buy deca durabolin

 

Buy deca durabolin, 50 mg and 200 mg Excipients : lactose monohydrate core, pregelatinized starch, croscarmellose sodium, povidone, magnesium stearate; shell – hypromellose, titanium dioxide (E171), lactose monohydrate, glycerol triacetate. Lyophilisate Active ingredient : buy deca durabolin 200 mg; Excipients : sodium salt of sulfobutyl ether beta-cyclodextrin (SBECD).

 

Description : Tablets 50 mg . White or almost white, standard round, biconvex film-coated tablets, engraved with “Pfizer” on one side and “VOR50” on othertablets 200 mg – white or almost white, oblong, biconvex tablet, for oral administration coated, engraved with “Pfizer” on one side and “VOR200” on the other.Valium for solution for infusion – white lyophilisate.

Pharmacological properties : Pharmacodynamics: Mechanism of Action : . buy deca durabolin – is an antifungal drug is a broad-spectrum, which belongs to the structure of the triazole group of antibiotics Mechanism of action of buy deca durabolin is associated with inhibition of 14α-sterol demethylation, mediated fungal cytochrome P450; This reaction is a key step in the biosynthesis of ergosterol. In vitro buy deca durabolin has a broad spectrum of antifungal activity and is active against Candida spp. (including strains of C. krusei , fluconazole-resistant and resistant strains of C. glabrata and C. albicans ), and has a fungicidal effect in respect of all studied strains of Aspergillus sp. and the pathogenic fungi which have become relevant in recent years, including Scedosporium or of Fusarium , which limited sensitivity to existing antifungal agents. The clinical efficacy has been demonstrated in infections caused by of Aspergillus spp. including A. flavus, A. fumigatus, A. terreus, A. niger, A. nidulans, Candida spp. , including S. albicans, C. dubliniensis, C. glabrata, C. inconspicua, C. krusei, C. parapsilosis, C. tropicalis, and C. guilliermondii, Scedosporium spp., including S. apiospermum, S. prolificans and spp of Fusarium . Other fungal infections, which employ a drug (often partial or complete response) included isolated cases of infections caused by of Alternaria spp. , Blastomyces dermatitidis, Blastoschizomyces capitatus, Cladosporium spp., Coccidioides immitis, Conidiobolus coronatus, of Cryptococcus neoformans, Exserohilum rostratum, Exophiala spinifera, Fonsecaea pedrosoi, Madurella mycetomatis, Paecilomyces lilacinus , Penicillium spp., including P. marneffei, Phialophora richardsiae, Scopulariopsis brevicaulis and Trichosporon spp., including T. beigelii. in vitro demonstrated buy deca durabolin activity against clinical strains of Acremonium spp., Alternaria spp., spp Bipolaris., Cladophialophora spp., Histoplasma capsulatum . The growth of most strains was inhibited at concentrations of buy deca durabolin from 0.05 to 2 mg / ml. In vitro revealed activity against buy deca durabolin Curvularia spp. spp and Sporothrix. , but its clinical significance is unknown.

