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testosterone phenylpropionate

With simultaneous use of fluvoxamine observed increase in concentrations of tricyclic antidepressants (clomipramine, imipramine, amitriptyline) and neuroleptics (clozapine, olanzapine), which largely metabolized by cytochrome testosterone phenylpropionate. In this regard, if treatment is started fluvoxamine should be considered reduced doses of these drugs.

Patients simultaneously receiving fluvoxamine, and drugs with a narrow therapeutic range of action metabolized by cytochrome (such as tacrine, theophylline, methadone, mexiletine) should be carefully monitored. If necessary, adjust the recommended dose of these drugs. It was reported a few cases of cardiotoxicity while receiving fluvoxamine and thioridazine. When interacting with fluvoxamine propranolol was an increase in the plasma concentration of propranolol. In connection with this reduction can be recommended dose of propranolol in the case of simultaneous reception fluvoxamine. While receiving fluvoxamine plasma concentrations of caffeine may increase. Thus, patients who consume large amounts of beverages containing caffeine should reduce their consumption while taking fluvoxamine, and when there are adverse effects of caffeine, such as tremor, palpitations, nausea, restlessness, insomnia.

At the same time taking fluvoxamine and ropinirole ropinirole may increase the concentration in plasma, thereby increasing the risk of overdose. In such cases, control, or, if necessary, dose reduction or cancellation of ropinirole during treatment with fluvoxamine.
Patients simultaneously receiving fluvoxamine, and drugs with a narrow therapeutic range of action is metabolized isoenzyme cytochrome  (such as phenytoin) should be carefully monitored and, if necessary, recommend a dose adjustment of these drugs.

When applied in combination with fluvoxamine was observed a significant increase warfarin warfarin plasma concentrations and prolonged prothrombin time.

Isozyme cytochrometestosterone phenylpropionate
terfenadine, astemizole, cisapride: combination therapy with fluvoxamine concentrations of terfenadine, astemizole, or cisapride plasma may increase, increasing the risk of lengthening the interval ventricular tachycardia type “pirouette”. Therefore, fluvoxamine should not be administered with these drugs.

Patients simultaneously receiving fluvoxamine, and drugs with a narrow therapeutic range of action is metabolized cytochrome  (such as carbamazepine, ciclosporin) should be carefully monitored, we recommend a dose adjustment of these drugs.

When concomitant administration with fluvoxamine benzodiazepines undergoing oxidative metabolism, such as triazolam, midazolam, alprazolam and diazepam, may increase their concentration in plasma.The dosage of these benzodiazepines should be reduced at the time of fluvoxamine.

Glucuronidation
Fluvoxamine has no effect on plasma concentration of digoxin.

Renal excretion
Fluvoxamine has no effect on the plasma concentration of atenolol.

Pharmacodynamic interactions
In case fluvoxamine combined with serotonergic drugs (such as triptans, tramadol, selective serotonin reuptake inhibitors and drugs testosterone phenylpropionateperforatum) may increase serotonergic effects of fluvoxamine (see. “Special Instructions”). Fluvoxamine was used in combination with lithium preparations for the treatment of patients with severe, poorly responsive to pharmacotherapy. It should be noted that lithium (and possibly also tryptophan) enhances the serotonergic effects of the drug, and therefore such combination pharmacotherapy must be carried out with care.

At the same time taking oral anticoagulants and fluvoxamine may increase the risk of hemorrhage.

These patients should be under a doctor’s supervision.

Cautions
As with other psychotropic drugs during treatment  is not recommended to consume alcohol.

Suicide / suicidal thoughts or clinical deterioration
Depression is associated with an increased risk of suicidal thoughts or suicidal behavior (self-harm or suicide). This risk persists until significant improvement. As improvement may not occur during the first few weeks of treatment or longer, patients should be closely monitored until such improvement.

In clinical practice widely increased risk of suicide at the early stages of recovery.

Obsessive-compulsive disorders can also be associated with an increased risk of suicidal events. Also, these states can accompany major depression. Therefore, the treatment of patients with obsessive-compulsive disorders have observed the same precautions as in the treatment of patients with major depression.

