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Indications

  • Arterial hypertension
  • Prevention of angina attacks (including Prinzmetal angina)
  • Preventing attacks of supraventricular arrhythmias (paroxysmal tachycardia, atrial flutter or flicker, arrythmia)

Contraindications

Hypersensitivity to the drug and other derivatives benzothiazepine, sinoatrial and atrioventricular block II and III degree (except for patients with a pacemaker), bradycardia, sick sinus syndrome without pacemaker, cardiogenic shock, Wolff-Parkinson-White syndrome Lown-Ganong-Levine in conjunction with atrial flutter or atrial fibrillation (except for patients with a pacemaker), testosterone cypionate reviews marked hypotension (systolic blood pressure less than 90 mm Hg), acute heart failure, chronic heart failure (decompensation stage), myocardial infarction signs of left ventricular failure, ventricular tachycardia with a wide QRS complex, pregnancy, lactation, age 18 years (effectiveness and safety have not been established), lactose intolerance, lactase deficiency and glucose-galactose malabsorption.

The caution should be used in patients with severe liver and kidney function, acute porphyria, severe aortic stenosis, in the acute phase of myocardial infarction (with no evidence of left ventricular failure), hypertrophic obstructive cardiomyopathy, mild to moderate hypotension, atrioventricular block I degree or lengthening of PQ interval, while the use of beta-blockers or digoxin, compensated chronic heart failure, with tendency to bradycardia in the elderly.

Application of pregnancy and during breastfeeding

During pregnancy and lactation Lannaher is contraindicated.
Women of childbearing age before the appointment of should exclude pregnancy.

Dosing and Administration

The tablets should be taken orally before meals, with liquid squeezed small amount of liquid. The testosterone cypionate reviews mode set individually.
The initial dose of the drug Lannaher is 1 tablet of 90 mg 2 times a day. The average daily dose is 180-270 mg. Correction of dosage regimen can be carried out only after 2 weeks. The maximum daily dose is 360 mg. Long-term treatment with a good therapeutic effect may reduce the dose.

Side effect

Since the cardiovascular system: bradycardia, ventricular arrythmia, congestive heart failure, sinus block, atrioventricular block up to asystole, marked reduction in blood pressure, fainting, flushing, angina, arrhythmias (including atrial and ventricular fibrillation), tachycardia, shortness of breath , peripheral edema. When used in high doses – angina pectoris, bradycardia, atrioventricular block. From the digestive system: dry mouth, increased appetite, vomiting, nausea, heartburn, diarrhea, hypertrophic gingivitis, constipation, hypercreatininemia, abdominal pain, abnormal liver function, ileus . On the part of the central nervous system: headache, fatigue, asthenia, fatigue, anxiety, dizziness, somnolence, insomnia, depression, pathological fear ekstrapirapidnye disorders, Parkinson’s disease (ataxia, “mask-like” face, “shuffling” gait, stiffness arms or legs, trembling hands and fingers, difficulty in swallowing). When used in high doses – paresthesias. From the senses: visual disturbances (transient blindness). Allergic reactions: increased sensitivity, itching, skin rash, redness of the skin, Stevens-Johnson syndrome, erythema multiforme, exfoliative dermatitis. Other: the drug may lead to increased concentrations of “liver” enzymes in serum, peripheral edema. When used in high doses – lung edema (shortness of breath, cough, stridor), thrombocytopenia, agranulocytosis, galactorrhea, increase in body weight. With a sharp lifting of the drug may develop “cancellation” syndrome with concomitant tachycardia, hypertension and worsening of angina.

 

Overdose

Symptoms: bradycardia, marked reduction in blood pressure, turning into a collapse, disturbance of atrioventricular and sinoatrial conduction, heart failure, cardiogenic shock, asystole, nausea, vomiting, metabolic acidosis, hyperkalemia.
Treatment: Depending on the severity of the overdose symptoms. It is necessary to wash out the stomach, activated charcoal to appoint further treatment is symptomatic. If necessary, it is recommended to appoint atropine, isoprenaline, dopamine or dobutamine, and, when expressed conduction disturbances may use elektrokardio¬stimulyatsii.
Hemodialysis and peritoneal dialysis are not effective. Interaction with other drugs

Interaction with other drugs

Pharmacodynamic
In simultaneous reception of with antihypertensives there is a growing anti-hypertensive action.
At the same time taking and digoxin may increase blood concentrations of digoxin.
At the same time taking with antiarrhythmics, beta-blockers, cardiac glycosides may develop bradycardia, a violation of atrioventricular conduction, the onset of symptoms . heart failure,
the simultaneous use of adenosine, an increased risk of prolonged bradycardia.
Salicylates further inhibit the ability of platelet aggregation.
Ethanol:. increase in the antihypertensive effect of
procainamide, quinidine and other drugs causing prolongation of the interval QT, increase the risk of a significant lengthening.
means inhalation anesthesia (derivatives of hydrocarbons), thiazide diuretics, and other drugs that reduce blood pressure, increase the hypotensive effect of .
Phenytoin reduces effect.
Antipsihooticheskie agents (neuroleptics) increase the antihypertensive effect of .
co-administration of nitrates is possible (including long-acting forms).
Preparations lithium may increase the neurotoxic effects of (nausea, vomiting, diarrhea, ataxia, tremor and / or ringing in the ears).
Indomethacin and testosterone cypionate reviews other non-steroidal anti-inflammatory drugs, steroids and estrogen, as well as sympathetic drugs reduce the antihypertensive effect.
Enhances cardiodepressive action of general anesthetics.

Pharmacokinetic
cimetidine a biotransformation process weakens in the liver, excretion it slows, increasing the duration of action of .
and increases the concentration of theophylline in plasma karmazepina (40-70%) and increase the risk of adverse reactions, including ataxia, nystagmus, diplopia, headache, vomiting, confusion, and also increases the concentration of cyclosporine, digoxin (50%), imipramine, lithium, and midazolam.
Enhances the effect of hypoglycemic agents for oral administration (eg, chlorpropamide and glipizide).
At the same time use of and cyclosporine in patients with kidney transplant, may develop intoxication last paresthesia. It is therefore necessary to closely monitor the plasma levels of cyclosporine concentrations in this group of patients. Eating increases the absorption and bioavailability of by 20-30%.
It may increase the bioavailability of propranolol. Increases concentration moratsizina plasma.
Phenobarbital, diazepam, rifampicin reduce the concentration of plasma.
Increases concentration of quinidine blood, valproic acid (may require dose reduction).
Antiviral agents: ritonavir may increase plasma concentrations of BCCI.
Anxiolytics and hypnotics: It inhibits the metabolism of midazolam (increased plasma concentration with increased sedation.
BCCI:. elimination of nifedipine decreased (increased plasma concentration)
significantly increases the concentration of lovastatin plasma also enhances the effect of simvastatin is therefore necessary to reduce their simultaneous application of the dose of simvastatin at the same time.. use of with simvastatin and lovastatin should be monitored for patients, due to the possibility of myositis or rhabdomyolysis.