated with a lesion of the peripheral nervous system, stimulates the exchange of nucleic acid through a folic acid activation. Lidocaine -mestnoanesteziruyuschee means for causing all kinds of local anesthesia: terminal, infiltration, and conductors.
After intramuscular thiamine is rapidly absorbed from the injection site and enters the blood (484 ng / ml after 15 minutes on the first day of dosing with 50 mg) and unevenly distributed in the body when its content in leukocytes of 15% red blood cells of 75% and plasma 10%. In the absence of significant reserves in the body of vitamin, it must be ingested daily. Thiamine penetrates the blood-brain and placental barriers and is found in breast milk. Thiamine is excreted in the urine through the alpha phase of 0.15 hours, the beta phase – after 1 hour in the terminal phase – for 2 days. The major metabolites are tiaminkarbonovaya acid Pyramin and some unidentified metabolites. Of sustanon 250 reviews all the vitamins thiamine stored in the body in the smallest amounts. An adult human contains about 30 mg of thiamine as thiamine pyrophosphate, 80%, 10% thiamine triphosphate and the remaining amount as thiamine monophosphate. After intramuscular injection of pyridoxine is rapidly absorbed into the bloodstream and distributed in the body, acting as a coenzyme after phosphorylation group CH 2 OH in the 5th position. About 80% of vitamin binds to plasma proteins. Pyridoxine is distributed throughout the body and crosses the placenta and is found in human milk, is deposited in the liver and is oxidized to 4-pyridoxine acid, which is excreted in the urine, a maximum 2-5 hours after absorption. The human body contains 40-150 mg of vitamin Wb and its daily elimination rate of approximately 1,7-3,6 mg at 2.2-2.4% fill rate.
As a pathogenetic and symptomatic treatment in the complex therapy of diseases and syndromes of the nervous system of various origins: neuralgia, neuritis, facial nerve paresis, optic neuritis, ganglionitis (including herpes zoster), plexopathy, neuropathy, polyneuropathy (diabetic, alcohol, etc..) nocturnal muscle cramps, particularly in older age groups, the neurological manifestations of osteochondrosis: radiculopathy, lumbar ischialgia, muscular-tonic syndromes.
Pregnancy and breast-feeding ( see. Section “Use in <pregnancy and breastfeeding period” ).
Decompensated heart failure.
Increased individual sensitivity to the drug.
Pregnancy and lactation:
use of the drug is contraindicated ‘during pregnancy and breast-feeding ( see “Contraindications” section. ).
Dosing and Administration
Injection is performed by deep intramuscular injection.
In cases of severe pain syndrome for the rapid achievement of a high level of drug in the blood, it is advisable to start treatment with 2.0 ml daily for 5-10 days. Subsequently, after decrease pain and mild forms of disease or transferred further to therapy dosage form for oral administration (e.g., a drug kompozitum) or on rarer injection (2-3 times per week for 2-3 weeks) with the possible continuation of therapy dosage form for oral administration
(eg, drug sustanon 250 reviews compositum). Recommended weekly monitoring by a physician therapy.
Going to therapy dosage form for oral administration is recommended in the most possible short time. Running low dose t3 clen cycle trying to lose bodyfat isn’t a real hot idea imo.
The reasons for the unique selective effect of busulfan on granulocytopoiesis not been fully established. Although the drug does not allow to achieve cure, but it significantly reduces the total number of granulocytes and results in relief of symptoms and improvement of the general condition of patients. Therapy sustanon 250 cycle busulfan was more effective than irradiation spleen on such criteria as the survival and maintain the hemoglobin level; the effectiveness of both methods did not differ in their effect on spleen size.
The half-life was 3.4 hours after the first dose, and 2.3 hours after the last dose. These data suggest that the busulfan may increase the speed of its own metabolism with repeated use.
Stationary busulfan plasma concentration range from 0.5 to 2.0 micrograms / ml (8.2 mM). Sustanon 250 cycle plasma concentrations were 3,1-5,9 mg / ml in a patient who received a total dose of 16 mg / kg, and 3,8-9,7 mg / ml in two patients who received a total dose of 20 mg / kg.
Patients receiving high doses of busulfan and its metabolites were detected in urine 3-gidroksisulfolan, tetrahydrothiophene-1-oxide and sulfolane. A small amount of the drug (1-2%) is excreted in the urine in unchanged form.
When administered in high doses busulfan penetrates into the cerebrospinal fluid, where its concentration is comparable to plasma. Value busulfan concentrations in plasma and cerebrospinal fluid averaged 1.3: 1. Value for busulfan concentrations in saliva and plasma is 1.1:. 1
degree reversible binding to plasma proteins varies from negligible to 55%. The degree of irreversible binding to blood cells and plasma proteins is 47% and 32%.
busulfan is used for the palliative treatment of chronic myeloid leukemia in the chronic phase of the disease.
Busulfan cause long-term remission in polycythemia vera, especially occurring with marked thrombocytosis.
Busulfan may be effective in some cases in essential thrombocythemia and myelofibrosis.
- patients with previously identified resistance to busulfan;
- patients with hypersensitivity to any component of the formulation.