It is known that patients with suicide-related events in history or substantially exhibiting suicidal ideation, before treatment are at greater risk of suicidal thoughts or suicidal behavior, and should be monitored closely during treatment.

Careful monitoring of patients, especially at high testosterone phenylpropionate risk should accompany drug therapy especially in its early stages and following dose changes. It is necessary to warn patients (and caregivers) about the need to keep track of any clinical deterioration, suicidal behavior or suicidal thoughts and unusual changes in behavior, and immediately seek the advice of a specialist with the appearance of symptoms.

test prop cycle

Treatment of patients with hepatic or renal insufficiency should start with low doses under strict medical supervision. Some side effects observed in clinical trials were often associated with symptoms of depression, not to treatment test prop cycle .
General disorders: asthenia, malaise.
Violations of the heart: palpitation, tachycardia.
Violations of the gastrointestinal tract: abdominal pain, constipation, diarrhea, dry mouth, dyspepsia, nausea, , vomiting.
Disorders of the nervous system: irritability, anxiety, agitation, dizziness, insomnia or drowsiness, tremor, headache.
Disorders of the skin and subcutaneous tissue disorders: sweating.
Violations of the metabolism and nutrition: anorexia.
Violations of the vessels: orthostatic hypotension
Violations of the musculoskeletal and connective tissue disorders: arthralgia, myalgia.
Disorders of the nervous system: ataxia, extrapyramidal disorders.
Mental Disorders: State of confusion, hallucinations.
Violations of the genital organs and the breast: violation (delayed) ejaculation.
Violations of the skin and subcutaneous tissue: skin hypersensitivity reactions (including rash, pruritus, angioedema).
Violations of the liver: liver dysfunction (elevated liver enzymes).
Violations of the nervous system: convulsions.
Mental disorders: mania
Violations of the genital organs and the breast: galactorrhoea.
Violations skin and subcutaneous tissue disorders: photosensitivity reactions.

In addition to the side effects described in clinical studies during the post-marketing use of fluvoxamine it was reported the following side effects. The exact frequency can not be test prop cycle provided, and therefore classified as “unknown.”

Violations of the blood and lymphatic system: hemorrhage (eg, gastrointestinal bleeding, ecchymosis, purpura).

Disorders of the endocrine system: inadequate secretion of antidiuretic hormone.

Violations of the Metabolism and nutrition: hyponatremia, weight gain, weight loss.

Disorders of the nervous system: serotonin syndrome; phenomenon; like neuroleptic malignant syndrome; akathisia / psychomotor agitation; paresthesia; dysgeusia.

Mental disorders: during treatment with fluvoxamine or shortly after the end of the reported cases of suicidal ideation and suicidal behavior.

Violations of the kidney and urinary tract: urination disorders (including urinary retention, urinary incontinence, urinary frequency, nocturia and enuresis).

Violations of the genital organs and the breast: anorgasmia.

General disorders: drug withdrawal syndrome, including withdrawal symptoms in newborns.

Overdose

Symptoms
The most characteristic symptoms are gastrointestinal disorders (nausea, vomiting and diarrhea), somnolence and dizziness. In addition, there are reports of violations. cardiac (tachycardia, bradycardia, hypotension), liver function disturbances, convulsions and coma.

Fluvoxamine has great therapeutic breadth dose safety against overdosage. Since its release to the market reports of deaths attributed to overdose of fluvoxamine alone, rarely observed. The highest registered dose of fluvoxamine adopted one patient was in ’12, this patient was completely cured. More serious complications were observed in cases of deliberate overdose of fluvoxamine in combination with other drugs.

Treatment
No specific antidote to fluvoxamine does not exist: In case of overdose gastric lavage is recommended, which should be conducted as soon as possible after taking the drug, and symptomatic treatment. In addition, we recommend multiple dose activated charcoal, the appointment of osmotic laxatives if necessary. Forced diuresis or dialysis are not effective.