Pharmacokinetics

The pharmacokinetics of buy deca durabolin were studied in healthy people, and representatives of special groups of patients.
The pharmacokinetics of buy deca durabolin is non-linear due to saturation of its metabolism. With increasing doses there is a disproportionate (more pronounced) increase in AUC (area under the “concentration-time” curve). According to calculations, increase the oral dose of 200 mg 2 times a day up to 300 mg two times a day increases AUC τ in average 2.5 times. When intravenous or oral administration of bolus plasma concentration close to the equilibrium within 24 hours. If the patient does not receive a loading dose, when repeated application buy deca durabolin 2 times per day occurs accumulation of the drug, and the equilibrium concentration in plasma is achieved by the 6th day . most patients
buy deca durabolin is rapidly and almost completely absorbed after oral administration; maximum plasma concentration (C max ) achieved in 1-2 hours after administration. Bioavailability of buy deca durabolin when administered is 96%. Repeated dose of buy deca durabolin with fatty foods C max and AUC τ are reduced by 34% and 24%, respectively.
Absorption buy deca durabolin is not dependent on the pH of gastric juice.
Calculated buy deca durabolin volume distribution at steady state of 4.6 l / kg, indicating that the distribution of the active drug in the tissue. Plasma protein binding is 58%.
buy deca durabolin is determined in cerebrospinal fluid.
The pharmacokinetics of buy deca durabolin is characterized by high interindividual variability.
Studies in vitro showed that buy deca durabolin is metabolised by the action of the hepatic cytochrome P450 isoenzymes -. CYP2C19, CYP2C9 and CYP3A4
Studies in vivo also testify CYP2C19 that plays an important role in the metabolism of buy deca durabolin. This enzyme exhibits genetic polymorphism. For example, the reduced metabolism of buy deca durabolin may be expected in 15-20% of Asians and 3-5% of white and black. Studies in Caucasians and Japanese showed that patients with low metabolic AUC τ buy deca durabolin on average 4-fold higher than in homozygous patients with high metabolism. Heterozygous patients with active metabolism AUC τ buy deca durabolin on average 2-fold higher than in homozygous.
The major metabolite is buy deca durabolin N-oxide, which accounts for 72% of labeled metabolites in circulating plasma. This metabolite has minimal antifungal activity and does not contribute to the effect of buy deca durabolin.
The unchanged in urine output of less than 2% of the dose.
After repeated intravenous and oral administration of buy deca durabolin labeled about 80% and 83% of the radioactive dose, respectively, is found in urine. Most (> 94%) of the total dose was excreted within the first 96 hours after oral and intravenous administration.
The terminal half-life of buy deca durabolin is dependent on the dose and is approximately 6 hours while taking the drug orally in a dose of 200 mg. Due to the nonlinearity of the pharmacokinetics of the terminal elimination half-life does not allow to predict the cumulation or elimination of buy deca durabolin. Pharmacokinetics in special groups Gender In an oral re-use C max and the AUC T in healthy young women were 83% and 113% respectively higher than in healthy young males ( 18-45 years). No significant differences in C max and the AUC T in healthy elderly males and healthy elderly women ( > 65 years) is not present. The need for dose adjustment based on gender is not marked. The concentration of plasma in men and women alike. Age Repeated oral administration of C max and AUC τ in healthy elderly men ( >65) 61%) and about 86% higher, respectively, than in healthy young men (18-45 years) . No significant differences in C max and the AUC T in healthy elderly women ( > 65 years) and healthy young females (18-45 years) there. Safety buy deca durabolin in young and elderly patients are the same, and therefore the dose correction in old age is required. The average equilibrium concentration of drug in plasma in infantsreceiving the drug at a dose of 4 mg / kg every 12 hours, comparable with those of the adults receiving buy deca durabolin . at 3 mg / kg every 12 h mean concentration was – 1186 ng / ml in children and 1155 ng / mL in adults. In this regard, the recommended maintenance dose in children aged from 2 to <12 years of age is 4 mg / kg every 12 hours. Renal impairment In single dose of buy deca durabolin oral dose of 200 mg in patients with normal renal function and patients of lung (clearance creatinine 41-60 ml / min) to severe (creatinine clearance <20 mL / min) renal dysfunction The pharmacokinetics of buy deca durabolin were not significantly dependent on the degree of renal dysfunction. Contact buy deca durabolin plasma protein is similar in patients with varying degrees of renal insufficiency (see. In the “Dosage and Administration” and “Cautions”), in patients with moderate or severe renal impairment (serum creatinine levels > 220 umol / L or 2.5 mg / dL) was observed accumulation auxiliary constituting the lyophilisate for solution for injection – SBECD. Recommendations for Measuring and monitoring cm. In the “Dosage and Administration” and “Cautions”. Abnormal liver function after a single oral administration (200 mg) AUC of buy deca durabolin in patients with mild to moderately severe hepatic cirrhosis (Child-Pugh A and B ) 233% higher than that of patients with normal liver function. Abnormal liver function does not affect the communication of buy deca durabolin plasma proteins. Repeated oral administration AUCX buy deca durabolin is comparable in patients with moderate hepatic cirrhosis (Child-Pugh B) receiving the drug at a maintenance dose of 100 mg 2 times a day, and patients with normal function liver receiving buy deca durabolin 200 mg 2 times a day. Data on the pharmacokinetics in patients with severe hepatic cirrhosis (Child-Pugh C) is not present. The recommendations on dosing see. Section “Dosing and administration”.

 

Indications

  1. invasive aspergillosis
  2. severe forms of invasive Candida infections (including C. krusei ), resistant to fluconazole.
  3. esophageal candidiasis, caused by S. albicans , in immunocompromised patients.
  4. serious fungal infections caused by Scedosporium spp and Fusarium spp.
  5. severe fungal infections intolerant or refractory to other drugs.
  6. Prevention “breakthrough” of fungal infections in febrile patients with high-risk groups (recipients of allogeneic bone marrow, patients with relapsed leukemia).

Contraindications
buy deca durabolin is contraindicated in patients with hypersensitivity to buy deca durabolin or any components of the drug.
Concomitant use of buy deca durabolin and CYP3A4 substrates – terfenadine, astemizole, cisapride, pimozide, or quinidine is contraindicated, since the increase in the concentration of the latter in plasma may lead to QT prolongation, and in rare cases, to development atrial / ventricular fibrillation (see. section interaction with other drugs and other forms of interaction).
Concomitant use of buy deca durabolin and sirolimus is contraindicated, since buy deca durabolin significantly increases the concentration of healthy people sirolimus plasma (see. section interactions with other drugs).
Concomitant use of buy deca durabolin rifampicin, carbamazepine and long-acting barbiturates (e.g., phenobarbital) is contraindicated since these drugs cause a significant decrease buy deca durabolin plasma concentrations (see. section interaction with other drugs and other forms of interaction).
Concomitant use of ergot alkaloids (ergotamine, dihydroergotamine) which are substrates for CYP3A4, is contraindicated, as increasing the concentration of these substances in the plasma can lead to ergotism (see. see Interactions with other drugs and other forms of interaction).

Precautions
Severe hepatic failure, severe chronic renal failure (for parenteral administration). Safety and efficacy in children under the age of 2 years is not installed. Increased sensitivity to other drugs, derivatives of azoles.

