side effects of trenbolone enanthate

It stimulates nicotinic receptors and increases the sensitivity of the postsynaptic membrane to acetylcholine. It facilitates the conduction of excitation in the neuromuscular junction, and restores neuromuscular conductivity in the side effects of trenbolone enanthate case of its blockade of muscle relaxants nedepolyariziruyuschego type of action. It increases smooth muscle tone, increases the secretion of digestive and sweat glands, causing cramps. By increasing the activity of the cholinergic system, galantamine improve cognitive function in patients with dementia of the Alzheimer’s type, but does not affect the development of the disease.
Following oral administration, rapidly and completely absorbed from the gastrointestinal tract. The absolute bioavailability is high – up to 90%. Therapeutic concentrations achieved 30 minutes after administration. Maximum plasma concentration after administration of 10 mg is observed at the 2nd hour, and 1.2 mg / ml. The half-life -5 hours. After multiple dose an equilibrium state plasma concentrations of galantamine. To a small extent associated with blood proteins. It passes easily through the blood-brain barrier. To a small extent (about 10%) is metabolized in the liver by demethylation. Displayed (unchanged and as metabolites) mainly with urine (74%). Renal clearance is approximately 100 ml / min. Patients with Alzheimer’s plasma concentration of galantamine may increase. In moderate and severe impairment of hepatic and renal function, plasma concentrations of galantamine increased.

Indications

dementia of the Alzheimer type mild to moderate;

  • polio (immediately after the cessation of the febrile period, and the recovery period and the period of residual effects);
  • myasthenia gravis, progressive muscular dystrophy, cerebral palsy, neuritis, sciatica, myopathy.CONTRAINDICATIONS
    Hypersensitivity to any component of the drug; bronchial asthma; bradycardia; atrioventricular block; hypertension, angina pectoris; chronic heart failure; epilepsy;hyperkinesis; severe renal (creatinine clearance less than 9 ml / min) and liver (more than 9 points on a scale Child-Plough) violations; mechanical intestinal obstruction; chronic obstructive pulmonary disease; obstructive disease or recent myocardial surgery on the gastrointestinal side effects of trenbolone enanthate tract organs; obstructive disease or recent myocardial surgical treatment of urinary tract or prostate gland; Children under 9 years of age; pregnancy and lactation.

    Be wary
    of mild to moderate impaired renal or hepatic function; sick sinus syndrome or other supraventricular conduction abnormalities, concomitant use of drugs that slow the heart rate (digoxin, beta-adrenoblokotory); general anesthesia, gastric ulcer and 12 duodenal ulcer, increased risk of erosive and ulcerative lesions of the gastrointestinal tract. Celiac enteropathy (wheat starch part of the drug).Lactose deficiency, galactosemia, the glucose-galactose malabsorption syndrome (lactose included in the formulation).

    Dosing and Administration
    Inside, during a meal, washed down with water. Adults The daily dose is 10-40 mg, divided into 2-4 reception. When Myastenia gravis daily dose divided into 3 admission. Alzheimer’s treatment is recommended to start with the pills 5 mg 2 times a day. Within 4 weeks, the daily dose can be gradually increased to 20 mg – 1 tablet of 10 mg 2 times a day and night -utrom. During treatment it is necessary to ensure adequate intake of fluids. If during treatment require discontinuation of the drug, the treatment of the restoration should be started with the lowest dose and gradually increase it. Patients with moderate hepatic impairment and kidney initial dose – 5 mg 1 time for at least 1 week per day, which is taken in the morning and then increased to 5 mg 2 times a day, which is taken for 4 weeks. The total daily dose should not exceed 15 mg. Children (9 years old) Treatment of polio, cerebral palsy: from 9 to 11 years – a daily dose of 5 -15 mg, divided into 2-3 doses, from 12 to 15 years – the daily dose is 5-20 mg divided by 2-4 reception.

