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;
  • pregnancy;
  • lactation.Precautions
    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.Cautions
    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.

Read More29/05/2018

Sustanon steroid

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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;
  • diabetes.

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.

Side Effects
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.

special instructions

  • 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.Read More29/05/2018

Sustanon 250 for sale

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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.


  • Contraception.
  • 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;
  • jaundice;
  • 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
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.Read More29/05/2018


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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.

Maintenance treatment:
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.

Treatment discontinuation:
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.

Drug interactions
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. online anabolic steroids pharmacy

Read More29/05/2018

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