Pregnancy and lactation
Adequate information on the use of buy deca durabolin in pregnant women do not.
Animal studies have shown that the drug in high doses has a toxic effect on reproduction. Possible risk to humans is not known.
buy deca durabolin should not be used in pregnant women unless the expected benefit to the mother clearly outweighs the potential risk to the fetus.
Derivation buy deca durabolin in breast milk has not been studied. buy deca durabolin should not be used in women who are breastfeeding, unless the expected benefit clearly outweighs the risk.

Dosing and Administration coated tablets buy deca durabolin tablets, coated tablets, taken orally for at least 1 hour before or 1 hour after meals. Valium for solution for infusion prior to intravenous infusion powder buy deca durabolin should be dissolved and diluted (see. Section Instructions for use). The solution for infusion is not recommended to be administered as a bolus . buy deca durabolin is recommended to be administered at a rate of not more than 3 mg / kg / hr for 1-2 hours. Before therapy is necessary Adjusted electrolyte disturbances such as hypokalemia, hypomagnesemia and hypocalcemia (see also section “Side effects. cardiovascular system”) use in adults Purpose buy deca durabolin intravenous or oral should start with the recommended loading dose, to the first day to achieve a serum concentration close to the equilibrium. Given the high oral bioavailability (96 .%, see Pharmacokinetics), you can switch from intravenous to oral administration of the drug in the presence of clinical indications. The following table provides detailed information on the dosage of the drug:


Selection of doses
film-coated tablets : In case of insufficient efficacy of treatment maintenance dose may be increased to 300 mg every 12 hours inside. In patients weighing less than 40 kg the dose may be increased to 150 mg every 12 hours in. If the patient does not tolerate the drug in high dose, it reduces in steps of 50 mg to 200 mg every 12 hours inside (or 100 mg every 12 hours . in patients weighing less than 40 kg) Phenytoin may be used with buy deca durabolin if the maintenance dose of the latter is increased from 200 to 400 mg every 12 hours inside (from 100 to 200 mg every 12 hours into patients weighing less than 40 kg); (see. the sections “Special Instructions” and “Interaction with other medicinal products”). Rifabutin can be used with buy deca durabolin if the maintenance dose of the latter increased from 200 to 350 mg every 12 hours inside (from 100 to 200 mg every 12 hours inside patients weighing less than 40 kg); . (. See “Special Instructions” and “Interaction with other medicinal products”) length of treatment depends on the clinical effect and the results of the mycological analysis. Valium for solution for infusion : In case of insufficient efficacy of treatment maintenance dose may be increased to 4 mg / kg every 12 h intravenously. If patients can not tolerate the drug in the higher dose, the intravenous dose was reduced to 3 mg / kg every 12 hours. Rifabutin and phenytoin can be used simultaneously with buy deca durabolin if the maintenance dose of the latter is increased to 5 mg / kg every 12 h (see. section “Special instructions” and “Interaction with other medicinal products”). The duration of treatment depends on the clinical response and the results of the mycological analysis. Use in the elderly dosage adjustment in the elderly is not required. Use in patients with impaired renal function Tablets coated : renal impairment does not affect the pharmacokinetics of buy deca durabolin when administered. Therefore dosage adjustment of buy deca durabolin oral in patients with mild, moderate or severe renal impairment is not required. The lyophilisate for solution for infusion : In patients with moderate or severe renal impairment (creatinine clearance less than 50 mL / min), there is accumulation auxiliary component of the drug – sulphobutylether beta-cyclodextrin (SBECD). Such patients should be prescribed buy deca durabolin inside except in cases where the risk-benefit justifies its intravenous administration. In such situations, you need to regularly monitor the levels of creatinine; if it should increase discuss the possibility of return to receive inside buy deca durabolin. buy deca durabolin displayed during hemodialysis clearance 121 ml / min. Four hour hemodialysis session does not remove a significant part of the dose of buy deca durabolin and it does not require correction. SBECD displayed during hemodialysis with clearance of 55 mL / min. Use in patients with impaired hepatic function In acute liver injury, manifested by increased activity of “liver” transaminases (AJIT, ACT), dosage adjustment is not required. In such cases it is advisable to continue monitoring of liver function tests to identify them further improve. In patients with mild to moderate hepatic cirrhosis (Child-Pugh A and B) is recommended to assign the standard loading dose of buy deca durabolin, a maintenance dose reduce by 2 times. Patients with severe hepatic impairment buy deca durabolin function should be used only in cases where the expected benefit outweighs the potential risk. in patients with severe under the constant control of the liver function of treatment should be carried out in order to detect signs of drug toxicity. use in children Safety and buy deca durabolin effectiveness in children less than 2 years have not been established (see. also “Pharmacodynamics” section) In this regard, buy deca durabolin is not recommended for children under 2 years of age. Experience with children is limited, making it difficult the choice of optimal dosages. However, pharmacokinetic studies in children buy deca durabolin was used in the following schemes. Children aged 2 to <12 years :

 

Intravenously inside
Loading dose
(first 24 hours)
6 mg / kg every 12 hours
(for the first 24 h)
6 mg / kg every 12 hours
(for the first 24 h)
Maintenance dose 
(the first 24 h after)
4 mg / kg every 12 hours 4 mg / kg every 12 hours

If the child can swallow tablets, the dose shall be rounded to the nearest dose in mg / kg, 50 mg times, and administered as whole tablets.
The pharmacokinetics and tolerability of higher doses have not been studied in children .. Teens aged 12 to 16 years : drug dosed as well as in adults.

