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Completeness beginning insulin absorption and the effect depends on the site of injection (abdomen, thigh, buttocks), the dose (amount of injected insulin), insulin concentration in the formulation, etc., unevenly distributed in the body; It does not cross the placental barrier low t treatment and into breast milk. It destroyed insulinase mainly in the liver and kidneys. Excreted by the kidneys (30-80%).

Indications

 

  • Diabetes, require insulin therapy.
  • Pregnancy in patients with diabetes mellitus.Contraindications
  • Increased sensitivity to insulin or to one component of the drug.
  • Hypoglycemia.Use during pregnancy and lactation
    During pregnancy, especially important to maintain good control in patients receiving insulin therapy (with insulin-dependent diabetes or gestational diabetes). The need for insulin usually decreases during the I trimester and increase during the II and III trimester. During birth and immediately after their need for insulin can dramatically decrease. Patients with diabetes are advised to inform the physician about pregnancy or planning pregnancy. In patients with diabetes during lactation may require dose adjustment of insulin, diet, or both.Dosing and Administration
    Dose low t treatment determined by the physician individually depending on the blood glucose level. The drug should be administered subcutaneously. Perhaps, and intramuscular administration.

    Intravenous  NPH is contraindicated.
    The temperature of the injectable preparation must comply room. Subcutaneous injections should be done in the shoulder area, thighs, buttocks or abdomen. Injection sites must be alternated so that the same site was used no more than approximately once a month. When insulin administered subcutaneously care should be taken not to fall into a blood vessel at the injection. After injection, do not massage the injection site. Patients should be trained in the proper use of the device for administering insulin. Insulin injection mode individually.

    Preparations for the introduction of
    Just prior to use cartridges low t treatment should be rolled between your hands ten times and shake, turning 180 ° and up to ten times the total resuspend insulin until it takes the form of a homogeneous turbid liquids or milk. Do not shake vigorously as this may result in foam that can prevent proper set dose. Inside each cartridge is a small glass bead to facilitate mixing insulin. Do not use insulin if it has flakes after mixing.
    The device does not allow the cartridge to mix their contents with other insulin directly into the cartridge. Cartridges are not designed to be refilled.
    Before the injection should be familiar with the manufacturer’s instructions on the use of pen-injector for administering insulin.

    Side effects Hypoglycemia is the most common side effects of the introduction of insulin preparations, includingH. Severe hypoglycemia may lead to unconsciousness and, in extreme cases, death. Allergic reactions: patients may experience local allergic reactions such as redness, swelling or itching at the injection site. These reactions usually disappear over a period of several days to several weeks. In some cases, these reactions may be caused by factors not related to the insulin, such as skin irritation or wrong cleaning agent for injection. Systemic allergic reactions caused by insulin occur less frequently, but are more serious. They can manifest themselves with generalized itching, difficulty breathing, shortness of breath, decreased blood pressure, increased heart rate, increased sweating.Severe cases of systemic allergic reactions may be life threatening. In rare cases, severe allergy to low t treatmentimmediate holding of NPH treatment is required. You may need a change of insulin or desensitisation holding. With prolonged use – may develop lipodystrophy at the injection site.

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If the next injection of Humira drug was accidentally omitted, it is necessary to make an injection as soon as it is detected. The following injection testosterone undecanoate should be carried out in accordance with the previously planned schedule.

