side effects of trenbolone enanthate

Side effects of trenbolone enanthate of herpes zoster (by Herpes zoster) (drug helps relieve pain, reduce its duration and the percentage of patients with pain caused by herpes zoster, including acute and post-herpetic neuralgia);treatment of infections of the skin and mucous membranes caused by the virus by Herpes simplex 1,2 type, including first identified and recurrent genital herpes (by Herpes genitalis) , as well as labial herpes (by Herpes labialis) ;prevention (suppression) of recurrences of infections of the skin and mucous membranes caused by the virus by Herpes simplex 1,2 types, including genital herpes;Prevention of transmission of genital herpes healthy partner when using the drug as a suppressive therapy in combination with safer sex;

Adults and children aged 12 years and older:

  • prophylaxis of cytomegalovirus (CMV) infection, as well as the reaction of acute transplant rejection (patients with renal transplant patients), opportunistic infections and other herpes infections (HSV, VZV) after organ transplantation.

Contraindications:

Hypersensitivity to valacyclovir, acyclovir and any other components of the drug; HIV infection in CD4 + lymphocytes content of less than 1 in 100 l; children’s age (up to 12 years for the prevention of cytomegalovirus infection after transplantation, up to 18 years – for other indications).

Carefully

Hepatic / renal impairment, advanced age, hypohydration, concomitant use of nephrotoxic drugs, pregnancy, lactation period, symptomatic forms of HIV patients.

Application of pregnancy and during breastfeeding

There are limited data on the use of valaciclovir in pregnancy. Valacyclovir is used only in cases where the potential benefit to the mother outweighs the potential risk to the fetus.

Recorded data on the outcome of pregnancy in women taking valacyclovir or acyclovir (an active metabolite of valaciclovir), showed no increase in the number of birth defects in their children compared with the general population. Since the register included a small number of women taking valacyclovir during pregnancy, the reliable and specific conclusions about the safety of valaciclovir in pregnancy can not be done.

Acyclovir, the major metabolite of valaciclovir, is excreted in breast milk. Upon receiving valaciclovir oral dose of 500 mg, C max acyclovir in breast milk in 0,5-2,3 times (an average 1.4 times) higher than the corresponding concentration of acyclovir in plasma, maternal blood. The average value of the concentration of acyclovir in breast milk was 2.24 micrograms / ml (9.95 micromol / L). When receiving valaciclovir mother oral dose of 500 mg 2 times / day child undergo the same influence of acyclovir, acyclovir when receiving an oral dose of about 0.61 mg / kg / day.

Dosing and Administration

Inside, regardless of meals, drinking water.

Treatment of shingles (Herpes zoster) Adults: The recommended dose is 1000 mg 3 times daily for 7 days.

Treatment of infections caused by HSV
Adults:
The recommended dose for the episode therapy is 500 mg two times a day for 5 days. In more severe cases of the disease debut should be begun as soon as possible, and its duration can be increased from 5 to 10 days. In the case of relapse treatment should last 3 or 5 days. In recurrent HSV is considered an ideal appointment of valaciclovir in the prodromal period or immediately upon appearance of the first symptoms of the disease.

Alternatively, for the treatment of herpes labialis assignment effectively valaciclovir dose of 2 g twice a day. The second dose should be taken approximately 12 hours later (but not earlier than 6 hours) after the first dose. Using such a dosing regimen of treatment duration is one day. Therapy should be initiated with the appearance of the earliest symptoms of herpes labialis (eg tingling, itching, burning).

Prevention (suppression) of recurrences of infections caused by HSV Adults: Patients with preserved immune recommended dose is 500 mg once daily. In patients with immunodeficiency recommended dose is 500 mg 2 times a day.

 

Prevention of transmission of genital herpes healthy partner
Infected immunocompetent persons with recurrent no more than 9 times a year, the recommended dose of valacyclovir is 500 mg 1 time per day for a year and more every day.
Data on the prevention of infection in other populations of patients with absent.

Prevention of cytomegalovirus (CMV) infection after transplantation

Adults and adolescents aged 12 years and over:
The recommended dose is 2 g 4 times a day, is appointed as soon as possible after transplantation.
The dose should be reduced according to creatinine clearance.
The duration of treatment is 90 days, but in patients with a high risk rate the treatment can be extended.