Instructions for solution for infusion
buy deca durabolin is available in vials for single use only. The contents of the vial are dissolved in 19 ml of water for injection. The result is a clear 20 ml of concentrate containing 10 mg / ml of buy deca durabolin. If the solvent does not enter into the bottle under vacuum, the vial can not be used. Before use, the required volume of concentrate (see. Table) are added to a recommended compatible infusion solutions (see. Below). Ultimately receive buy deca durabolin solution containing 0.5-5 mg / ml.

Necessary amounts of concentrate Vfend 10 mg / mL

Body weight (kg)  Vfend volumes of concentrate (10 mg / mL) required
for the preparation of:
The dose of 3 mg / kg
(number of bottles)
The dose of 4 mg / kg
(number of bottles)
The dose of 6 mg / kg
(number of bottles)
thirty 9.0 ml (1) 12 ml (1) 18 ml (1)
35 10.5 ml (1) 14 ml (1) 21 ml (2)
40 12.0 ml (1) 16 ml (1) 24 ml (2)
45 13.5 ml (1) 18 ml (1) 27 ml (2)
50 15.0 ml (1) 20 ml (1) 30 ml (2)
55 16.5 ml (1) 22 ml (2) 33 ml (2)
60 18.0 ml (1) 24 ml (2) 36 ml (2)
65 19.5 ml (1) 26 ml (2) 39 ml (2)
70 21.0 ml (2) 28 ml (2) 42 ml (3)
75 22.5 ml (2) 30 ml (2) 45 ml (3)
80 24.0 ml (2) 32 ml (2) 48 ml (3)
85 25.5 ml (2) 34 ml (2) 51 ml (3)
90 27.0 ml (2) 36 ml (2) 54 ml (3)
95 28.5 ml (2) 38 ml (2) 57 ml (3)
100 30.0 ml (2) 40 ml (2) 60 ml (3)

buy deca durabolin is a sterile lyophilisate without preservative intended for single use. From a microbiological point of view, the drug should be administered immediately. It can be stored up to 24 hours at a temperature of from 2 ° C to 8 ° C when the solution was prepared under controlled aseptic conditions. The concentrate may be diluted with the following solutions : 0.9% sodium chloride intravenousAdvanced sodium lactate solution for intravenous administration of 5% glucose solution and sodium lactate complex intravenous solution of 5% glucose solution and 0.45% sodium chloride intravenous solution of 5% glucose solution for intravenous administration of 5% glucose solution 20 mEq KCl solution for intravenous administration 0.45% sodium chloride solution for intravenous administration of 5% glucose solution and 0.9% sodium chloride intravenous compatibility of buy deca durabolin with other solutions than those indicated above is not known.

Side effects

The table below lists the adverse events that were observed in the application of the drug and may have been associated with the treatment. The most common adverse reactions were visual disturbances, fever, rash, vomiting, nausea, diarrhea, headache, peripheral edema and abdominal pain. Adverse reactions were usually easy or moderately expressed. Clinically significant drug safety based on age, race or gender is not identified

The system of the body
Frequency *
Adverse drug reactions  
Are common
Very frequent Fever, peripheral edema
Frequent Chills, fatigue, chest pain, reaction / inflammation at the injection site, flu-like syndrome
Cardiovascular
Frequent Lowering blood pressure, thrombosis, phlebitis
few Atrial fibrillation, bradycardia, tachycardia, ventricular fibrillation.
Very rare Supraventricular tachycardia, complete atrio-ventricular block, bundle branch block, nodal arrhythmia, ventricular tachycardia (including ventricular flutter), lengthening the interval QT, ventricular fibrillation.
Indigestion
Very frequent Nausea, vomiting, diarrhea, abdominal pain
Frequent Increase in liver function tests (including ACT, AJIT, alkaline phosphatase, gamma-GT, LDH, bilirubin), jaundice, cheilitis, cholestasis.
few Cholecystitis, cholelithiasis, constipation, duodenitis, dyspepsia, liver increase, gingivitis, glossitis, hepatitis, hepatic failure, pancreatitis, tongue edema, peritonitis
Very rare Pseudomembranous colitis, hepatic coma
Endocrine
few Insufficiency of the adrenal cortex
Rarely Hyperthyroidism, hypothyroidism
immune
few Allergic reactions, anaphylactoid reactions
Blood and lymphatic
Frequent Thrombocytopenia, anemia (including macrocytic, microcytic, normocytic, megaloblastic, aplastic), leukopenia, pancytopenia
few Lymphadenopathy, agranulocytosis, eosinophilia, disseminated intravascular coagulation syndrome, inhibition of bone marrow hematopoiesis
Very rare lymphangitis
Metabolism and nutrition
Frequent Hypokalemia, hypoglycemia
few hypercholesterolemia
Musculoskeletal
Often Backache
few Arthritis
Nervous
Very frequent Headache
Frequent Dizziness, hallucinations, confusion, depression, anxiety, tremor, agitation, paraesthesia
few Ataxia, cerebral edema, hypertension, gipostezii, nystagmus, dizziness, fainting
Very rare Hyena-Barre syndrome, oculomotor crisis, extrapyramidal syndrome
Respiratory
Frequent Respiratory distress syndrome, pulmonary edema, sinusitis
Skin and subcutaneous tissue 
Very frequent Rash
Frequent Itching, maculopapular rash, photosensitivity skin reaction, alopecia, exfoliative dermatitis, swelling of the face, purpura
few Toxic epidermal necrolysis, eczema, psoriasis, Stevens-Johnson syndrome, urticaria
Very rare Angioedema, discoid lupus erythematosus, erythema multiforme, toxic epidermal necrolysis
senses
Very frequent Visual disturbances (including breach / enhancement of visual perception, the mist before his eyes, the change of color vision, photophobia)
few Blepharitis, optic neuritis, nipple swelling of the optic nerve, scleritis, violation of taste perception, diplopia
Very rare Bleeding in the retina, corneal opacity, optic atrophy
Genitourinary
Frequent Increased creatinine, acute renal failure, hematuria
few Increasing residual urea nitrogen, albuminuria, nephritis
Very rare Necrosis of renal tubules