The interaction with other drugs.
Fluvoxamine can not be used in combination ).
Fluvoxamine largely inhibits cytochrome test prop cycle. Drugs which are largely metabolized by these isoenzymes, displayed slower and may have higher plasma concentrations, in the case of co-administration with fluvoxamine. This is particularly important for drugs that have a narrow range of therapeutic action. Patients in need of careful observation, it is recommended to adjust the dose of these drugs, if necessary.

Fluvoxamine has a minimal inhibitory effect on cytochrome  isoenzyme and probably does not affect the non-oxidative metabolism and renal excretion.

proprionate

The mechanism of action of Luvox is associated with selective inhibition of serotonin reuptake by neurons of the brain and is characterized by a minimal effect on the noradrenergic system. Proprionate has a poor ability to bind to a-adrenergic, b-adrenergic, histaminergic, m-cholinergic receptors, dopaminergic or serotonergic receptors.

Absorption:
After oral administration, fluvoxamine completely absorbed from the gastrointestinal tract. Maximum plasma concentrations of the drug observed after 3-8 hours after administration. The absolute bioavailability is 53% following primary metabolism in the liver. Simultaneous administration of fluvoxamine with food does not affect the pharmacokinetics.

Distribution:
fluvoxamine  protein binding . The volume of distribution – 25 l / kg.

Metabolism:
Metabolism fluvoxamine occurs mainly in the liver. Although  isoenzyme of cytochrome  metabolism in the main fluvoxamine, drug concentration in the blood plasma of persons with impaired function of this isoenzyme is not much higher than those with normal metabolism. The average  from the blood plasma component for a single dose of 13-15 hours increases with repeated several reception (17-22 hours), and the equilibrium concentration in plasma is usually reached within 10-14 days. Fluvoxamine biotransformation in the liver (mainly by oxidative demethylation) at least nine to metabolites that are excreted through the kidneys. Two main metabolites have negligible pharmacological activity. Other metabolites may pharmacologically inactive. Fluvoxamine significantly inhibit cytochrome proprionate, moderately inhibit cytochromes proprionate, and slightly. The pharmacokinetics of a single dose of fluvoxamine is linear. Fluvoxamine equilibrium concentration higher than that of a single dose, and disproportionately higher at higher daily doses.

Special groups of patients:
The pharmacokinetics of fluvoxamine is the same in healthy people, the elderly and patients with renal insufficiency. The metabolism of fluvoxamine is reduced in patients with liver disease. The equilibrium plasma fluvoxamine concentration twice as high in children (aged 6-11 years) than in children (aged 12-17 years). Concentrations of drug in plasma are similar in adolescents with concentrations in adults.

Use during pregnancy and lactation
data of a small number of observations do not indicate any adverse effects of fluvoxamine during pregnancy. To date, no other epidemiological data are not available.

The potential risk for humans is unknown. The drug should be administered to pregnant women with caution.

some cases have been described of withdrawal symptoms in the newborn after use of fluvoxamine in late pregnancy.

Some infants after exposure to selective serotonin reuptake inhibitors in the third trimester of pregnancy occurred feeding difficulties and / or breathing, seizure disorders, unstable body temperature, hypoglycemia, tremor, disorders of muscle tone, increased neuro-reflex excitability syndrome, continuous crying, which could require longer hospitalization. Fluvoxamine passes into breast milk. In this regard, the preparation should not be used during lactation.

Dosage and administration
of fluvoxamine tablets should be taken orally, without chewing, drinking water.

depression

Adults
The recommended starting dose for adults is 50 or 100 mg (once in the evening). Recommended doses of a gradual increase to a level effective.

The effective daily dose is usually 100 mg, selected individually depending on the patient’s response to treatment . The daily dose may reach 300 mg. Daily doses greater than 150 mg should be distributed on several stages.

In accordance with the official testosterone propionate recommendations antidepressant treatment should continue for at least 6 months after remission of depressive episodes.

For the prevention of depression recurrence recommended once a day, daily.

Children
Due to lack of clinical experience Luvox is not recommended for the treatment of depression in children up to 18 years.