Special patient groups

Patients with impaired renal function
Treatment of shingles and infections caused by HSV, prevention (suppression) infection recurrence of HSV, prevention of transmission of genital herpes healthy partner
dose of valacyclovir is recommended to reduce in patients with a significant decrease in renal function (see. Dosing regimen in Table 1) . These patients need to maintain adequate hydration.
Experience of using valacyclovir in children with the values of creatinine clearance less than 50 mL / min / 1.73 m² no.

Table 1

 

testimony Creatinine clearance
ml / min
The dose of valaciclovir
Shingles (Herpes zoster) 15-30
for at least 15
1 g of 2 times a day,
1 g 1 day
Treating infections caused by HSV
(the scheme of 500 mg 2 times a day)
less than 15 500 mg 1 time per day
Treatment of herpes labialis
(scheme 2 g of 2 times a day during one day)
31-49

15-30

less than 15

1g twice a day for one
500 mg twice a day for a
500 mg dose
Prevention (suppression) of recurrences of infections caused by HSV:
patients with normal immunity less than 15 250 mg 1 time per day
patients with reduced immunity less than 15 500 mg 1 time per day
reducing the risk of transmission of genital herpes less than 15 250 mg 1 time per day

Patients who are on hemodialysis, valacyclovir is recommended immediately after hemodialysis in the same dose as patients with creatinine clearance less than 15 ml / min.

Prophylaxis of cytomegalovirus (CMV) infection after transplantation
destination valaciclovir mode in patients with impaired renal function should be set in accordance with Table 2.

Table 2.

 

Creatinine clearance ml / min The dose of valaciclovir
75 or more 2 g 4 times a day
from 50 to less than 75 1.5 g 4 times a day
from 25 to less than 50 1.5 grams 3 times per day
from 10 to less than 25 1.5 g of 2 times a day
less than 10 or dialysis * 1.5 g 1 per day

* In patients on hemodialysis, the valaciclovir should be administered after hemodialysis.

You must often determine the creatinine clearance, especially in the period when renal function is changing rapidly eg immediately after transplantation or engraftment, with valaciclovir dose is adjusted according to the creatinine clearance.

Patients with impaired liver function
in adult patients with impaired function of mild to moderate severity with preserved liver synthetic function of the dose of valaciclovir adjustment is required. Pharmacokinetic data in adult patients with severe hepatic impairment (decompensated cirrhosis) function, in violation of synthetic liver function and the presence of porto-caval anastomoses also indicate the need to adjust the dose of valaciclovir, however, clinical experience is limited in this pathology.

Children under the age of 12 years
do not have data on the use of the drug in children side effects of trenbolone enanthate.

Elderly patients
No dose adjustment is required with the exception of significant renal dysfunction. It is necessary to maintain an adequate fluid and electrolyte balance.

Side effect

On the part of the central nervous system:
headache, dizziness, psychotic symptoms, agitation, mental decline, ataxia, coma, confusion, or depression of consciousness, dysarthria, encephalopathy, mania, hallucinations, convulsions, tremor. These reactions are reversible and usually seen in patients with impaired renal function or in the background of other predisposing conditions. Patients with organ transplant, receiving high doses of valaciclovir (8 g / day) for the prevention of cytomegalovirus infection, neurological reactions occur more frequently than when lower doses.

The respiratory system: dyspnea.

From the digestive system:
nausea, abdominal discomfort, vomiting, diarrhea, reversible disturbances of liver function tests (ALT activity increase, aspartate aminotransferase, alkaline phosphatase), which are sometimes regarded as manifestations of hepatitis.

Hematopoietic system:
leukopenia (mainly seen in patients with lowered immunity), thrombocytopenia, anemia, thrombotic thrombocytopenic purpura.

For the skin:
erythema multiforme, rash, photosensitivity, alopecia.

Allergic reactions:
itching, hives, angioedema, anaphylaxis.

From the urinary system:
pain in the kidney projection, impaired renal function, including acute renal failure, renal colic. Renal colic may be associated with impaired renal function.

From the senses:
blurred vision.

Laboratory indicators:
reduction of hemoglobin, hypercreatininemia.