DOSAGE AND ADMINISTRATION
busulfan usually prescribed courses or permanently. Dose picked individually for each patient depending on the clinical condition and hematological parameters. If the patient requires the dose less than 2 mg / day (less than one tablet), a drug may be administered every day, and at intervals of one or more days. Share tablet into parts is impossible. Chronic myelogenous leukemia. The induction of remission in adults : Treatment is usually started immediately after diagnosis. The dose is 0.06 mg / kg / day; maximum starting dose is 4 mg / day, it can be administered in one step. Individual reaction to busulfan is variable; some patients can be high sensitivity of bone marrow cells to the drug. During remission induction control blood tests should be carried out at least once a week. The dose should only be increased in the absence of the desired effect after 3 weeks of treatment. The treatment should continue as long as the total number of cells decreases to 15-25h10 9 / L (typically within 12-20 weeks). Then treatment can be interrupted; then for a further 2 weeks further decrease the number of leukocytes can occur. Continued treatment in an induction dose after this point or after the platelet count of less than 100×10 9 / L accompanied by a significant risk of prolonged and possibly irreversible bone marrow aplasia. Maintenance therapy in adults . Long-term remission of leukemia can be achieved without further therapy busulfan; additional courses of treatment is usually carried out by increasing the number of leukocytes before 50h10 9 / L or when the symptoms of the disease. Some experts prefer to carry out continuous maintenance therapy. Continuous treatment is more grounded with a short duration of remission. The goal of treatment – to support the number sustanon 250 cycle of leukocytes at 10-15h10 9 / L; the number of blood cells should be monitored at least once every 4 weeks. Usually, a maintenance dose of 0.5-2 mg / day, but in individual cases it may be considerably lower. NOTE : busulfan should be administered at lower doses, if it is used in combination with other cytotoxic agents. Child . Chronic myeloid leukemia in children is rare. Busulfan may be used for the treatment of leukemia with the Philadelphia chromosome (Ph’-positive). Juvenile Ph’-negative variant on busulfan therapy responds poorly. Polycythemia vera . Generally, the dose is 4-6 mg / day; treatment is carried out for 4-6 weeks under careful control of blood cells especially platelets. With the development of relapses can be resumed course therapy or may alternatively be held in a maintenance therapy dose of about half of the induction dose. If the treatment is mainly carried polycythemia by venesection, is to monitor the number of platelets short courses. can be assigned Myelofibrosis . Typically, the initial dose is 2-4 mg / day. busulfan Careful monitoring of hematological parameters, given the very high sensitivity of bone marrow cells in myelofibrosis. Essential thrombocythemia . Generally, the dose is 2-4 mg / day. Treatment should be discontinued if the total number of white blood cells is reduced less than 5×10 9 / l or a platelet count of less than 500h10 9 / l.
In relation to this drug is no modern clinical data that could be used to determine the frequency of side effects. The incidence of side effects may vary depending on the dose received by the patient busulfan, as well as used in combination with the other preparations.
Histological features include atypical changes in the epithelium of the alveoli and bronchioles and the presence of giant cells with large nuclei giperhromaticheskimi. In case of a toxic lung disease prognosis despite the abolition of busulfan unfavorable, in this situation, use of corticosteroids is not enough.Interstitial pulmonary fibrosis usually develops gradually, but may have a sharp current. This pathology may be complicated by pulmonary infection. Described as ossification and dystrophic calcification of the lungs. It is possible that subsequent radiotherapy can enhance subclinical lung damage caused by busulfan. Other cytotoxic agents may cause additive lung toxicity defeat. On the part of the gastrointestinal tract : Very common: nausea, vomiting, diarrhea and ulceration of the oral mucosa when using high doses of busulfan. Probably the symptoms can be alleviated by the use of fractional doses. Hepatobiliary disorders : Very frequent: hyperbilirubinemia, jaundice, hepatic vein occlusion and tsentrolobulyarny sinusoidal fibrosis with hepatocellular atrophy and necrosis at high doses; Rare:. cholestatic jaundice and abnormal liver function with conventional doses tsentrolobulyarny sinusoidal fibrosis is believed that in the usual therapeutic doses of busulfan has no significant toxic effect on the liver. However, a retrospective analysis of pathological data of patients who received low-dose sustanon 250 cycle busulfan for at least two years for chronic granulocytic leukemia, revealed the presence of tsentrolobulyarnogo sinusoidal fibrosis. The combination of busulfan and thioguanine has a strong toxic effect on the liver. Skin and subcutaneous tissue disorders : frequent: alopecia at high-dose treatment, hyperpigmentation; Rare: Alopecia at conventional dose, skin reactions including urticaria, multiforme erythema, erythema nodosum, porphyria cutanea tarda, rash allopurinolovogo type, as well as excessive dryness and skin fragility full anhidrosis, dryness of the oral mucous membranes and cheilosis, Sjogren’s syndrome. More pronounced ray skin changes in patients receiving radiotherapy soon after high-dose busulfan treatment. There are cases of hyperpigmentation, particularly in dark-skinned patients. Often, it is most pronounced in the neck, upper trunk, nipples, abdomen and on the palmar creases. Hyperpigmentation can be part of a clinical syndrome. On the part of the kidney and urinary tract infections : Frequent: hemorrhagic cystitis in the treatment of high dose in combination with cyclophosphamide. Reproductive system and breast : very common: inhibition of ovarian function and amenorrhea with the symptoms of menopause in patients premenopausal in the treatment of high doses; severe and persistent ovarian failure, including the lack of puberty after administration of high doses of young women and girls who have not reached adolescence. Sterility, azoospermia and testicular atrophy in men receiving busulfan; infrequent: inhibition of ovarian function and amenorrhoea with menopausal symptoms in pre-menopausal patients at conventional dose treatment. In very rare cases, recovery of ovarian function were observed with continued treatment; very rare: gynecomastia Research busulfan in animal studies revealed its toxic effects on the reproductive system. Violations of the general : very rare: Clinical syndrome (weakness, severe fatigue, anorexia, weight loss, nausea and vomiting, skin hyperpigmentation) resembling adrenal insufficiency (Addison’s disease) but without biochemical evidence of adrenal suppression, mucous membrane hyperpigmentation and hair loss; rare: common epithelial dysplasia. (observed in rare cases after prolonged busulfan therapy). This syndrome is sometimes disappearing after the abolition of busulfan. In patients treated with busulfan, found numerous histological and cytological changes, including widespread dysplasia of cervical epithelium, the epithelium of bronchi and other sites. In most cases such changes occur in the results of long-term therapy, however transient anomaly described epithelium and after short-term treatment with high doses.
Overdose Symptoms : the manifestation of acute dose-limiting toxicity of busulfan in man is myelosuppression. If busulfan used at the high dose in combination with bone marrow transplantation, the dose-limiting factor is the toxic effect on the gastrointestinal tract with lesions of the mucous membranes, nausea, vomiting, diarrhea and anorexia. The main manifestation of chronic drug overdose – inhibition of bone marrow function and pancytopenia. Treatment : antidote is unknown. Information on the possible effectiveness of dialysis there. In the presence of signs of toxic effects on hematopoiesis conduct appropriate symptomatic therapy.