ADVERSE EFFECTS
The following are safety androgel reviewsreceived the placebo-controlled clinical trials.
Clinical and laboratory adverse events whose relationship with adalimumab was at least possible, distributed across the system and frequency . Infections Very common: upper respiratory tract infection is frequent; lower respiratory tract infections (including pneumonia and bronchitis), urinary tract infection, herpetic infection (including simple and herpes zoster), influenza, superficial fungal infections (including skin lesions and nails) Uncommon sepsis, joint, and wound infection, abscess, skin infection (including impetigo), an infection of the hair follicle (including boils and carbuncles), paronychia, pustular rash, tooth infection and periodontal, ear infection, gastroenteritis, candidiasis of the mouth and throat, vaginal infection (including fungal), viral infection Neoplasms Infrequent: papilloma of the skin . Blood androgel reviews and lymphatic system Common: anemia, lymphopenia Uncommon: leukopenia, leukocytosis, lymphadenopathy, neutropenia, thrombocytopenia Immune System Infrequent: hypersensitivity, seasonal allergy metabolic disorders Uncommon: hypercholesterolaemia, hyperuricaemia, anorexia, decreased appetite, hyperglycemia, increased or decreased weight Psychiatric disorders Infrequent: depression, anxiety (including nervousness and agitation), insomnia, confusion Nervous system Common: headache, dizziness, paraesthesia Uncommon: dysgeusia, headache, drowsiness, fainting, neuralgia, tremor, neuropathy bodies of Infrequent: conjunctivitis, blepharitis , pain, redness, dryness of the eyes, century edema, glaucoma organs of hearing and balance Uncommon: pain, nasal, ringing in the ears Cardiovascular system Common: hypertension Uncommon: flushing, hematoma, tachycardia, palpitationsRespiratory system Common: cough, sore throat, nasal congestion Uncommon: shortness of breath, asthma, dysphonia, lung crepitation, ulceration of the mucous membranes of the nose, swelling of the upper respiratory tract, redness throat Gastrointestinal tract Common: nausea, abdominal pain, diarrhea, dyspepsia, ulceration of the oral mucosa Infrequent: vomiting, flatulence, constipation, gastroesophageal reflux, dysphagia, gastritis, colitis, hemorrhoids, hemorrhoidal bleeding, vesicular rash in the mouth, toothache, dry mouth, gingivitis, ulceration of the tongue, stomatitis (including aphthous)Skin and subcutaneous tissue Common rash (including erythematous and itching), pruritus, hair loss Uncommon: macular or papular rash, dry skin, sweating, night sweats, eczema, dermatitis, psoriasis, urticaria, ecchymosis, purpura, acne, skin ulcers, angioedema, change in the nail plate, photosensitivity reactions, skin exfoliation, rheumatoid nodules Musculoskeletal Infrequent: arthralgia, pain in extremity, back pain and shoulder girdle, muscle cramps, myalgia, joint swelling, synovitis, bursitis, tendinitis Urogenital system androgel reviews Infrequent: hematuria, dysuria, nocturia, pollakiuria, pain in the kidneys, menorrhagia General disorders and reactions at the injection site Very common: injection site reactions (including pain, swelling, redness or pruritus) Common: fatigue (including asthenia), flu syndrome Uncommon: increase body temperature, feeling of fever, chills, chest pain, impaired wound healing laboratory abnormalities Common: increase in liver enzymes (including alanine aminotransferase and aspartate aminotransferase) Uncommon: increased triglycerides, alkaline phosphatase, creatine kinase, lactate dehydrogenase, urea and androgel reviews creatinine in the blood, increase in activated partial thromboplastin time, reduction of potassium in the blood, the formation of autoantibodies, protein in the urine

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Autoimmune processes treatment with adalimumab may result in the formation of autoimmune antibodies. The effect of long-term treatment on the development of autoimmune diseases is not known. If a patient develops symptoms suggestive of a lupus-like syndrome as a result of treatment with adalimumab, discontinue use of the drug.

Elderly patients occurrence frequency serious infections in patients older than 65 years who received adalimumab was andro gel higher in patients younger than 65 years. 12% of patients treated with adalimumab was 65 years and approximately 2.5% were older than 75. Adalimumab should be used with caution in elderly patients due to the high probability of occurrence of infectious diseases.No differences in efficacy in this patient group compared with younger patients have been identified, a dose adjustment is required. children Adalimumab has not been studied in children under 4 years, data on the use of the drug in children weighing  is limited. Efficacy and safety of adalimumab in children proved only for the treatment of juvenile idiopathic arthritis in patients from 13 to 17 years. SurgerySafety data of the drug Humira for surgical interventions are limited. When planning for the surgery must take into account the long period of elimination of adalimumab. Patients receiving adalimumab during surgery should be closely monitored for the emergence of infections. Obstruction of the small intestine insufficient response to treatment disease may signal the presence of a fixed fibrotic stricture (stenosis), which may require surgical treatment. According andro gel to reports adalimumab is not conducive to the formation or worsening of strictures.

Pregnancy and lactation
In animal studies at doses up to 100 mg / kg of adalimumab signs damaging effect on the fetus have been identified. However, adequate controlled studies in pregnant women the drug has not been studied.
Animal studies do not always make it possible to predict the effect of the drug on humans, so during pregnancy, use of Humira drug is contraindicated.
Women of reproductive age should avoid pregnancy during treatment with Humira.
Data on excretion of adalimumab in breast milk or no suction.
Many drugs and immunoglobulins into breast milk. Given the risk of developing serious adverse reactions in the newborn, it is advisable to discontinue breast-feeding or stop the drug, taking into account its importance to the mother. The birth effects of andro gel in the generic activities and childbirth are unknown.

