stanozolol tablets

For the treatment of systemic candidiasis (candidemia, visceral candidiasis chronic generalized (granulomatous) candidiasis) loading dose on day 1 of treatment is 12 mg / kg / day on subsequent days is administered at stanozolol tablets.
in cryptococcal infection, including cryptococcal meningitis, loading dose on day 1 of treatment is 12 mg / kg / day, administered in the following days at the rate of 6 mg / kg / day. Depending on the clinical response, the dose may be increased to 12 mg / kg / day. Duration of therapy -. 8-12 weeks
Patients with severe oropharyngeal candidiasis, Candida esophagitis, and the impossibility of oral fluconazole forms administered at the rate of 6 mg / kg – in the first day of therapy in the following days, 3 mg / kg / day.

Duration of treatment for oropharyngeal candidiasis – 2 weeks; When Candida esophagitis -. 3 weeks, continue taking fluconazole another 2 weeks after the relief of symptoms of infection
, for which the risk of infection development associated with the induced neutropenia (patients undergoing bone marrow transplantation for treatment with cytostatic and radiation therapy of malignant For the prevention of fungal infections in children neoplasms) dosestanozolol tablets is 3-12 mg / kg / day, depending on the severity and duration of neutropenia save. . Required to monitor patterns of peripheral blood of newborns under the age of 4 weeks  is used in the same doses as in older children, but increase the interval between administration of the drug: from 0 to 2 weeks of age are administered every 72 hours, with 2 4 weeks of life – every 48 hours.

The method of administration
Administered intravenously at a slow infusion mode; infusion rate – 200 mg (1 bottle) per hour. Do not use solution as an infusion environment for the introduction of other drugs.

Side-Effects
Fluconazole is generally well tolerated. It is noted that the frequency of adverse drug reactions significantly higher in the population of patients . From the nervous system : headache, dizziness, convulsions. On stanozolol tablets the part of the gastrointestinal tract : changes in taste, nausea, vomiting, diarrhea, flatulence, abdominal pain, dysfunction liver (increased levels of alkaline phosphatase, bilirubin, serum levels of transaminases, hepatitis, hepatocellular necrosis, including fatalities). since the cardiovascular system : prolongation of the interval, flicker / ventricular flutter. from the side of hematopoiesis : thrombocytopenia, leukopenia, neutropenia, agranulocytosis. From the urinary system : renal failure. Allergic reactions : skin rash, Stevens-Johnson syndrome, toxic epidermal necrolysis, anaphylactoid reactions. Other : renal failure, alopecia, hypercholesterolemia, hypertriglyceridemia, hypokalemia.

 

Overdose Symptoms : transient mental disorders stanozolol tablets – hallucinations, psychosis-reaction (paronoidalnoe behavior); . neurological disorders – ptosis, lacrimation, salivation, disturbances of the dynamics, convulsions, spontaneous urination, dyspnea Treatment : In acute poisoning shows hemodialysis; 3-hour hemodialysis procedure can be reduced serum concentrations of fluconazole by 50%.

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Following intravenous administration of fluconazole penetrates well into almost all tissues and body fluids. Drug concentrations in the kidneys, liquid sweat, the epidermis and dermis, synovial fluid, saliva, sputum, lung, peritoneal fluid, vaginal secretions and tissues of the vagina, breast milk similar to its plasma levels.Patients with fungal meningitis fluconazole content in cerebrospinal fluid reaches 80% of the respective levels in the plasma.
The plasma concentrations are directly proportional to the dose. When stanozolol for sale administered in therapeutic doses (200 mg / day in adults), the equilibrium concentration in serum reached the 4-5 day; when used in the first treatment day dose, twice the usual daily, equilibrium concentrations are set to 2-3 day. Apparent volume of distribution is close to the total volume of water in the body. The degree of binding with blood proteins fluconazole does not exceed 11-12%.
Fluconazole is derived mainly kidneys (80% – unchanged, 11% – in the form of metabolites). The half-life – long (30 hours). Fluconazole clearance is dependent on renal function and is directly proportional to creatinine clearance. After dialysis for 3 fluconazole hourly concentration in plasma decreased by 50%.

Indications
Cryptococcosis: cryptococcal meningitis, cryptococcal sepsis, cryptococcal infection of the lungs and skin,
systematic and generalized candidiasis: visceral candidiasis with the defeat of the endocardium, abdominal organs, respiratory system, eyes, organs, urinary and genital systems, candidemia,
disseminated candidiasis of the mucous membranes: the mouth, nose, throat, esophagus, non-invasive bronchopulmonary infections, candiduria;
vaginal candidiasis (acute or chronic recurrent form); deep endemic mycoses (histoplasmosis, coccidioidomycosis, sporotrichosis) in patients with normal immunity,
prevention of systemic fungal infections (primarily candidiasis) in patients undergoing bone marrow transplantation who receive cytotoxic therapy, patients with malignant tumors, on the background of chemotherapy and radiation therapy; Prevention of relapse of oropharyngeal candidiasis in patients.