INTERACTION WITH OTHER DRUGS
A combination of busulfan with other cytotoxic drugs may enhance toxic sustanon 250 cycle effects on lung tissue.
The appointment of phenytoin to patients receiving high-dose busulfan may result in a reduction of the effect of the latter.
The simultaneous use of busulfan and itraconazole may reduce the clearance of busulfan.
Cautions busulfan is a cytotoxic agent which should only be used under the supervision of physicians experienced in the use of these drugs. In the intact outer shell of the use of busulfan tablets do not pose a risk. Tablets should not be divided into parts. When using busulfan tablets should comply with the recommendations for the use of cytotoxic drugs. Busulfan should abolish the appearance of signs of toxic effects on lung tissue. Typically, busulfan not used in combination with radiotherapy or shortly after a course of radiotherapy. Busulfan is not effective under blast transformation. If patients with possible toxic lesions of the lungs in need of general anesthesia, the concentration of inspired oxygen should be kept at the lowest safe level; in the postoperative period is necessary to carefully monitor and maintain respiratory function. In patients with CML often marked hyperuricemia and / or hyperuricosuria that should be removed prior to administration of busulfan. During treatment with busulfan necessary prevention of hyperuricemia and Uric acid nephropathy, including adequate fluid intake and the use of allopurinol. It should be very careful when using busulfan for the treatment of polycythemia vera and essential thrombocythemia, considering the carcinogenic properties of the drug. If these diseases are not recommended for busulfan in young patients or in the absence of symptoms. If the appointment of busulfan necessary, treatment courses should be as short as possible. In the treatment of patients with high doses of busulfan should take anticonvulsant drugs for prophylactic purposes; preferable to prescribe benzodiazepine than phenytoin. At the same time taking busulfan and itraconazole should carefully monitor the condition of a patient for the purpose of early detection of signs of busulfan toxicity. Monitoring the . During treatment with busulfan should be regularly monitoring blood count in order to avoid severe myelosuppression and irreversible bone marrow aplasia. Mutagenic and carcinogenic properties . In patients treated with busulfan, a variety of chromosomal aberrations were observed. According to the WHO concluded there is a causal relationship between busulfan exposure and cancer development. In patients treated with busulfan for a long time, revealed widespread epithelial dysplasia; Some changes were similar to precancerous. Several patients receiving busulfan, cases of malignant tumors are described. There is evidence that the busulfan as other alkylating agents has leykozogennoe action. Although acute leukemia is probably a component of the natural history of polycythemia vera, prolonged alkylating agent therapy may increase the risk of its development. Teratogenic properties . Busulfan is teratogenic in animal studies, and has the potential teratogenic in humans. It described several cases of birth defects, which were not necessarily associated with busulfan; use of the drug in the third trimester of pregnancy may be associated with violation of fetal growth. At the same time, we know many cases of the birth of healthy children after exposure to busulfan in vivo, even during the first trimester of pregnancy. Fertility . In premenopausal women frequently observed the suppression of ovarian function and amenorrhoea with menopausal symptoms. In rare cases, recovery of ovarian function was noted in the continuation of treatment. Treatment with high-dose busulfan girls during childhood and adolescence, leading to ovarian failure, including the lack of puberty. Busulfan violates spermatogenesis in experimental animals; male sterility described cases, azoospermia, and testicular atrophy.
Pregnancy and lactation
As with any treatment with cytotoxic drugs, while taking busulfan any of the partners is necessary to comply with measures to prevent pregnancy.
It is possible to avoid the appointment of busulfan during pregnancy, especially during the first trimester. In each case it is necessary to assess the potential risk to the fetus and the expected benefit to the mother.
Women taking busulfan sustanon 250 cycle is not recommended to breastfeed.
Meldonium is a precursor of carnitine, a structural analog of gamma-butyrobetaine sustanon 250, a substance that is in every cell of the human body.
In high load conditions meldonium restores the balance between delivery and cellular oxygen demand, eliminating the accumulation of toxic products of metabolism in the cells, protecting them from damage; also has a tonic effect. As a result of its use increases the body’s resistance to stress and ability to quickly restore energy reserves.
The drug has a stimulating effect on the central nervous system (CNS) – increase of motor activity and physical stamina. Because of these properties use including to enhance physical and mental performance.
After oral administration, the drug is rapidly absorbed, bioavailability – 78 .% Maximum concentration (the C max ) in plasma is achieved in 1-2 hours after ingestion. It is metabolized in the body mainly in the liver with the formation of two major metabolites are excreted by the kidneys. The half-life (T 1 / 2 ) when administered depends on the dose sustanon 250, it is 6.3 hours.
Health and sustanon 250 in pregnant women has not been studied, therefore, in order to avoid possible adverse effects on the fetus, use of the drug is contraindicated in pregnant women.
Withdrawal of milk and effects on the health of the newborn have not been studied, therefore, if necessary, the drug should stop breastfeeding.
Inside. The daily dose for adults is 500 mg (2 capsules). All dose used in the morning at one time or dividing it into 2 doses. The course of treatment -. 10-14 days if necessary, repeat the treatment after 2-3 weeks. In connection with a possible stimulating effect of the drug is recommended in the morning.
Meldonium usually well tolerated. . However, in susceptible patients, as well as in cases of exceeding the recommended dose may cause adverse reactions Adverse drug reactions are grouped by system-organ classes according to the following gradation frequency: very common (> 1/10), common (> 1/100 and < 1/10), uncommon (> 1/1000 and <1/100), rarely (> 1/10 000 and <1/1000) and very rare (<1/10 000), the frequency is not known – according to available data to estimate the frequency impossible.
From the blood and lymphatic system
Frequency unknown: eosinophilia.
On the part of the immune system
Common: allergic reactions (redness, rash, itching, swelling).
With the side of the heart
Very rare: tachycardia.
From the side of blood vessels
Very rare: decrease in blood pressure.
On the part of the gastrointestinal tract Common: dyspepsia
From the nervous system Common: headache;
Frequency unknown: excitement.
Frequency unknown: weakness.
If any of thesesustanon 250 instructions side effects are compounded, or if you notice any other side effects not mentioned in the instructions, inform your doctor.