DOSAGE AND ADMINISTRATION
The recommended  testosterone gel dose of Humira in adult patients with rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis is 40 mg subcutaneously once every two weeks. In the appointment of Humira therapy of corticosteroids, non-steroidal anti-inflammatory drugs (including salicylates), analgesics (narcotic and non-narcotic), methotrexate and other basic antirheumatic drugs can be continued.
In some patients not receiving methotrexate, an additive effect with an increase can be achieved Humira multiplicity application to 40 mg once a week. Crohn’s disease . In the appointment of Humira therapy aminosalicylates, glyukokortiko steroids, and / or anti-metabolites (such as mercaptopurine and azathioprine) may be continued. The patients, the observed decrease in response to drug treatment, can obtain an additional effect of increasing the dose to 40 mg of Humira in the week. Some patients may not respond to therapy Humira during the first 4 weeks, however, treatment should continue as positive effect can be achieved within 12 weeks. The decision to discontinue therapy may be taken if the patient does not receive the effect from the treatment during this period. Chronic plaque psoriasis . The starting dose for adults is 80 mg. The maintenance dose – 40 mg every two weeks, starting one week after the . starting dose of juvenile idiopathic arthritis . Children from andro gel 13 to 17 years -. 40 mg biweekly clinical response is usually achieved within 12 weeks of treatment. The decision on termination of therapy may be taken if the patient does not receive the effects of the treatment during this period. The use of Humira Treatment with Humira is held under the supervision of a physician. If the doctor thinks it is possible, after appropriate training techniques subcutaneous injection, patients may self-administer the drug themselves. The drug Humira administered subcutaneously in the thigh or abdomen. The solution should be inspected before administration to determine the presence of foreign particles and discoloration. Adalimumab should not be mixed in the same syringe or vial with any other drugs. The remains of the solution and the material used should be destroyed.

 

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There has been no studies involving patients with a history of malignancy or in whom treatment with adalimumab continued in patients who develop malignancy. Thus, it should be more cautious in applying adalimumab in these patients. All patients and particularly patients previously treated with long-term therapy immunosuppressive  therapy (skin exposure longwave low testosterone treatments in combination with psoralen) psoriasis, should be screened for non-melanoma skin cancer, which is developed before or during treatment with adalimumab. Cases of acute or chronic leukemia described in connection with the use of post-marketing  antagonists for the treatment of rheumatoid arthritis, and other indications. In patients with rheumatoid arthritis higher risk of developing leukemia (up to two-fold) than the general population, even in the absence of treatment .

Allergies Serious allergic reactions associated with receiving adalimumab were uncommon during clinical trials. In postmarketing observations serious allergic reactions, including anaphylactic shock after receiving adalimumab were described very rarely. If an anaphylactic reaction or other serious allergic reactions, should immediately stop the introduction of adalimumab and assign the appropriate antiallergic therapy. Cover needle syringe contains natural rubber (latex). This can lead to serious allergic reactions in patients sensitive to latex. Hematologic complications There were few reports of development pancytopenia, including aplastic anemia when using low testosterone treatments antagonists. Rarely reported side effects in the blood system, including a significant cytopenia (including thrombocytopenia, leukopenia) in the treatment with adalimumab. The causal relationship of these reports to the reception adalimumab remains unclear. All patients should be advised to seek immediate medical attention if they develop symptoms suggestive of blood system disorders  while treatment with adalimumab . If confirmed significant hematological disorders treated with adalimumab should be suspended.