 

Adults
The recommended starting dose for adults sostavyaet be increased gradually until the effective daily dose should not exceed 300 mg in adults. Doses up to 150 mg can be taken once a day, preferably at night. Daily doses greater than 150 mg is recommended to distribute on 2 or 3 doses.

Children over 8 years and adolescents
The starting dose is 25 mg / day for one reception. Maintenance dose 50 – 200 mg / day. In the treatment of OCD in children aged 8 to 18 years, the daily dose should not exceed 200 mg. Daily doses of 100 mg is recommended to distribute on 2 or 3 doses.

If a good therapeutic response to a drug treatment can be continued with the help of individualized daily dose. If no improvement is achieved after 10 weeks, treatment with fluvoxamine should be reconsidered. So far, no systemic studies were organized, which could answer the question of how long can be carried out treatment with fluvoxamine, but obsessive-compulsive disorders are chronic, and proprionate therefore can be considered expedient to prolong the treatment of fluvoxamine over 10 weeks in patients with a good response for this drug. Selection of the minimum effective maintenance dose should be administered with caution individually. Periodically re-evaluate the need for treatment. Some clinicians recommend carrying out concomitant therapy in patients who respond well to drug therapy.

testosterone propionate dosage

Ketoprofen well penetrates through the skin and has a local anti-inflammatory and analgesic effect. Bioavailability gel – 5%. Suck part of ketoprofen bound to plasma proteins for about 99%. The drug is metabolized in the liver. About 80% of the dose excreted in urine as metabolites, less than 10% is excreted unchanged form. Not accumulates in the body.

Indications

  • It is used topically testosterone propionate dosage as an analgesic and anti-inflammatory drug for the symptomatic treatment: back pain, neuralgia, myalgia,
  • inflammatory and degenerative diseases of the musculoskeletal system (including arthritis, bursitis, synovitis, tendonitis, lumbago)
  • uncomplicated injuries, in the above privacy sports injuries, sprains, strains or tears the ligaments and tendons, bruises, post-traumatic pain,
  • in a combination therapy for inflammatory diseases of the veins (phlebitis, periflebit), lymph vessels, lymph nodes (lymphangitis, superficial lymphadenitis).

Dosage and administration:
For external use only.
2-3 times a day a small amount (3-5 cm) of gel applied to the skin in the painful place and easily rub.
No need for laying dry dressings, as the gel is well absorbed through the skin, has no odor does not contain dyes, leaves no oily stains, does not stain clothes.

Contraindications

  • Hypersensitivity to ketoprofen and / or other components of the preparation,
  • increased sensitivity to other non-steroidal anti-inflammatory drugs,
  • moist dermatitis, eczema, infected abrasions, wounds, burns
  • pregnancy, lactation.

Ketoprofen may cause bronchospasm in susceptible individuals to acetylsalicylic acid and other nonsteroidal anti-inflammatory drugs.

 

Side effects
: Allergic reactions, skin flushing, photosensitivity, skin rash, purpura.

Interaction with other drugs
in cases of frequent and prolonged use testosterone propionate dosage can appear symptoms of interaction with other drugs, such as when administered systemically.
Joint reception with other non-steroidal anti-inflammatory drugs, corticosteroids, ethanol, corticotropin may lead to ulceration and the development of gastro-intestinal bleeding. Co-administration with oral anticoagulants, heparin, thrombolytics, antiplatelet, tsefaperazon, cefamandole increases the risk of bleeding. It reduces the effect of antihypertensive drugs and diuretics (inhibition of prostaglandin synthesis). Increases the hypoglycemic effect of insulin and oral hypoglycemic agents (requires recalculation of the dose). Co-administration with sodium valproate causes a disturbance of platelet aggregation. Increases concentration of plasma verapamil and nifedipine.

Special instructions:
Avoid contact with the drug on the mucous membranes and eyes. Do not use on damaged skin.
During long-term use caution should be exercised in patients with severe liver failure and / or kidney disease.
In cases of rash appears necessary to stop treatment and spend the appropriate therapy.