No cases of overdose were reported meldonium. The drug has low toxicity and does not cause severe adverse reactions.
Symptoms: lowering blood pressure, accompanied by headache, tachycardia, dizziness and general weakness.
Treatment : symptomatic.
In severe overdose need to monitor liver and kidney function.
Meldonium allowed simultaneously used with long-acting nitrates, and other antianginal drugs, cardiac glycosides and diuretics. It can also be combined with anticoagulants, antiplatelet agents, antiarrhythmic drugs and other drugs that improve the microcirculation.
Meldonium may increase the effects of nitroglycerin, nifedipine, beta-blockers, other antihypertensive agents and peripheral vasodilators. The simultaneous use of the drug with other drugs meldonium is not allowed because it can increase the risk of adverse reactions.
Patients with chronic diseases of the liver and kidneys should be careful with long-term use of the drug. If necessary, long-term (over a month) use of the drug should consult with a specialist.
As a result of its use of the body acquires the ability to withstand stress and to quickly restore energy reserves. Because of these properties sustanon 300 is used to treat a variety of disorders of the cardiovascular system, the blood supply to the brain, as well as to improve physical and mental performance. As a result of reducing the concentration of carnitine is synthesized hard gamma-butyrobetaine, which has vasodilating properties. In the case of acute ischemic myocardial injury inhibits the formation of necrotic areas, shorten the rehabilitation period. In heart failure, increases myocardial contractility, increases exercise tolerance, reduces the frequency of angina attacks. In acute and chronic ischemic cerebrovascular disorders improves blood circulation in the ischemic focus, promotes redistribution of blood to the ischemic area. The drug eliminates functional disturbances of the nervous system in patients with chronic alcoholism in the syndrome of abstinence. Bioavailability drug after intravenous administration is 100%. The maximum plasma concentration is reached immediately after its introduction. It is metabolized in the body into two major metabolites which the kidneys.
In the treatment of coronary heart disease (angina, myocardial infarction); chronic heart failure and cardiomyopathy dyshormonal, as well as in the treatment of acute and chronic disorders of blood supply to the brain (stroke and cerebrovascular insufficiency). Hemophthalmus and retinal hemorrhages of different etiologies, thrombosis of the central retinal vein and its branches, retinopathy of different etiology (diabetic, hypertensive). Reduced performance; mental and physical stress (including athletes). abstinence syndrome in alcoholism (in combination with a specific treatment of alcoholism).
Hypersensitivity to the drug testosterone sustanon, increased intracranial pressure (in violation of the venous outflow, vnutricheregshyh tumors), age 18 years (effectiveness and safety have not been established), pregnancy, lactation.
Application of pregnancy and during breastfeeding
Health and Safety in pregnant women has not been studied, therefore, in order to avoid possible adverse effects on the fetus, its use is contraindicated. Isolation sustanon 300 milk and its impact on the health of the newborn have not been studied, so, if you must use, should stop breastfeeding.
Dosing and Administration
In view of the possible development of stimulating effect, it is recommended to use in the morning. Mildronat administered intramuscularly (i / m), intravenous (i / v) and parabulbarly. The route of administration, the dose and duration of treatment is determined individually depending on the indication, the severity of the condition and others. 1. Cardiovascular diseases in the complex therapy:
- coronary heart disease (myocardial infarction) in / jet by 0.5-1.0 g per day applying the entire dose at once or dividing it into 2 of the introduction;
- coronary heart disease (stable angina); congestive heart failure and cardiomyopathy dyshormonal in / jet by 0.5-1.0 g per day (5-10 ml of the, applying the entire dose at once or dividing it into 2 administration, or / m 0.5 g 1-2 times a day, a course of treatment 10-14 days, followed by transfer to a reception inside. The total course of treatment 4-6 weeks. 2. Cerebrovascular accidents in the complex therapy in the acute phase of 0.5 g 1 time per day / in 10 days, going to the ingestion of 0.5-1 The total course of treatment – 4-6 weeks. In chronic cerebrovascular insufficiency (vascular encephalopathy) 0.5 g sustanon 300in / m or / 1 time a day for 10 days, followed by 0.5 g orally. The total course of treatment -4-6 weeks. Repeated courses (usually 2-3 times a year) are possible after consultation with the doctor. 3. Ophthalmopathology (hemophthalmus and retinal hemorrhages of different etiologies, thrombosis of the central retinal vein and its branches, retinopathy of different etiology (diabetic, hypertensive)). 0.05 g (0.5 ml of the drug parabulbarno within 10 days. Including used in a combination therapy. 4. The mental and physical overload of 0.5 g in / m or / 1 time per day. The course of treatment -10-14 days. If necessary, repeat the treatment after 2-3 weeks. 5. Chronic alcoholism , 0.5 g (5 ml sustanon 300 / m or / in 2 times a day. The course of treatment -7-10 days.
Rarely – allergic reactions (redness, rash, itching, swelling), as well as dyspepsia, tachycardia, decrease or increase in blood pressure, agitation.Very rarely – eosinophilia, general weakness.
Symptoms: lowering blood pressure, accompanied by headache, tachycardia, dizziness and general and does not cause side effects and dangerous to patient health.
Interactions with other drugs can be combined with antianginal drugs, anticoagulants, antiplatelet agents, antiarrhythmics, diuretics, bronchodilators. Enhances the effect of cardiac glycosides. In view of the possible development of mild tachycardia and hypotension, caution should be exercised when combined with nitroglycerin, nifedipine, alpha-blockers, other antihypertensive agents and peripheral vasodilators, enhances their effect.
Many years of experience in the treatment of acute myocardial infarction and unstable angina in cardiology departments shows that Mildronat not the drug of I series with acute coronary syndrome and its use is not absolutely necessary.
Effects on ability to drive and use machines There are no data on the adverse effects of the drug speed of psychomotor reactions.
Most untrained people in Australia, at the very beginning of their physical struggles face the onset of rapid fatigue. Or as another example - you see the approaching bus and rushing headlong for a stop. But after a few seconds your pace begins to subside. The body is not accustomed to the load starts to overwork and the speed of running begins to fall. At such moments, you wonder how it would be super to have good endurance and not choke after jogging at 100 meters. A hardy person can be identified right away - developed musculature, accuracy and clarity of movements, posture, and so on.