Other:
dysmenorrhea, nasopharyngitis, respiratory tract infection, increased blood pressure, tachycardia, fatigue; in patients with severely impaired immune system, especially in adult patients with advanced stages of HIV infection receiving valacyclovir in high doses (8 g / day every day) for a long time, there have been cases of renal failure, microangiopathic hemolytic anemia and thrombocytopenia (sometimes in combination ). Such side reactions have been observed in patients with the same disease, but do not receive valacyclovir.

Overdose

Symptoms: an overdose of valacyclovir may cause acute renal failure and the development of neurological symptoms, including confusion, hallucinations, agitation, depression of consciousness and coma, nausea and vomiting are also marked. To prevent overdose should follow caution when using the drug. Many cases of overdose have been associated with use of the drug for the treatment of patients with renal impairment and elderly patients function, due to non-compliance with the dosing regimen (dose valaciclovir repeatedly received in excess of the recommended).

Treatment.
Patients are subject to careful monitoring for timely diagnosis of toxic effects. Hemodialysis significantly accelerates the removal of aciclovir from the blood plasma and can be considered the best method of treatment in the event of symptomatic overdose.

Interaction with other drugs cimetidine and tubular secretion blockers reduce the effect (reduce speed, but not the conversion of fullness in the acyclovir). Correction of dosage regimen in patients with normal creatinine clearance is not required.

Nephrotoxic drugs increase the risk of renal dysfunction. Care must be taken (to observe the change of renal function) of the drug when combined side effects of trenbolone enanthate higher doses (4 g per day and more) with drugs that affect the other kidney (eg, cyclosporine, tacrolimus).

Acyclovir is excreted by the kidneys, mainly in unchanged form, by means of the active renal secretion. The combined use of drugs with this mechanism elimination can lead to increased concentration of acyclovir in plasma.

After assigning side effects of trenbolone enanthate drug in 1000 mg probenecid and cimetidine, are displayed in the same manner as valaciclovir, aciclovir AUC value increases and thus reduce its renal clearance. Given the wide therapeutic index acyclovir correction side effects of trenbolone enanthate drug dose in this case is not required.

Care must be taken in the case of simultaneous use of valaciclovir at higher doses (4 g per day and higher) and drugs that compete with acyclovir for the elimination way since there is a potential threat increase in plasma levels of one or both drugs or their metabolites. It was observed increase in AUC values of acyclovir and the inactive metabolite of mycophenolate mofetil, while the use of these drugs.

The pharmacokinetics of valaciclovir is not altered by simultaneous administration with digoxin, aluminum / magnesium-containing antacids, thiazide diuretics.

special instructions

In patients at risk of dehydration, especially in elderly patients, in the period of treatment is necessary to ensure adequate fluid replacement. Since acyclovir excreted by the kidneys, the dose of the drug side effects of trenbolone enanthate be adjusted depending on the degree of renal impairment. In patients with renal failure there is an increased risk of developing neurological complications, these patients must be thoroughly monitored. Typically, these reactions are reversible and disappear after discontinuation of the drug.

In patients with chronic renal failure (CRF) is often recommended to determine creatinine clearance, particularly at a time when kidney function is changing rapidly (such as immediately after transplantation or engraftment), the valaciclovir dose is adjusted according to the creatinine clearance rates.

No data on the use of valaciclovir in high doses (4 g or more per day) in patients with liver disease, so high doses side effects of trenbolone enanthate they should be used with caution.

Suppressive valacyclovir therapy decreases the risk of transmission of genital herpes, but does not exclude the risk of infection and does not lead to a complete cure. side effects of trenbolone enanthate drug therapy is recommended in combination with safer sex. Acceptance of the drug in high doses for a long time for conditions involving severe immunodeficiency (bone marrow transplantation, clinically expressed form of HIV infection, renal transplantation), led to the development of thrombocytopenic purpura and hemolytic uremic syndrome, or death.

If you have any side effects on the central nervous system (including agitation, hallucinations, confusion coznaniya, delirium, seizures, and encephalopathy) drug overturned.

Effect on management of vehicles and mechanisms.
There is no data on the effect of valacyclovir used in therapeutic doses, the ability to drive vehicles and mechanisms. However, in assessing the patient’s ability to drive a car or moving machinery should take into account that you may experience side effects of the central nervous system, so be careful.

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