The combination with anakinra Serious infections were observed in clinical trials in the combined use of anakinra and another  antagonist, etanercept, with no observed clinical improvement effect compared with etanercept monotherapy. Based on the nature of the adverse events seen with combination of etanercept and anakinra similar to intoxication can occur when the combination of anakinra  antagonists. Thus, simultaneous treatment with anakinra adatimumaba contraindicated. Combination with Abatacept Combined use antagonists and abatacept associated with increased risk of infectious diseases, including severe infections, as compared  antagonists. Increasing clinical effect when using this combination is not observed. Thus, the combined use of antagonists of low testosterone treatments and abatacept contraindicated. Immunosuppression In a study in 64 patients  treated , showed no signs of depression of delayed-type hypersensitivity reactions, reducing the concentrations of immunoglobulins or modification of effector  and , monocytes / macrophages, and neutrophils. vaccination ofPatients with juvenile idiopathic arthritis is recommended as far as possible be fully vaccinated according to the current calendar of preventive inoculations prior to initiating therapy with adalimumab. Patients receiving adalimumab may receive passing vaccinations, except for live vaccines. Chronic heart failure is not carried out trials of adalimumab in patients with chronic heart failure, but there have been cases of adverse events associated, in clinical trials another antagonist of . Cases of progression have also been described in patients treated with adalimumab. It should be used with caution in adalimumab patients with chronic heart failure Ilow testosterone treatmentsfunctional class, and in chronic heart failure functional class the use of adalimumab is contraindicated. If you are developing or progressing symptoms treatment with adalimumab should be discontinued. attrezzi yoga manubri palestra allenamento funzionale definizione

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Patients should be informed of the need to see a doctor for symptoms ( persistent cough, weight loss, low-grade fever), pointing to the development of tuberculosis infection. Other opportunistic infections in patients treated with adalimumab, infrequently observed androgel 1.62 opportunistic infections, including fungal infections. These infections require prompt diagnosis and adequate treatment. Patients who develop fever, malaise, decreased body weight, sweating, cough, dyspnea and / or pulmonary infiltrates on chest radiograph or other severe systemic disorders with the development of shock or without him, should immediately consult a doctor for diagnostic procedures. patients who remained in areas endemic for various fungal infections, should assume the development of fungal infections. Such patients are at risk of histoplasmosis or other fungal infections, and doctors should therefore carry out an empirical antifungal therapy to determine the pathogen .

Assays for antigen-antibody histoplasmosis may be negative in some patients with active infection. Whenever possible, the androgel 1.62 decision on the appointment of empiric antifungal therapy in these patients should be taken after consulting a physician with expertise in the diagnosis and treatment of fungal infections, and should take into account both the risk of severe fungal infection and the risk of antifungal therapy. Patients who have developed severe fungal infection, it is recommended to stop taking  prior to cure the infection. Reactivation of hepatitis antagonists is associated with the risk of reactivation of hepatitis  in patients who are chronic carriers of this virus. In some instances,  reactivation occurring in connection with the reception of the antagonists of , is fatal. Most of these cases occurred in patients taking other medicines that suppress the immune system, which could also contribute to reactivation. In patients at risk  infection should be carried out diagnostics of the primary symptoms  infection before initiating therapy .

It should be used with caution in androgel 1.62 antagonists are those patients who are carriers  Those patients who are carriers of  and require treatment , should be carefully examined for the detection of active  infection symptoms during therapy and for several months after the end of therapy. There are no reliable data on the safety or efficacy of treatment of carriers antivirals in conjunction  for the prevention reactivation. In patients who developreactivation, the use of adalimumab should be stopped and effective antiviral therapy with appropriate supportive treatment should be initiated. Neurological complications The use of , including adalimumab, associated with rare cases of onset or complications of clinical symptoms and / or radiographic signs of demyelinating diseases, including multiple sclerosis. It should be used with caution in adalimumab patients with demyelinating diseases of the nervous system or the current history.

Malignancies There is a higher risk of lymphoma in patients with rheumatoid arthritis, which is characterized by a long, severe inflammation, which complicates the risk estimation. During long open clinical trials of adalimumab average incidence of malignancies was similar to that expected for the general population of that age, gender and race. Based on available data, we can not exclude the possible risk of developing lymphomas or other malignancies in patients treated  antagonists. Reported malignancies, some of which are fatal, in children and adults treated with androgel 1.62. Approximately half of the cases developed lymphomas .In other cases presented various malignancies, including rare malignancies associated with immunosuppression. Malignant tumors occurred at a mean of 30 months of therapy. Most patients were receiving concomitant treatment with immunosuppressants. Rarely reported gepatolienalny  lymphoma androgel 1.62 against adalimumab therapy, usually resulting in death. Most patients initially received infliximab and concomitant therapy of Crohn’s disease with azathioprine or mercaptopurine. Causation  with taking adalimumab has not been proven. trainer for bodybuilding

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