Determination of endurance and its types
At the very beginning should still know what endurance. There are different definitions of this term, but the sports community on the side of the definition, which gave physiologist V. Farfel. Endurance - the ability of a person to resist the advancing fatigue. A fairly complete and concise definition. To date, there are many different methods and programs to improve endurance, but the development and improvement of the quality of the case is far from quick.
Endurance manifests itself in two main forms:
- The duration of operation at the same power level until the first signs of fatigue
- Speed operation upon the occurrence of fatigue
Additionally, you can still be noted that the endurance allows the body to recover faster after exercise.
During endurance training is highlighted in red blood cells. They contribute to an increased consumption of oxygen in human organs. In this way we improve lung capacity, improves the respiratory muscles and in general the whole anaerobic processes in the body.
Since their training, it is necessary to put the exact problem solving which you will develop and maintain the health of your body. They are solved in the course of special and general physical training. Therefore, endurance is further divided into:
- Special - a specific type of activity. This endurance is more suitable for athletes. Development of this type of constitution is performed by performing a specific exercise. For example, special endurance in boxing, developed through long-term work on the bag.
- General (or aerobic) - for continuous operation of moderate intensity, with the participation of a large group of muscles. As you might guess in this type of endurance, energy is taken "out of thin air" Such energy can be generated on the training of the cardiovascular or respiratory systems. In addition, the overall endurance is an integral part of the comprehensive development of every person as It is a kind of base for special endurance.
To build endurance professionals recommend to try to follow a few simple rules that will enhance the effectiveness of training:
A simple implementation technique
- The possibility of a prolonged exercise complex
- The active work of the majority of muscle groups
- Increased activity of systems which limit the time endurance.
Today, there are various methods for the development of endurance, built on five principles
Development of general endurance in Australia
To begin to develop overall endurance is better to stick to a uniform rate of exercise at first. The combination of the various components of exercise should be such that the most appropriate classes induced response in the organism and maximum endurance growth. But this beginning is suitable for people who are already a little familiar with physical exertion. And what about those who have never participated in sports and decided for themselves to open this world? So people should better to enroll in a club for rehabilitation or fitness. The body gradually enter into the taste and then there is, it will be possible to try to make sets of exercises for development.
If you change the intensity of the exercises and their execution time, number of repetitions, the nature of relaxation, you can pick up a load of impact on stamina, thus diversifying their weekly training. The main principle in training - gradually. As their growth and development, you can increase the load. Do not immediately assume gipernagruzki, as such actions you will accomplish nothing, and can only hurt yourself. More advanced people can do the exercises with a change of pace. For example, running 200 meters with an average speed, we make a short and sharp acceleration of 30-50 meters, then again to 200 meters with an average speed of 100 meters and at the maximum possible.
To work out an effective program for the development of endurance is necessary to use a variety of different exercises. Here are some of them:
- Different variations and alternations running (running on a small distance, medium distance and accelerations, etc., as well as running with small weighting, shuttle run).
- Outdoor games - football, basketball, volleyball, tennis and other
- Variations of squats and pull-ups
- Swimming and skiing
- Exercises Mab Bounce
And remember. Do not hesitate to kill his laziness and weakness, especially in the morning. Sport - is an excellent tool to develop themselves and self-confidence.
Fat - a mandatory component of any organism. He is in the body of each person, but an excess amount of its negative impact on health. Suffering and aesthetics: look ugly folds of fat, forcing people to give up your favorite outfits.And if men are taking it more or less calm, the woman critically examine the figure in the mirror and sigh, "All Tomorrow sit on a diet ..."
However, only one change in diet is not enough. It is necessary to supplement the diet to exercise to make the body "warm up" to cleave unwanted fat deposits. One of the most effective ways to burn fat is to run.
As a child, each of us played tag, hide and seek and other outdoor games. But what to say, even the usual running around the yard is a great pleasure. With age, people just run less frequently, perhaps already playing with their children or being afraid to miss the bus or train. But this can not be called fat-running. To burn calories, running should be systematic, measured, thoughtful. Regular exercise will not only help get rid of unwanted fat, but always be on our toes.
Clothing and footwear for running in Australia
Athletics everyone can, because in the run do not need any sporting equipment and special shape. The main thing is that the clothes are not shackled movement and absorbs moisture. To run is not suitable synthetics, it is better to stay on the cotton fabric.
Consider the features clothes for running for different seasons and weather conditions:
- Summer . Universal version: cotton T-shirt and shorts. If it's very warm, she can wear a halter top, and a man - a T-shirt. Do not forget about the headdress, because you can get heat stroke. Baseball may subside during intensive running, but the bandana or scarf - the most it.
- Autumn . It is time when you need to be warmed. Even if the autumn is warm enough jacket for running is essential to a strong wind does not catch a cold. Also need long pants. On the body and put on cotton underwear. Do not interfere, and a light tight cap. On a typical day can be run in a tracksuit of soft tissues (such as corduroy), and in rainy weather is best to choose a waterproof plaschevka.
- Winter . The time of year for extreme runners. In winter, you can not run a lot because there is a risk chill throat. Even for a 30 minute jog should be well insulated. Underwear c / b linen, then warm sweater with high collar jacket covering the hips. Insulate and legs: stockings or tights, and over them - padded trousers. Some companies produce special overalls for winter sports.
- Spring . Deceptive warm weather can play a cruel joke. So much "undress" after the winter is not necessary. Suit for spring runs the same as the one that put the fall: underwear, jacket, pants and hat. As for shoes, the ideal option - sneakers. No shoes, namely running shoes on thick soles. In winter, they need to be warmed; summer can also easier to manage. Do not forget the socks - is necessary for hygiene.
Jogging for fat burning in Australia
No matter how simple running, there are some features that will help make the most productive workout.
1. It is best to start running in the morning. When the body just woke up, he is ready for various kinds of stress. In addition, morning run will help the whole day to be on our toes.
2. Studies have found that the fat begins to burn only after 20 minutes of running, so at least 30-50 minutes should be run in order to achieve good results.