* Criteria for evaluation of frequency were as follows: very common > 10%; frequent – of > 1% to <10%; rare – from > 0.1% to <1%; very rare – from 0.01% to <0.1%)

Visual disturbances
In the treatment with buy deca durabolin frequent visual impairment. Approximately 30% of patients experiencing a violation of visual perception: blurred vision, color vision change or photophobia. Visual disturbances are transient and fully reversible; in most cases they disappear spontaneously within 60 min. Repeated use of buy deca durabolin marked weakening of their severity. Visual disturbances are usually easily expressed, rarely require discontinuation of treatment and do not lead to any consequences in the long term. Visual impairment may be associated with higher plasma concentrations and / or dosages of the drug.
The mechanism of their development is unknown, although the drug is likely to act on the retina. In studying the effect of buy deca durabolin on retinal function in healthy volunteers showed a reduction in the amplitude of the waves on the electroretinogram (ERG). With this method, the electrical current measured at the retina. Changes in the ERG does not grew with continued treatment for 29 days and completely disappeared after the abolition of buy deca durabolin. The effect is more long-term treatment with buy deca durabolin (over 29 days) on visual function is not known. Skin reactions Skin reactions occur in 19% of patients receiving buy deca durabolin. In most cases, the rash is easy to moderate. In rare cases, treatment with buy deca durabolin develop severe skin reactions including Stevens-Johnson syndrome (uncommon), toxic epidermal necrolysis (rare) and multiforme erythema (rare). When the patient’s rash should be carefully monitored, and if the progression of skin changes buy deca durabolin advisable to cancel.In patients receiving long-term buy deca durabolin therapy may develop photosensitivity skin reactions (see. “Special Instructions” section). Liver function tests The overall incidence of clinically significant increase of transaminases in patients receiving buy deca durabolin, is 13.4%. Liver function abnormalities can be associated with higher plasma concentrations and / or dosages of the drug. In most cases, the deviation in liver function disappear with continued treatment (without changing the dose or after the correction) or its termination. In the application of buy deca durabolin in cases of severe hepatotoxicity is rarely observed in patients with serious underlying medical conditions. These cases may include cases of jaundice, hepatitis and hepatocellular insufficiency, leading to death. Reactions associated with infusionanaphylactoid reactions may occur Intravenous infusion of buy deca durabolin, including flushing, fever, sweating, tachycardia, chest tightness, shortness of breath, fainting, nausea, itching and rash. These symptoms occur immediately after the start of the infusion (see. “Special Instructions” section).

Overdose

Antidote buy deca durabolin is not known. In case of overdose symptomatic treatment is shown. Ability to conduct gastric lavage.
buy deca durabolin is removed by hemodialysis with clearance of 121 mL / min. SBECD (sulphobutylether beta-cyclodextrin) and dialyzed with a clearance of 55 ml / min. In case of overdose, hemodialysis may contribute to the removal of buy deca durabolin and SBECD from the body.

