testosterone gel

Adalimumab slowly absorbed and distributed, and reaches its maximum serum concentration after approximately 5 days. The absolute bioavailability of adalimumab with a single subcutaneous injection of 40 mg of 64%. The distribution and excretion : The distribution with a single intravenous injection is from 4.7 to 6.0 liter, indicating that the adalimumab substantially uniform distribution in the blood and extravascular fluids. Adalimumab is displayed slowly , a clearance is typically less than 12 ml / h. Testosterone gel is an average of two weeks and ranged from 10 to 20 days. The clearance , and do not change significantly when administered dose of 0.25-10 mg / kg, and the half-life is similar to the case of intravenous and subcutaneous administration of the drug. Adalimumab concentration in synovial fluid of rheumatoid arthritis patients is from 31 to 96% of the serum.

Pharmacokinetics adalimumab at steady state
equilibrium concentrations after subcutaneous application adalimumab 40mg once every two weeks in patients with rheumatoid arthritis at the end of the dosing interval are about 5 mg / ml (without the simultaneous methotrexate) and 8.9 ug / ml (compared to simultaneous use of methotrexate). With increasing doses of adalimumab in a range of 20, 40 and 80 mg once every two weeks and once per week subcutaneously observed almost linear increase in serum adalimumab concentrations in testosterone gel the end of the dosing interval. With prolonged use (over 2 years) adalimumab clearance does not change.
In the appointment of 40 mg adalimumab monotherapy once in 2 weeks average equilibrium minimum concentration of the drug in patients with psoriasis was 5 ug / ml.
There was a trend to increased clearance of adalimumab depending on the weight the body and the presence of antibodies to adalimumab.
for patients with Crohn’s disease, with a starting dose of 160 mg Humira at 0 week and followed by a dose of 80 mg for 2 weeks, adalimumab reaches its maximum serum concentration (approximately 12 ug / ml) for 2 th and 4 th week. In patients with Crohn’s disease equilibrium concentration observed (approximately 7 mg / ml) in the 24th and 56th weeks of maintenance therapy with 40 mg of adalimumab every 2 weeks.
Special populations Elderly Age has minimal effect on the clearance of adalimumab. Gender , testosterone gel race differences pharmacokinetic parameters (adjusted for body weight) in patients of different sex and race were found. hepatic and renal failure. Data on the pharmacokinetics of adalimumab in patients with impaired hepatic or renal function there.

INDICATIONS

  • Moderate to severe active rheumatoid arthritis (as monotherapy or in combination with methotrexate or other disease modifying anti);
  • Active psoriatic arthritis (as monotherapy or in combination with methotrexate or other disease modifying anti);
  • The active ankylosing spondylitis;
  • Crohn’s disease (moderate to severe) with an inadequate response to conventional therapy or ineffective (or decrease efficiency) of infliximab;
  • Chronic plaque psoriasis (moderate and severe) as shown systemic therapy or phototherapy, and when other systemic therapy options are not optimal.
  • Juvenile idiopathic arthritis in patients from 13 to 17 years as monotherapy or in combination with methotrexate.

CONTRAINDICATIONS

  • Hypersensitivity to adalimumab or any of its auxiliary components
  • Pregnancy
  • lactation
  • Children under the age of 18 years, except for patients 13 to 17 years with juvenile idiopathic arthritis.
  • Infectious diseases, including tuberculosis
  • Chronic heart failure III-IV functional class testosterone gel.
  • Joint reception with drugs anakinra and abatacept.

testim gel

Treatment: removal of preparation, if necessary – hospitalization, the appointment of symptomatic treatment for the correction of water-salt balance, hemostasis disorders and other disorders.. . See “Important information”.

No cases of overdose for other indications have not been observed.