3. Alternating runs with other exercises to diversify the usual breathing exercise. He ran a couple of kilometers in an easy pace, you can stop and do some squats, swings his arms and legs, torso twists. Then resume running again. Manipulation of the body will help to "disperse" fat and will split it.
4. In order to burn fat jogging should be intense, so it would be good to find a route with climbs uphill. No less useful and downs: there is a load on the calf muscles, which can also have excess fat.
5. Regularity - the key to accelerating the achievement of results. The body gets used to the daily stress and over time it begins to "prepare" for the upcoming run. Soon it will be possible to run allocate less time because the body will be easier to break down fat.
How many calories are burned while running
Counting calories women learned long ago. Each food intake increases the amount of calories in the body and any physical load, on the contrary, leads to burning. Almost all the products you can find the appropriate label, such as "250 kcal per 100 g." So many people want to know how many calories spent while running in order to know whether it is possible to eat regular chocolate.
To accurately calculate calories burned while running, you need to know your weight, body fat percentage, and be taken into account while working out. A very fat people fat burning process will be more complicated and longer, rather than a person of average weight category. It is also believed that the men burned calories faster than women.
The table provides data showing the number of calories expended when running in an hour.
Moderate jogging plus intensive walking burns 250 calories / hour in women weighing more than 60 kg.
Moderate jogging plus intensive walking burns 320 calories / hour for men weighing more than 80 kg.
Moderate jogging without stopping burns 600 calories / hour in women weighing more than 60 kg.
Moderate jogging plus intensive walking burns 840 calories / hour for men weighing more than 80 kg.
Women weighing less than 60 and less than 80 kg male, average burn 400-450 calories per hour with walking and running from 800 to 1000 calories when running without interruption.
The benefits of running for the figure
Sometimes it can be seen as a slender girl or a guy with no visible flaws figures actively running every day. Why are they doing that? To maintain good health!
Regular athletics - is:
- Keeping the body in good shape
- Continuous synthesis of new cells as a result of the collapse of the old
- Activation of the circulatory system, and as a result, the supply of oxygen and nutrients all body systems
- Improved performance due to gas exchange through the skin and lungs
- Excellent health and good mood
But as running affect the figure? Only if the fat burning process takes place at athletics? Recall that most of all tired with vigorous race - of course, feet. Calf muscles are strengthened considerably after only a month of regular exercise, and beautiful sport feet - this decoration is not only women but also men.
Second - it's the press. Unbeknownst to the runner, the abdominal muscles are often cut when running, because breathing is often carried out using the abdominals. Besides lifting burns excess fat from the abdomen, behind which lurk the coveted "cubes".
The jogging is good for the figure, in addition to "polishing" the legs and the press? The active hand movements help to keep toned pecs. In addition, athletes unfamiliar with such a problem, as the saggy skin on the hands. Trim, slim figure with clearly distinguished boundaries shoulder, abdomen (from the girls, respectively, waist) and hips - that's a typical result after a few months of active jogging.
Athletics - one of the oldest sports, not to lose relevance and popularity today. Running is truly unique - you can achieve impressive results, almost no discomfort at playing.
And no fat is not afraid, and do not have to grasp the meaning of labels in the search for high-calorie foods. Fans running, are engaged in more than three years, claiming that his title - "Queen of sports" - athletics won deservedly.
What to choose: powerlifting or bodybuilding? What is the difference between the two sports that make us stronger and more beautiful? Read this article and decide to your preferences!
Bodybuilding and Powerlifting: differences and similarities
powerlifting differs from bodybuilding
INCREASES TESTOSTERONE IN NATURAL WAYS
NORMALIZATION OF SLEEP
PHYSICAL ACTIVITY AND SPORTS WITH WEIGHTS
EXCLUDING BAD HABITS
ADDITIONAL RECOMMENDATIONS TO IMPROVE HORMONE
Classification of minerals
The first group of complaints: overtraining
The second group of complaints: excitement
The third group of complaints: increased blood pressure
The theory of a balanced diet: the basics
The theory of adequate nutrition
The main types of vitamins
|Name||The role of human||Signs of deficiency||Where is contained|
|Vitamin "B1" (thiamine)||Member metabolic stimulant of the nervous and muscular activity, the digestive tract works||Muscle weakness, impaired memory, attention, polyneuritis||Cereals, peas, beans, meat, offal, yeast|
|Vitamin "B2" (riboflavin)||Maintaining visual acuity, normal function of the skin and mucous membranes||Inflammation of the eye, increased photosensitivity, decreased visual acuity, occurrence of "Zayed" in the mouth, stomatitis||Whole grain breads, cereals, beans, meat, yeast|
|Vitamin "B3" ( "PP" or nicotinic acid)||He takes part in metabolic processes, is a component of enzymes that optimizes the nerve fibers responsible for the skin condition||"Skin roughness", bowel disorders, fatigue, irritability, insomnia||Whole grain breads, beans, potatoes, eggs, fish, yeast, meat|
|Vitamin "B6" (pyridoxine)||It regulates the metabolism of fats and proteins, the nervous system, muscles||Nervousness, irritability, muscle fatigue||Yeast, liver, eggs, meat, , milk, beans, bell peppers, peas, potatoes|
|Vitamin "B9" (folic acid)||It helps the synthesis of amino acids, stimulates the process of hematopoiesis, promotes the assimilation of vitamin "B12"||Anemia, the fetus - hypoplasia, malformations||Kidney, liver, leafy greens, beets, cabbage, potatoes, many fruits|
|Vitamin "B12" (cyanocobalamin)||Has a high activity in the process of blood formation, regulates carbohydrate metabolism||Anemia||Meat, beef liver, fish, seafood, milk|
Bodybuilding steroids are basically used to boost the level of testosterone in an athlete's or bodybuilder's body. As such, the heightened hormone levels helps to produce muscle mass as well as burn fat for a more defined body. Even though most people only know about the harmful effects of synthetic bodybuilding steroids, many companies offer the option of natural bodybuilding steroids. While they work slower at raising the testosterone level, they produce the same desired results and they are safer to your body.