Interaction with other drugs The influence of other drugs on the pharmacokinetics of buy deca durabolin buy deca durabolin is metabolised by the action of cytochrome P450 isoenzymes – CYP2C19, CYP2C9 and CYP3A4. Inhibitors or inducers of these isoenzymes may cause, respectively, increase or decrease buy deca durabolin plasma concentration. The levels of buy deca durabolin in plasma is significantly reduced, while the application with the following drugs : Rifampicin (inductor CYP450): Rifampicin (600 mg once daily) reduces C max ( maximum plasma concentration) and the AUC T of buy deca durabolin by 93% and 96%, respectively. Concomitant use of buy deca durabolin and rifampicin is contraindicated (see Contraindications).. Carbamazepine and long-acting barbiturates (potent inducers of CYP450): Carbamazepine and long-acting barbiturates (eg, phenobarbital ) is likely to significantly decrease buy deca durabolin plasma concentrations, although their interaction was not studied. Concomitant use of buy deca durabolin with carbamazepine and long-acting barbiturates is contraindicated (see Contraindications).. Given the small pharmacokinetic interaction and no significant interaction, correction doses of the following drugs is not required : Cimetidine (nonspecific inhibitor CYP450, while also increasing the pH of gastric juice): cimetidine (400 mg, 2 times a day) and causes an increase AUCX buy deca durabolin Cmax by 18% and 23% respectively. Dose adjustment of buy deca durabolin is not recommended. Ranitidine (increases gastric pH): Ranitidine (150 mg 2 times a day) has no significant effect on C max and the AUC Tbuy deca durabolin. Antibiotics macrolide erythromycin (an inhibitor of CYP3A4; 1 g, 2 times a day ) and azithromycin (500 mg once daily) had no significant effect on Cmax and the AUC T buy deca durabolin. The action of buy deca durabolin on other drugs buy deca durabolin inhibits the activity of cytochrome P450 isoenzymes – CYP2C19, CYP2C9 and of CYP3A4. Therefore buy deca durabolin may increase the plasma concentration of substances that are metabolized by these isoenzymes CYP450. Simultaneous use of buy deca durabolin with the following drugs is contraindicated : Terfenadine, astemizole, cisapride, pimozide and quinidine substrates (CYP3A4): Although the interaction of these drugs have not been studied yet the simultaneous use of buy deca durabolin with terfenadine, astemizole, cisapride, pimozide, or quinidine is contraindicated, since the increase of their plasma concentrations can lead to QT prolongation, and in rare cases to the development of fibrillation / atrial ventricular (see. “Contraindications”).Sirolimus (substrate CYP3A4): buy deca durabolin AUCT increases Cmax and sirolimus (2 mg dose) to 556% and 1014%, respectively. The simultaneous use of buy deca durabolin and sirolimus is contraindicated (see Contraindications.). Ergot alkaloids substrates (CYP3A4): Although the interaction of these drugs have not been investigated, however, buy deca durabolin may cause an increase in the concentration of ergot alkaloids (ergotamine and dihydroergotamine) in the plasma and ergotism development. Concomitant use of ergot alkaloids with buy deca durabolin is contraindicated (see. “Contraindications”), interaction with buy deca durabolin may increase blood concentrations of these medications listed below. In this regard, at their simultaneous application needed constant supervision and / or correction dose .Cyclosporine (CYP3A4 substrate): In patients undergoing kidney transplantation and are in stable condition, buy deca durabolin increases C max and the AUC T cyclosporine at least 13% 70%), respectively. In the appointment of buy deca durabolin in patients receiving cyclosporine, it is recommended to reduce the dose of cyclosporine twice and monitor its levels in plasma. Increasing concentrations of cyclosporine followed by nephrotoxicity. After the abolition of buy deca durabolin is necessary to monitor cyclosporine levels and, if necessary, increase the dose (see section “Special Instructions”.). Tacrolimus (CYP3A4 substrate): buy deca durabolin increases C max and the AUC T (area under the concentration-time curve up last quantitative measurements) tacrolimus (0.1 mg / kg, single dose) at 117% and 221%, respectively.When assigning buy deca durabolin patients receiving tacrolimus, it is recommended to reduce the dose to the last one-third of its control and plasma levels. Increased levels of tacrolimus accompanied nephrotoxicity. After the abolition of buy deca durabolin is necessary to monitor tacrolimus concentrations and, if necessary, increase the dose (see section “Special Instructions”.) . Warfarin (of CYP2C9 substrate): Concomitant use of buy deca durabolin (300 mg 2 times a day) with warfarin (30 mg once daily) was accompanied by an increase in maximum prothrombin time up to 93%>. When concomitant administration of warfarin and buy deca durabolin is recommended to monitor the prothrombin time. Other oral anticoagulants eg phenprocoumon, acenocoumarol (substrates of CYP2C9, CYP3A4): buy deca durabolin may increase the plasma concentrations of coumarins and prothrombin time. If patients receiving coumarin preparations prescribed buy deca durabolin, you must monitor the prothrombin time with short intervals and accordingly select doses antikoagulyangov. Sulfonylureas (substrates of CYP2C9): buy deca durabolin may increase the concentration of sulfonylureas (eg tolbutamide, glipizide and glibenclamide) in plasma and cause hypoglycemia. With simultaneous use of them must be carefully monitored blood glucose levels. Statins substrates (CYP3A4): in vitro metabolism of buy deca durabolin inhibits lovastatin (human liver microsomes). Therefore buy deca durabolin may cause an increase in plasma concentrations of statins metabolized by the action of CYP3A4. When odnovremenennom their application is recommended to evaluate the feasibility of correction dose statin. Increasing the level of statin therapy is sometimes accompanied by the development of rhabdomyolysis. Benzodiazepines (substrate of CYP3A4): Although clinical interaction studies have not been studied, buy deca durabolin inhibit midazolam