Cautions Long-term use of the drug testim gel is not recommended due to the possible formation of antibodies reduce the effectiveness of treatment. Men is not effective at high levels of follicle stimulating hormone . In women before prescribing the should be evaluated follicular growth and cervical index (for two days prior to the effect of the stimulation). In the process of stimulation – ultrasonography and monitoring of plasma estradiol concentrations should be performed daily. Ovarian reaction can also be assessed using cervical index. In the application of gonadotropin preparations may develop syndrome. Syndrome OHSS 1st degree does not require treatment, accompanied by a slight increase clomid ovulation calculator in the size of the ovaries (5-7 cm), the high concentration of sex steroids and pain abdomen. The patient should be informed about her condition and carefully monitored. Syndrome testim gel2nd degree requires hospitalization and symptomatic treatment including intravenous infusion solutions for maintaining bcc (in case of increase in hemoglobin concentration). Ovarian cysts the size of 8-10 cm are accompanied by abdominal symptoms, nausea and vomiting. For syndrome OHSS grade 3 ovarian cysts characteristic size of 10 cm or more, ascites, hydrothorax, and an increase in abdominal pain, shortness of breath, a violation of water-electrolyte balance blood and increase its viscosity, accompanied by increased platelet adhesion to the risk of thromboembolic complications. Hospitalization is required. In the case of the syndrome treatment with should be discontinued. In the case of pregnancy symptoms of syndrome may be increased. In pregnancy arising after the induction of ovulation, gonadotropic drugs increases the risk of multiple pregnancies and, consequently, the risk to the mother (morbidity pregnancy and birth) and neonatal (low body weight).

Also, women with infertility, which offered treatment methods of reproductive technologies (especially in vitro fertilization), common pathology of the fallopian tubes, which can lead to an increased risk of ectopic pregnancy, in connection with which clomid side effects in men, in the early stages of pregnancy should be carried ultrasound for further localization ovum. during treatment testim gel and within 10 days after discontinuation of treatment, it can affect the value of immunologic tests for in the blood plasma / urine, which can lead to a false positive pregnancy test. pregnancy and the period breastfeeding is not used during normal pregnancy and breastfeeding. The drug has no negative impact on the ability to drive vehicles and other mechanisms.

Side effects: Local reactions: pain at the injection site, flushing, headache, fatigue, irritability, anxiety, depression; allergic reactions (fever, skin rash, angioedema); suppression of gonadotropic pituitary function. The women in the combined treatment of infertility (in conjunction with menotropinami or clomiphene) – OHSS syndrome (large ovarian cysts (prone to rupture), hemoperitoneum, hydrothorax, ascites, weight gain, edema, dizziness, breast tenderness, oliguria, increased blood viscosity, in rare cases – thromboembolic complications. The men – swelling, hypersensitivity nipple breast, gynecomastia, testicular enlargement in the inguinal canal (with cryptorchidism), prostatic hyperplasia, acne vulgaris, penis enlargement, premature puberty . If any of these instructions side effects are compounded deca injection, or if you notice any other side effects not mentioned in the instructions, inform your doctor.

Interaction with other drugs testim gel should not be mixed with other drugs! Avoid joint use of the with high doses of corticosteroids.

androgel side effects

Maximum plasma concentration is reached after 4-12 hours after injection. The half-life of 29-30 hours and therefore, in the case of daily intramuscular injection, there may be drug accumulation. Gonadotropin androgel side effects excreted by the kidneys. 10-20% of the dose is found in urine in an unmodified form, while the main part is excreted as fragments of β-chain.

Indications hypogonadal (due to a violation of the hypothalamus activity and pituitary gland). In women: – induction of ovulation in infertility, caused anovulation or impaired follicular maturation; – Preparation of follicles for puncture in controlled ovarian hyperstimulation programs (for assisted reproductive technologies); – maintenance gnc testosterone. phase corpus luteum In boys and men: – hypogonadotropic hypogonadism; – delayed puberty, due to the lack of gonadotrophic pituitary function; – cryptorchidism not due to anatomical obstruction.