Since the body already produces testosterone naturally in the testicles, bodybuilding steroids generally just help the body produce more and add it to the bloodstream more rapidly. This can produce a variety of effects on the body, however. At the surface level, bodybuilding steroids produce a large amount of acne on the user's body. They can also give the user a deeper voice, increased body hair, and an increase in strength. Observers might notice that a bodybuilding steroid user's muscles have increased in size in a short amount of time, too. While these are not necessarily negative results, abusing bodybuilding steroids will generate even more of these effects which can be harmful if taken to an extreme.
Bodybuilding steroids work by bypassing the normal path that testosterone takes to enter the bloodstream. Contrary to popular belief, bodybuilding steroids do not produce the negative effects that are normally attributed to them. Instead, steroids only magnify the effects that the body has as a result of testosterone. Since the effects are magnified, they are more noticeable. Men who use bodybuilding steroids often suffer from an increased sense of anxiety and aggression. Users also retain a large amount of sodium and suffer from hypertension and occasional heart palpitations, both of which result in an enlarged heart. Bodybuilding steroids have also been known to cause impotence and headaches in some cases.
Bodybuilding steroids have both negative and positive effects. On one hand, athletes often suffer from harmful effects if they do not consult with experts or trainers first. On the other hand, bodybuilding steroids have been known to help out several patients with certain medical problems. If you have doubts, natural bodybuilding steroids can be safe and effective for achieving your bodybuilding goals. Be sure to check with an expert or a physician even with natural bodybuilding steroids because abusing these can have detrimental effects on your health.
The modern athlete and bodybuilder goes to great lengths to enhance his body and athletic capabilities through such enhancers as creatine, anabolic steroids, amphetamines, steroid precursors, human and animal organs, human growth hormone, Erythropoietin among others.
The various Types of Steroids
Steroids are found in various forms such as soluble powders, tablets and injections. They include estradiol and testosterone (both are sex hormones) and hormones that boost performance particularly oxandrolone, stanozolol and nandrolone.
Vitamin D and the glucocorticoid Dexamethasone are also types of steroids.
Most steroids are exogenous and available as replacements or supplements.
Steroids are not just drug supplements used in enhancing performance and building muscles. This is just half of what they do.
There all kinds of steroid compounds in nature found in plants and animals.
Steroids are produced in vertebrates for the body to function properly and very different; it’s erroneous to say all steroids increase body mass and muscle building.
Broadly, steroids are either anabolic steroids or corticosteroids. Corticosteroids are produced naturally within the human body along the adrenal cortex so that the body can function optimally.
When athletes use steroids the products in questions are basically anabolic steroids.
Commonly used anabolic steroids include nandrolone, dihydrotestosterone and testosterone from where other analogues steroid variants emanate.
Among them the most popular and important is testosterone due to its medicinal benefits and physiological affects on people.
Anabolic steroids are the most important among gym enthusiasts and bodybuilders who want to increase strength while building some muscle.
Essentially, anabolics are used mostly due to their ability to increase muscle mass and muscle function.
Synthetic versions of anabolic steroids when used lead to rapid and almost permanent dramatic increase in the production of endogenous testosterone and synthesis of protein.
The results include increase in body strength and a lean body mass particularly after exercise/training.
The effect of anabolic steroids in the body is well documented and clearly seen in perfectly ripped bodybuilders and gym rats.
However, as a hugely unregulated market with lots of fake steroids for bodybuilding, abuse and overdosing usually occurs with devastating effects.
Side Effects of steroids abuse
The reason steroids are regulated is because they are very powerful hormones with an effect on the entire body. In a nutshell, abuse of anabolic steroids in men leads to:
- Testicle shrinkage
- Development of breasts
- Male pattern kind of baldness
In women, anabolic steroid abuse ends up in:
- Male-pattern kind of baldness
- Increase in body hair
- Clitoral enlargement
- Deepening of voice
- Coarse skin
- Decrease in body fat
- Decline in breast size
There are also other effects of anabolic steroids abuse that cut across both genders. This includes:
- Tendon ruptures
- Short stature among adolescents who abuse them
- Heart attacks
- Heart enlargement particularly the left ventricle
- Cancer of the liver, tumours and peliosis hepatis
- Severe cysts and acne
- Fluid retention
- Oily scalp
- Aggression and rage
- Delusions and mania
Due to the real dangers of anabolic steroids and their side effects, tested and formulated legal steroids for bodybuilding without these harmful effects have been developed.
However, the important thing is accessing them legally from the right source.
Why you should buy Legal Steroids?
Buying legalised steroids is important for a number of reasons:
Being in the right side of the law
Buying legal steroids for bodybuilding mean you won’t be afraid of getting into serious altercation with the law within your jurisdiction.
‘Legal’ simply refer to the fact that you can access them in your country without the fear of breaking any law.
Essentially, most nations consider them to be drugs and illegal access, purchase and vending attracts huge monetary and administrative fines or prison time.
By buying legal steroids there’s no reason to fear any of these will ever happen to you.
Illegal steroids contain harmful ingredients or badly combined elements that hurt vital organs such as the heart and the liver leading to cancer, liver complications, kidney problems and cardiovascular complications.
Steroids enter directly into the blood and they are not the easiest to filter or control filtering.
Legal steroids have passed the various tests laid down by FDA for steroids legal in the US.
Of importance is how these substances are used and the user’s ability to stick to a laid down tested routine. Abusing, overdosing legal steroids is counterproductive.
Legal alternatives of Banned Steroids
With the real devastation of anabolic steroids clear, especially after an extended use, there are lots of legal alternatives worth checking out.
These legal equivalents are effective as hormone boosters and sport supplements helping to cut and bulk without the dangerous side of pure anabolic steroids.
They include the genuine article of legal alternatives, D-Bal or Dianabol orally taken and great for muscle gain, Anadrole that delays fatigue, increases red blood cells production, boosts strength and encourages bulking.
Others include Anvarol a legal equivalent to Anavar and Trenbolone alternatives among a host of others.
How to ensure what you are buying is Safe and Effective?
Check the website
The information provided by the vendor is important. The site has to provide enough evidence the types of steroids they are selling are legal.
A Better Business Bureau logo can be a sign of confidence while systems of cyber crime prevention like ‘https security/SSL certificates’ and antivirus in-built in it mean safe purchases.