metabolism in vitro, (human liver microsomes). Therefore buy deca durabolin may cause an increase in plasma levels of the benzodiazepine that are metabolized by the action of CYP3A4 (midazolam, triazolam, alprazolam), and the development of prolonged sedation. With the simultaneous use of these drugs is recommended to discuss the feasibility of correcting dose benzodiazepines. Vinca alkaloids (substrate of CYP3A4): buy deca durabolin may increase the content of vinca alkaloids in the plasma (eg, vincristine and vinblastine) and cause neurotoxicity. It is recommended to discuss the feasibility of dose adjustment of vinca alkaloids. With simultaneous use of buy deca durabolin with the following medications significant pharmacokinetic interactions have been identified, therefore a dose adjustment is required : prednisolone (CYP3A4 substrate): buy deca durabolin increases C max and the AUC T prednisolone (60 mg single dose) by 11% and 34%, respectively. No dose adjustment is recommended. Digoxin (transport, mediated by P-glycoprotein): buy deca durabolin did not have a significant effect on C max and the AUC T digoxin (0.25 mg once daily). Mycophenolic acid (UDP-glucuronyl transferase substrate): buy deca durabolin has no Effect on C max and the AUC T mycophenolic acid (1 g single dose). phenytoin (substrate of CYP2C9 and a potent inducer of CYP450): the simultaneous use of buy deca durabolin and phenytoin should be avoided unless the expected benefit outweighs the potential risk. phenytoin (300 mg once per day) reduces Cmax and AUC τ buy deca durabolin by 49% and 69% respectively. buy deca durabolin (400 mg. Twice daily. See section 4.2) increases the C max and AUC τ phenytoin (300 mg once daily) by 67% and 81% respectively.With simultaneous use of phenytoin with buy deca durabolin recommended careful monitoring of phenytoin levels in plasma. Phenytoin may be used in conjunction with buy deca durabolin if the maintenance dose of the latter is increased to 5 mg / kg every 12 h intravenously or from 200 to 400 mg every 12 hours inside (from 100 to 200 mg every 12 hours into patients weighing less than 40 kg); see Dosage and Administration).. Rifabutin (inducer of CYP450): Rifabutin (300 mg once daily) reduced C max and the AUC T buy deca durabolin (200 mg twice daily) by 69% and 78%, respectively. While appointing rifabutin C maxand AUC τ buy deca durabolin 350 mg 2 times a day up 96% and 68% of the application rates of buy deca durabolin alone at a dose of 200 mg 2 times a day. When applied in a dose of buy deca durabolin of 400 mg twice a day C max and AUC τ , respectively, 104% and 87% higher than in the monotherapy dose of buy deca durabolin of 200 mg 2 times a day. buy deca durabolin at 400 mg 2 times a day increases the C max and the AUC Tof rifabutin by 195% and 331%, respectively. If the expected benefit of treatment outweighs the risk, rifabutin can be used simultaneously with buy deca durabolin. In this case, a maintenance dose of buy deca durabolin should be raised to 5 mg / kg every 12 h intravenously or from 200 to 350 mg every 12 hours inside (from 100 to 200 mg every 12 hours into patients weighing less than 40 kg) (see. Section dosage and administration). With simultaneous treatment of rifabutin and buy deca durabolin is recommended to conduct regular detailed analysis of the blood and control the adverse effects of rifabutin (eg, uveitis).Omeprazole (inhibitor of CYP2C19; substrate of CYP2C19 and CYP3A4): Omeprazole (40 mg once daily) increases C max and the AUC T buy deca durabolin 15% and 41% respectively. Dose adjustment of buy deca durabolin is not recommended. buy deca durabolin increases C max and the AUC T omeprazole by 116% and 280%, respectively. In the appointment of buy deca durabolin in patients receiving omeprazole, a dose of the latter is recommended to reduce by half. buy deca durabolin may also inhibit the metabolism of other proton pump inhibitors, which are substrates of CYP2C19. Indinavir (inhibitor and CYP3A4 substrate): Indinavir (800 mg three times daily) had no significant influence C max and AUC τ . buy deca durabolin buy deca durabolin not significantly affect the C max , C min and AUC τ of indinavir (800 mg three times a day). Other HIV protease inhibitors (substrates and inhibitors of CYP3A4): Studies in vitro indicate that buy deca durabolin may inhibit the metabolism of HIV protease inhibitors (e.g. saquinavir, nelfinavir and amprenavir).Studies in vitro have also shown that HIV protease inhibitors may inhibit the metabolism of buy deca durabolin. In the case of simultaneous use of buy deca durabolin with HIV protease inhibitors, patients should be monitored in order to identify possible toxic effects. Non-nucleoside reverse transcriptase inhibitors (substrates of CYP3A4, inhibitors or inducers of CYP450): in vitro studies show that delaverdin and efavirenz can inhibit the metabolism of buy deca durabolin. Efavirenz and nevirapine may induce the metabolism of buy deca durabolin, although this effect has not been studied. buy deca durabolin may inhibit the metabolism of non-nucleoside reverse transcriptase inhibitors. With simultaneous use of buy deca durabolin with a non-nucleoside reverse transcriptase inhibitors Patients should be monitored in order to identify possible toxic effects. Pharmaceutical incompatibility Valium for solution for infusion : The infusion of buy deca durabolin should not be performed through a single catheter or cannula with other drugs, including drugs for parenteral nutrition (eg , Aminofuzinom 10% Plus). However, buy deca durabolin may be administered simultaneously with total parenteral nutrition through a separate entrance to the multi-channel catheter. 4.2% bicarbonate solution for intravenous infusion of sodium solution is not compatible with buy deca durabolin, so it is not recommended for use as a solvent. Compatibility with other concentrations is not known. This drug should not be mixed with other medicinal products except those listed in section Instructions for solution for injection. Simultaneously with the introduction of buy deca durabolin should not hold the infusion of blood products and solutions of electrolytes.