Contraindications:
Hypersensitivity to fluconazole and other drugs from the group of azoles; pregnancy; lactation. Concomitant use is contraindicated stanozolol for sale with terfenadine or astemizole .

Precautions
hepatic insufficiency, rash during treatment with fluconazole in patients with superficial fungal infection and invasive / systemic fungal infections, concomitant use of terfenadine and fluconazole at a dose of less than 400 mg / day, potentially proaritmogennoe status in patients with multiple risk factors of patients (organic heart disease , electrolyte disturbances, concomitant use of drugs that cause arrhythmias), pregnancy.

Pregnancy and lactation
The use of fluconazole during pregnancy is indicated only in severe generalized and potentially life-threatening fungal infections. If necessary, the appointment during lactation should stop breastfeeding.

Dosing and Administration
The doses and dosing regimens depend on nosology. Adults For the treatment of systemic candidiasis, including visceral candidiasis, disseminated candidiasis, Candida pneumonia, chronic generalized (granulomatous) candidiasis, Candida peritonitis, candidemia loading  – 400 mg on the first day of therapy, then – 200 mg per day. When insufficient clinical efficacy of the dose can be increased to 400 mg / day. . The duration of therapy depends on clinical efficacy for the treatment of cryptococcosis of various localization loading  on the first day of therapy is 400 mg; on subsequent days 200 mg once a day, in low clinical efficacy – 400 mg once a day. Duration of therapy cryptococcal meningitis is not less than 8 weeks, until obtaining a negative. For the prevention of relapse of cryptococcal meningitis in  patients after completion of a full course of primary treatment stanozolol for sale administered at a dose of 200 mg / day for a long period of time. In deep endemic mycoses: histoplasmosis, coccidioidomycosis, sporotrichosis loading on the first day of therapy is 400 mg ; on subsequent days 200 mg once a day. The duration of therapy is determined individually; it can be 11-24 months. with coccidioidomycosis; 2-17 months. when paracoccidioidomycosis; 1-16 months. with sporotrichosis; 3-17 months. with histoplasmosis; Considering the need to long-term use of fluconazole at these infections (up to 2 years), preferably step therapy. For the prevention of candidiasis are immunocompromised, including patients in need of bone marrow transplants, the recommended  is 50-400 mg 1 time / day, depending on the degree of risk of fungal infection. If you have a high risk of generalized infection, eg in patients with severe or long-anticipated persistent neutropenia, the recommended dose is 400 mg 1 time / day. Is prescribed for a few days before the expected occurrence of neutropenia; after increasing the number of neutrophils , treatment was continued for 7 days. Children aged 1 month. up to 12 years accepted the following relationship dosages stanozolol for sale® in children and adults:

In children, as well as with similar infections in adults, the duration of treatment depends on the clinical and mycological effect. The drug is administered in the form of in / infusion of 1 times / days (see method of administration.); daily dose should not exceed 600 mg / day.

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If further provides a transplant of hematopoietic stem cells, caution must be exercised in the appointment of fludarabine, which relates to cytotoxic agents.

When non-irradiated blood transfusion patients treated with fludarabine, observed the development of the reaction “graft versus host” (reaction transfuziruemyh immunocompetent lymphocytes versus-host disease), which is associated with a high incidence of deaths. Patients buy stanozolol who need blood transfusions and receiving or receiving fludarabine, only irradiated blood to be transfused.

decay syndrome tumors arising in the treatment fludarabine observed in patients with large tumor mass. Since fludarabine can have a therapeutic effect at the first week of therapy, it is necessary to take precautions in patients with probable risk of developing this complication.

Regardless of the presence or absence of a history of autoimmune processes, and also from Coombs tests results there is a risk of life-threatening autoimmune reactions (autoimmune hemolytic anemia, autoimmune thrombocytopenia, thrombocytopenic purpura, pemphigus, Evans’ syndrome) buy stanozolol during or after treatment with fludarabine. Possible re-hemolytic process after the resumption of treatment with fludarabine. Patients receiving fludarabine should be closely monitored for hemolysis detection. With the development of hemolysis recommended termination of therapy. The most commonly used therapeutic measures for the treatment of autoimmune hemolytic anemia – Blood transfusion (irradiated) and glucocorticosteroids.