    Side effect On the part of the cardiovascular system: reduction or increase in blood pressure, orthostatic collapse, heart failure, edema, atrioventricular block, atrial flutter or atrial fibrillation, QT-interval lengthening, ventricular and supraventricular tachycardia, supraventricular arrhythmias, “tides”, bradycardia, ischemia or myocardial infarction. From the digestive system: abdominal distension, dyspepsia, gastrointestinal discomfort, anorexia, diarrhea, abdominal pain, nausea, vomiting, gastritis, dysphagia, dry mouth, increased salivation, diverticulitis, gastroenteritis, duodenitis, hepatitis , perforation of the esophageal mucosa, bleeding from the upper and lower gastrointestinal tract. from the musculoskeletal system: muscle cramps, muscle weakness, fever. Laboratory findings: elevated liver enzymes, anemia, hypokalemia, increased blood sugar, or alkaline phosphatase . blood Hematological: thrombocytopenia purpura. From the urinary system: urinary incontinence, hematuria, urinary frequency, urinary tract infection, urinary retention, kalkulez, renal colic. From the nervous system: often tremor, syncope, lethargy, dysgeusia, visual and auditory hallucinations, behavioral reactions, including agitation / aggression; transient ischemic attack or stroke; headache, dizziness, convulsions, muscle cramps, paresthesias, ataxia, hypo- or hyperkinesia, apraxia, aphasia, anorexia, somnolence, insomnia. From the senses: rhinitis, epistaxis, visual disturbances, spasm of accommodation, infrequently – tinnitus . On the part of the mind: depression (very rarely with suicide), apathy, paranoid reactions, increased libido, and delirium. Common: chest pain, excessive sweating, weight loss, fatigue, dehydration (in rare cases, with the development of renal failure) bronchospasm.

    Overdosing
    Symptoms: oppression of consciousness (even coma); convulsions; increased severity of side effects; severe muscle weakness in conjunction with tracheal mucosa hypersecretion and bronchospasm, may lead to fatal respiratory tract blockade.
    . Treatment: gastric lavage, symptomatic therapy
    as used antidote atropine in doses of 0.5-1 mg intravenously.
    Subsequent doses of atropine determined depending the therapeutic response and the condition of the patient.

    Interaction with other medicinal products
    is not recommended to be combined with other holinomimetikami.
    It is an antagonist of opioid effects on the respiratory center.
    Shows pharmacodynamic antagonism m-anticholinergic (atropine, homatropine methyl bromide, etc.), Ganglionic, non-depolarizing muscle relaxants, quinine, procainamide.
    Aminoglycoside antibiotics can . reduce the therapeutic effect of galantamine
    galantamine enhances neuromuscular blockade during general anesthesia (including when used as a muscle relaxant suxamethonium perifercheskogo); drugs that reduce heart rate (digoxin, beta-blockers.) – the risk of worsening bradycardia
    cimetidine may increase the bioavailability of galantamine.
    All drugs that inhibit enzymes and isozymes of cytochrome P450 (CYP2D6, CYP3A4) may increase plasma galantamine concentration while their application side effects of trenbolone enanthate in rezultatate which may increase the frequency of cholinergic side-effects (mainly nausea and vomiting). In this case, depending on the particular patient tolerance therapy may need to decrease maintenance dose of galanthamine.
    Inhibitors of the isoenzyme CYP2D6 (amitriptyline, fluoxetine, fluvoxamine, paroxetine, quinidine) galanthamine reduce clearance of 25-30%. For this reason, it is not recommended concurrently with ketoconazole, zidovudine, erythromycin.
    Dampening effect on the central nervous system of ethanol and sedatives.

    Cautions
    During treatment should refrain from doing jobs that require high concentration and speed of the psycho-motor reactions, including driving.
    Treatment of acetylcholinesterase inhibitors is accompanied by a decrease in body weight. Especially it should be borne in mind when treating patients with Alzheimer’s disease, which usually occurs weight loss. In this connection it must be ensured body mass.
    In the period of treatment is necessary to ensure adequate fluid intake.
    Like other cholinomimetics, the drug may cause side effects vagotonic cardiovascular system (including bradycardia), which should be considered in patients with sick sinus syndrome and other disorders of conduction, and while the use of drugs that reduce heart rate (digoxin or beta-blockers).
    in the treatment of Nivalin there is the risk of syncope, and therefore, blood pressure need to be monitored frequently, especially while taking the drug at higher doses (40 mg daily dose). In order to prevent such adverse effects, the dose should be selected carefully at the beginning of treatment.
    The efficacy in patients with other types of dementia and memory impairment has not been established.
    The drug is not suitable for treating patients with mild cognitive impairment, i.e. with isolated memory impairment, higher than the expected level for their age and education, but does not meet the criteria for Alzheimer’s disease.

     

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