Special instructions

Sampling for culture and other laboratory studies (serology, histopathology) for isolation and identification of pathogens should be performed prior to treatment. Therapy may be initiated before culture results and other laboratory tests, however, if any, treatment should be adjusted accordingly.
Obtained clinical strains with reduced susceptibility to buy deca durabolin.
However, elevated minimum inhibitory concentration (MIC) is not always possible to predict clinical inefficiency; there are cases when buy deca durabolin was effective in patients infected with organisms resistant to other azoles. Rate correlation between activity in vitro and clinical outcome is difficult, given the complexity of the patients, which included clinical studies; values border concentrations of buy deca durabolin, allowing to estimate the sensitivity to this drug have not been established. Hypersensitivity : Patients with hypersensitivity to other azoles, buy deca durabolin should be administered with caution Adverse events with the cardiovascular system : the use of buy deca durabolin is associated with prolongation of the QT interval on the electrocardiogram, which is accompanied by rare cases of flicker-ventricular flutter in patients receiving therapy with buy deca durabolin (in critically ill patients with multiple risk factors, such as cardiotoxic chemotherapy, cardiomyopathy, hypokalaemia and concomitant therapy, which could contribute to the development of this complication). Patients with these potentially proarrhythmic states buy deca durabolin should be administered with caution (see Dosage and administration). Hepatotoxicity : In the treatment with buy deca durabolin observed infrequent (0.1-1 %%) cases of serious reactions from the liver (including clinically manifested hepatitis, cholestasis and hepatocellular failure, including fatalities). Adverse effects of the liver are mainly observed in patients with severe disease (primarily malignant tumors of blood). In patients with no risk factors observed transient response of the liver, including hepatitis, jaundice.Disturbances of liver function are usually reversible and disappear after cessation of treatment. Monitoring the liver function : During treatment with buy deca durabolin is recommended to regularly monitor liver function, particularly liver function tests and bilirubin. When clinical signs of liver disease, which may be associated with buy deca durabolin, should be discussed discontinuation expediency (see section Dosage and Administration.). Adverse events in the kidneys : In critically ill patients receiving buy deca durabolin, cases of acute renal failure are observed. Monitoring the renal function : Patients should be monitored for signs of renal dysfunction. To do this, you must carry out laboratory tests, in particular to determine the serum creatinine level. (see Dosage and administration). Infusion Reactions : When intravenous buy deca durabolin infusion reactions occur, mainly “flushing” and nausea. If these symptoms are, you should discuss the appropriateness of treatment discontinuation (see Side effects.). Skin reactions : In rare cases, treatment with buy deca durabolin patients developed exfoliative cutaneous reactions, such as Stevens-Johnson syndrome. At the onset of the rash, patients should be observed. With the progression of skin lesions buy deca durabolin reasonable to remove. Additionally, buy deca durabolin accompanied by cutaneous photosensitivity reactions, especially in prolonged treatments. During treatment, patients are advised to avoid intense or prolonged exposure to direct sunlight. Cyclosporine and tacrolimus (substrates of CYP3A4): In patients receiving cyclosporine or tacrolimus, can be observed clinically significant their interaction with buy deca durabolin (see section Interaction with other drugs and other forms of interaction. .) phenytoin (CYP2C9 substrate and a powerful inducer of the CYP450): while the use of phenytoin with buy deca durabolin is recommended constant monitoring of phenytoin levels. If possible, avoid simultaneous use of buy deca durabolin and phenytoin unless the expected benefit outweighs the potential risk (see Interactions with other drugs and other forms of interaction.). Rifabutin (inducer of CYP450): With the simultaneous use of rifabutin with buy deca durabolin is recommended clinical analysis blood and control the undesirable effects of rifabutin (e.g., uveitis). Simultaneous with the appointment of buy deca durabolin and rifabutin should be avoided unless the expected benefit outweighs the potential risk (see. Section Interaction with other drugs and other forms of interaction). Women of childbearing age Women of childbearing age during treatment should always use effective methods of contraception.

Effects on ability to drive and use machinery

buy deca durabolin may cause transient and reversible visual impairment, including mist, violation / enhancement of visual perception and / or photophobia. If you have these symptoms, patients should avoid the performance of potentially hazardous activities such as driving or using complex machinery. When receiving buy deca durabolin patients should not drive a car at night.

Form release coated tablets : 2, 7, and 10 tablets in blister packs of PVC and aluminum foil; On 1 blister pack of 2, 7 or 10 tablets; 2, 4, 8 blister pack of 7 tablets; 3, 5, 10 blister packs of 10 tablets, together with instructions for use in a carton box. Valium for solution for infusion : At 3.4 g lyophilisate vials clear colorless glass with rubber caps and sealed with aluminum caps with plastic insert. 1 bottle with instruction on use in carton box. Vials are intended for single use. steroiden kaufen

steroide kaufen deutschland

anabolika steroide kaufen