Men and women, sexually active should use reliable methods of contraception during (and for 6 months after) treatment with fludarabine.

During and after treatment with fludarabine should avoid vaccination with live vaccines.

Most patients are not sensitive to fludarabine are also insensitive to chlorambucil.

Use only transparent and colorless solution, free of visible particulates. In case of damage do not use the drug container.

The chemical and physical stability of the solution prepared for injection or infusion, maintained for 3 days at a temperature of 25 ° C or in the refrigerator (2-8 ° C) when diluted concentrate solution or 0.9% sodium chloride 5% dextrose solution for infusion for infusions. From the point of view of microbiological purity dilute solution should be used immediately, the diluted solution be stored in the refrigerator (2-8 ° C) for up to 24 hours.

When working with fludarabine should follow the rules of treatment with cytotoxic drugs. Avoid contact with the solution! After contact with skin, mucous membranes or eyes, wash thoroughly with plenty of water.

Effects on ability to drive a car and to management of mechanisms
Some side effects of drugs, such as buy stanozolol increased fatigue, weakness, blurred vision, may adversely affect the ability to drive and engage in potentially hazardous activities that require high concentration and psychomotor speed reactions.

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Very often – neutropenia, thrombocytopenia and anemia; often – myelosuppression. Immune system: Infrequent – autoimmune disorders (including autoimmune hemolytic anemia, thrombocytopenic purpura, pemphigus, Evans’ syndrome, acquired hemophilia), and allergic reactions. From the digestive system: very often – nausea, vomiting, diarrhea; often – anorexia, stomatitis, mucositis; rarely – gastrointestinal bleeding, changes in liver enzymes and pancreas.

On the part of metabolism: rarely stanozolol – as a result of tumor lysis may develop hyperuricemia, hyperphosphatemia, hypocalcemia, metabolic acidosis, hyperkalaemia, haematuria, urate crystalluria.

From the nervous system: often – peripheral neuropathy; rare – confusion; seldom – agitation, convulsions, coma.

From a sight organ: often – blurred vision; rarely – optic neuritis, optic neuropathy and blindness.

The respiratory system: very often – cough; rarely – shortness of breath, pulmonary fibrosis, pneumonitis.

Cardio-vascular system: seldom – heart failure, arrhythmias.

From the urinary system: rarely – hemorrhagic cystitis.

Skin and skin appendages: often – skin rash; rarely – Stevens-Johnson syndrome, toxic epidermal necrolysis (Lyell’s syndrome). Reported rarely available enhance growth of skin cancer and skin cancer during or after treatment with fludarabine.

Other: very often – fever, fatigue, weakness, accession secondary infections; often – fever, malaise, peripheral edema; rarely – lymphoproliferative disorders (associated with the Epstein-Barr virus). Patients treated with fludarabine before, after or simultaneously with the alkylating cytotoxic agents or radiotherapy, in rare cases with myelodysplastic syndrome acute myeloid leukemia .

Overdose
If you use high doses of fludarabine may develop irreversible changes in the central nervous system, blindness, coma, and death, as well as the development of severe thrombocytopenia and neutropenia due to bone marrow suppression. In the case of drug-threatening symptoms should be lifted immediately and supportive therapy. A specific antidote is not known.

Interaction with other medicaments
The use in combination with fludarabine pentostatin (dezoksikoformitsinom) for treating stanozolol often resulting in death due to high pulmonary toxicity.

Therapeutic efficacy may be reduced fludarabine reuptake inhibitors of adenosine and dipyridamole.

In the treatment of the combination of fludarabine and cytarabine in patients with CLL and AML was observed pharmacokinetic interaction.

When combined with fludarabine cytarabine shows a higher intracellular peak concentrations and AUC intracellular metabolite of cytarabine -arabinose tsitozintrifosfata. Plasma concentrations of cytarabine and excretion arabinose tsitozintrifosfata not changed. fludarabine solution for the on / in the application can not be mixed with other drugs.

Cautions
fludarabine treatment should be under the supervision of a physician who is experienced in the use of cytotoxic agents.

When therapy with fludarabine is recommended to periodically assess peripheral blood for anemia, neutropenia and thrombocytopenia, carefully monitor the concentration of serum creatinine and creatinine clearance, as well as to closely monitor the functions of the central nervous system for timely detection of possible neurological disorders.

Bone marrow suppression usually is reversible. When therapy with fludarabine greatest reduction in the number of neutrophils in the average observed in the 13 days (3-25 days) from the start of treatment, platelet count – an average of 16 days (2-32 days). Myelosuppression may be severe and have a cumulative character. several cases of hypoplasia or aplasia of the bone marrow has been described in adults, manifested pancytopenia, sometimes fatal. The duration of clinically significant pancytopenia ranged from 2 months to 1 year. These episodes have been identified as the pretreated and untreated patients.