Use of the drug during pregnancy and lactation
in the I and II trimes testosterone propionate dosage

proponate

Paracetamol has antipyretic and analgesic effect: reduces pain, observed for colds – a sore throat, headache, muscle and joint pain, reduces fever. Pheniramine has anti-allergic effect: eliminates itchy eyes, nose, and throat, edema and hyperemia of the mucous membranes of the nasal cavity, nasopharynx and sinuses, reduces rhinorrhea and lacrimation. Ascorbic acid proponate up for an increased need for vitamin C for colds and flu, especially in the early stages of the disease. It increases the body’s resistance to infectious diseases.

 

CONTRAINDICATIONS
Hypersensitivity to paracetamol and other components of the drug; treatment with other drugs containing substances included ; portal hypertension, alcoholism, pregnancy, lactation; children’s age (15 years).

Be wary – asthma, chronic obstructive pulmonary disease, deficiency of glucose-6-phosphate dehydrogenase, blood diseases, congenital hyperbilirubinemia , erosive and ulcerative lesions of the gastrointestinal tract, giperoksalaturiya, liver and / or kidney failure, angle-closure glaucoma, prostatic hyperplasia.

Dosing and Administration
Inside. The contents of 1 sachet dissolved in a glass of warm water and drink after foaming. Taking the drug should be with a lot of liquid in 1 -. 2 hours after a meal
if your doctor has not given other instructions, when use of the drug following the dosage must be observed. Adults and children over 15 years should take 1 sachet of powder 2-3 times day. The maximum daily dose – 3 bags. The interval between doses should be 4-6 hours. When proponate (creatinine clearance 10 mL / min) the interval between doses of the drug should be more than 8 hours. The maximum duration of treatment for children -. 3 days should not take the drug for more than 5 days without consulting a doctor.

Side effects:
Allergic reactions (including skin rash, pruritus, urticaria, angioedema, anaphylactic shock), headache, dizziness, sleep disturbances, irritability, decreased psychomotor speed reactions, nausea, vomiting, epigastric pain; dry mouth; urinary retention; paresis of accommodation; bronchial obstruction, anemia, thrombocytopenia, agranulocytosis.
With prolonged use at high doses – hepatotoxic effects, hemolytic anemia, aplastic anemia, methemoglobinemia, pancytopenia, erosive and ulcerative lesions of the gastrointestinal tract, bleeding in the gastrointestinal tract, renal toxicity (papillary necrosis).

Overdosing
conditioned usually paracetamol, appears after taking over the last 10-15 g. There are: pale skin, anorexia, nausea, vomiting; gepatonekroz; increased activity of “liver” transaminases, increased prothrombin time.

With symptoms of overdose seek emergency medical attention. Treatment : gastric lavage, followed by the appointment of activated carbon; symptomatic therapy, administration of methionine after 8-9 hours after the overdose and N-acetylcysteine – 12 hours.

Interaction with other drugs
Enhances the effects of sedatives, ethanol. Antidepressants, antiparkinsonian agents, antipsychotics, phenothiazine derivatives – increase the risk of urinary retention, dry mouth, constipation.Glucocorticoids increase the risk of developing glaucoma.
Paracetamol reduces the effectiveness of uricosuric drugs. Pheniramine simultaneously with proponate inhibitors, furazolidone can lead to a hypertensive crisis, excitation, hyperpyrexia. When concomitant administration of the drug with barbiturates, phenytoin, carbamazepine, rifampicin and other inducers of microsomal oxidation (phenytoin, ethanol, phenylbutazone, tricyclic antidepressants) increase the production
of hydroxylated active metabolites, and increased risk of hepatotoxic action of paracetamol with small overdoses.
Inhibitors of microsomal oxidation (cimetidine) decrease the risk of hepatotoxicity.

Cautions
During treatment should refrain from drinking alcohol, hypnotics and anxiolytics (tranquilizers) medications. Do not take with other medicines containing paracetamol. Use caution when performing work that requires concentration, high speed motor and mental reactions. If symptoms persist for 3 – 5 days, consult a doctor.

Product form Powder for oral solution 4 g of powder in a bag of composite material (paper, aluminum foil and polyethylene). On 8 sachets with instructions for use in paper cartons.