Does the website have a blog or a steroid forum? With posts in the blog and forum you’ll find lots of answers and pointers.
The manufacturer need to have made the steroids in cGMP certified facilities that are periodically checked by such bodies as FDA.
A regularly inspected facility mean the quality control is trustworthy and the legal steroids safe to use.
The steroids packaging contains all the information about the substances used.
They must be legal and sold by a Better Business Bureau registered company/website among other organisations that ensure only sites that sell quality products are well reviewed.
With the advent of the internet and social media user reviews have become very handy while purchasing delicate products such as steroids.
Find as many reviews as you can from current and past users, customer testimonials from various steroids for bodybuilding sites, forums and social networking groups.
All in all you will find critical information to help you choose the right bodybuilding legal steroids to use.
Apart from scouring the web in search of recommendations and legal steroid variants talk to friends, bodybuilders, colleagues and trainers.
Know what they use and what is not worth your time.
Buying from stores that allow credit card payments is imperative; such stores are always checked to find if they are legitimate.
You can also request a chargeback in case the order was never shipped.
Legit steroid vendors are very clear about their payment methods.
Without a label you’ll never know whether the product has safe ingredients or not.
Buy legal steroids with a label that clearly indicates their name, ingredients, usage and other important information.
Final thoughts on Legal Steroids
Legal steroids are great substitutes to pure anabolic steroids. They allow bodybuilders to gain the kind of body they want massively within a set time.
No prescription is needed to buy them and lack the harmful and dangerous side effects of steroids.
In this article, we would be reading about steroids and possible side effects as well as about remedies to avoid these side effects. Steroids are substances that help an individual to gain muscle mass and performance in a short span of time. Now that we have learnt about the meaning of steroids, let us start with the varying types of steroids.
Steroids are hormones, which can be classified into three types:
Anabolic Androgenic Steroids: These steroids help in building muscles like testosterone.
Glucocorticosteroids: These steroids are anti-inflammatory in their nature.
Minerocorticosteroids: They are produced by adrenal glands for regulation of water and salt in the human body.
Steroids are also known as juice, roids, gym candy, arnies, A’s, anabolics, pumpers, and stackers. In this article, we would be reading about anabolic steroids.
Anabolic Steroids refer to synthetic substances or compounds related to androgens, male sex hormones, which help in promotion of the anabolic (skeletal muscle) and androgenic (development of male sexual features) effects.
These steroids can be taken in many forms such as orally or through injections or nasal sprays. Some of the common oral steroids are Anadrol, Anavar, Dianabol, Nibil, Nilevar, Winstrol, and Maxibolin while some of the common injectable steroids are Deca-Durabolin, Drolban, Equipoise, Winstrol Depot, and Durabolin to name a few.
As per a recently concluded survey, it was found that more and more sportsmen and teenagers are taking steroids to enhance their body performance and muscle mass. However, it should not be forgotten that steroids can take a heavy toll on its user’s health & body.
It is generally seen that steroid users exhibit symptoms such as premature balding, acne, depression, rapid weight again, jaundice, and rapid muscle development. The abuse of steroids can be associated with higher risks for heart ailments such as attacks and strokes. Such an abuse can also lead to liver damages. Shared steroids, when taken in an injectable form, can lead to bacterial endocarditis, hepatitis B and C, and even HIV/AIDS. Apart from all these risks, steroids can cause many other undesirable body changes such as development of breast and shrinking of genitals in men, deepening of voice in women, and hair loss in both sexes.
When the human body experiences a build up of steroids, ailments such as kidney diseases, stunted growth, hypertension, diabetes, and blockage of insulin can be caused. Women steroid users can face ailments such as baldness, unnatural hair growth, and menstrual irregularities while men can witness breast enlargement, sterility, impotence, and shrinking of testicles.
Some of the other possible side effects of steroid abuse are anxiety, depression, increased appetite, irregular hair growth, sexual problems, personality changes, sleeping troubles, mania, psychological dependence, decreased sperm production, increased libido, and fluid retention to name a few.
Now that we have learnt about the meaning and types of steroids, let us find why people are taking steroids to gain a complete insight on their popularity despite their side effects.
Steroids act on androgen receptors on cells such as muscle cells to increase tissue production by altering testosterone to prolong its effects. They have the ability to block the effects of cortisol, a catabolic hormone. When an individual on steroids indulge himself or herself on exercises, the availability of androgen receptor sites is increased. This helps him or her in achieving peak performances in a short span of time. However, it must be noted that the usage of steroids must always be preceded by a qualified medical advice.
In order to reap optimum benefits of steroids and avoid its side effects, it is advisable for a user to follow qualified medical advice before usage. If any precautions are advised by the doctor, they must be religiously followed and must never be ignored at any stage of time. If an individual on steroids experience any difficulty or change in body/behavioral patterns then usage of steroids must be immediately stopped & medical intervention must be immediately sought.
If one can observe the basics then he or she may not face any kind of side effects. Such an observant approach will also help the individual on steroids to gain from the usage of steroids. If an individual who is keen to take on steroids has an allergy to any chemical or medical substance, the same should be disclosed before the doctor before using steroids. This will help the doctor to render qualified medical advice to help the concerned individual stay away from all possible side effects and ailments. One thing is for sure, if steroids are taken in good faith and after complete usage knowledge then they can help their users to gain muscle mass and enhance body performance in a short span of time. On the other hand, incomplete or no knowledge about the usage can ruin even healthy bodies and successful careers.
If one is looking for the best steroids in the town then he must be ready to make a research before making any final decision. This is imperative to get the best steroids at the best prices. Along with that, it also allows the users to have complete knowledge about the steroid market and gain some good knowledge & facts.
In short, it is best to respect steroids to gain muscle mass and enhance performance. Steroids do not pose any damage to the body until they are abused or misused. But, steroids can ruin a human body if their users start abusing them.
Steroid side effects can be minimized by the user himself. The user just needs to be cautious of steroid usage. If that can be done, then there is nothing between the dream of having a well-developed body and the reality of having the same. So if you want to have a well-curved and developed body then steroids can help you immensely but you must always remember not to abuse them.