Patients with increased risk for stanozolol opportunistic infections recommended preventive therapy. Amid fludarabine therapy it was noted development of serious opportunistic infections, in some cases leading to death.

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In humans, 2-fluoro-ara-AMP rapidly and completely dephosphorylated to the nucleoside 2-fluoro-ara-A. After a single infusion to patients with stanozolol dosage maximum concentration  of 2-fluoro-ara-A is 3.5-3.7 mol and reached the end of infusion . Determine the appropriate level of 2-fluoro-ara-A after five injections of the drug showed moderate cumulation with a mean Cmax equal to 4.4-4.8 mmol at the time of the end of infusion. During the five-day treatment levels of 2-fluoro-ara-A in the plasma increased in two times. Thus accumulation of 2-fluoro-ara-A after several treatment cycles may be small. Communication 2-fluoro-ara-A plasma proteins – small. After reaching  plasma levels of 2-fluoro-ara-A is reduced in three phases: elimination  in the alpha phase is about 5 minutes, the beta phase and 1.2 hours in the terminal phase of about 20 hours.

2-fluoro-ara-A excreted mainly by the kidneys (40-60% of the administered I / dose). 2-fluoro-ara-A is delivered to the leukemic cells active transport where refosforiliruetsya to partially monophosphate to the triphosphate and da. Triphosphate  is the major intracellular metabolite and the only known metabolite possessing cytotoxic activity. The maximum concentration of in leukemic lymphocytes from  patients was observed after an average of 4 hours after andriol kopen the infusion and characterized by significant fluctuations average value of about 20 micromolar. The concentration  in leukemic cells was always much higher than its maximum concentration in the plasma, indicating that the cumulation of material in the target cells.

A clear correlation between the pharmacokinetics of 2-fluoro-ara-A and the therapeutic effect of the drug in cancer patients have been identified, however, the frequency of neutropenia and changes in hematocrit indicate the dose-dependent cytotoxic effect of fludarabine phosphate as hematopoietic suppression.

Individuals with impaired renal function was observed reduction of the total clearance of the drug, indicating the need for dose reduction.

Indications

  • B-cell lymphocytic leukemia stanozolol dosage.
  • Non-Hodgkin’s lymphoma.

Contraindications

  • Increased sensitivity to fludarabine or other components of the preparation.
  • Impaired renal function (creatinine clearance less than 30 mL / min).
  • Decompensated haemolytic anemia.
  • Pregnancy and lactation.
  • Children’s age (lack of sufficient clinical data)

Precautions: after a careful assessment of risk / benefit ratio fludarabine should be used in frail patients with marked decrease in bone marrow function (thrombocytopenia, anemia and / or granulocytopenia), in patients with renal or hepatic insufficiency, immunodeficiency, opportunistic infections in history, in patients older than 75 years.

Dosage and administration
are allowed only in / in the introduction of fludarabine, so as to avoid accidental extravascular hit.

Adult
recommended dose fludarabine phosphate is 25 mg / m2 body surface / w once a day for 5 days every 28 days. The required dose (calculated in accordance with the patient’s body surface area) in a syringe.For I / bolus dose of the above formulation was diluted in 10 ml of 0.9% sodium chloride solution as required dose can be diluted in 100 ml 0.9% sodium chloride and administered kapelyyu for 30 minutes.There are no clear data on the optimal duration of treatment is not. The course of treatment depends on the observed effect and tolerability.

It is recommended that treatment with fludarabine to achieve a therapeutic response (usually 6 cycles), after the drug overturned.

Use in patients with impaired hepatic function
on the efficacy and safety data of fludarabine in patients with impaired hepatic function is limited. Patients in this group fludarabine administered with caution after a careful assessment of risk / benefit ratio.Treatment of these patients should be under close supervision. It may be necessary to reduce the dose or cancel treatments.

Use in patients with impaired renal function
In patients with possible impaired renal function and in patients older than 70 years is necessary to determine the creatinine clearance. If creatinine clearance in the range of 30-70 ml / min the dose should be reduced by up to 50%, and controlled to treat blood tests to assess toxicity. If creatinine stanozolol dosage clearance less than 30 mL / min fludarabine treatment is contraindicated.

Side effects:
The frequency of adverse events listed based on clinical trial data regardless of the causal relationship with fludarabine, in accordance with the following gradation of frequency: very common (more than 10%), common (more than 1% but less than 10%), uncommon (more than 0.1% but less than 1%), rare (more than 0.01% but less than 0.1%).