Contraindications: General: organic androgel side effects lesions, such as tumors of the pituitary gland, the hypothalamus; gonadal dysgenesis; Hypersensitivity to the or to any component of the drug;hypothyroidism; adrenal insufficiency; hyperprolactinemia; . deep vein thrombosis in women: hormone-dependent tumor or currently suspected them (uterine cancer, breast cancer); Ovarian hyperstimulation syndrome in history; primary ovarian failure, bleeding or spotting from the vagina (not associated with menstruation) of unknown etiology; malformations of reproductive organs in which pregnancy is not possible; fibroid tumors of the uterus, in which offensive and child bearing impossible; Infertility is not associated with ovulation (eg, cervical or tubal origin); early menopause; obstruction of the fallopian tubes trenbolone side effects; normal pregnancy and lactation. In men: androgen tumors (prostate cancer, breast cancer, testicular tumor); Infertility is not associated with hypogonadotropic hypogonadism; . Severe renal insufficiency Boys: children up to 3 years; precocious puberty. If you have one of these diseases, before taking this medication, you should consult with your doctor.

Precautions Androgel side effectsis used in patients with coronary artery disease, congestive heart failure; epilepsy, migraine (including history); bronchial asthma, chronic renal failure, hypertension; in women with risk factors for thrombosis (thrombosis or thromboembolism, or relatives of the 1st degree relatives, obesity , thrombophilia); boys in the prepubertal period.

Dosing and Administration Drug treatment should be done only under medical supervision, having the appropriate specialization and experience in the treatment of infertility. The solution for injection should be prepared androgel side effects immediately before administration using the supplied solvent. Do not use if solution contained undissolved particles or it opaque. In women: to induce ovulation of follicles, and to puncture preparation administered . In order to maintain the corpus luteum of the ovary phase 3, 6 and 9 days after ovulation administered at 1500-5000 ME formulation.In boys and men: For the differential diagnosis of cryptorchidism and anorchia boys and to assess testicular function with hypogonadotropic hypogonadism once introduced . In hypogonadotropic hypogonadism is administered tren steroid time per week in combination with drugs menopausal gonadotropin . For the treatment of cryptorchidism boys 3-6 years administered 1 time per week androgel side effects product for 3 weeks (if necessary, in combination with a gonadotropin releasing hormone (GnRH)). For accelerating puberty in boys introduced times per week for 3 months.

Overdose In connection with the use of high in women with ovulation induction may develop severe syndrome. Symptoms: a sharp pain in the abdomen (especially in the groin area), nausea, vomiting, diarrhea, flatulence, oliguria, tachypnea, swelling lower limbs, in severe cases – hypovolemia, blood clots, disruption of water and electrolyte balance, ascites, peritonitis, hydrothorax, acute pulmonary insufficiency, thromboembolic complications. This condition is accompanied by the development of large ovarian cysts with danger of rupture and intra-abdominal bleeding, ascites, hydrothorax and the risk of thromboembolic complications.

low testosterone treatment

In case of overdose can be expected to more rapid development and pronounced the major side effects. Treatment low testosterone treatment is symptomatic, with obligatory use of mesna.

Interaction with other medicinal products
In an application with drugs that cause myelotoxic, neurotoxic and nephrotoxic effects may be increased side effects.
When used together with inducers of microsomal liver enzymes may increase the formation of alkylating metabolites.
In an application enhances the hypoglycemic effect of antidiabetic drugs. Allopurinol strengthens myelosuppression. Mesna reduces nephrotoxicity.
Ifosfamide may enhance skin reactions to radiation.
Simultaneous treatment with warfarin can reduce blood clotting and increase the risk of bleeding.

special instructions

  • Before treatment is necessary readjustment of foci of chronic infection and correction of possible electrolyte imbalance.
  • At the time of treatment should be regularly monitored picture peripheral blood (especially paying attention to the number of neutrophils and platelets), laboratory parameters of liver low testosterone treatment function, kidney and urine regularly for the presence of red blood cells, the appearance of which may precede the development of hemorrhagic cystitis.
  • Women and men during treatment and for 3 months after treatment with ifosfamide should use reliable methods of contraception.
  • If impairment of renal function and urinary flow rate may increase the toxic effect of the drug on the central nervous system, and therefore you may need to reduce the dose of ifosfamide.
  • To ensure the elimination of uric acid patients should consume enough fluids.
  • At the first signs of inflammation of the bladder or the appearance of blood in the urine, ifosfamide therapy should be discontinued.
  • In the treatment with ifosfamide is possible to suppress the natural defense mechanisms, the development of antibodies in the patient’s body in response to the vaccine may be reduced.
    Effects on ability to drive and use machines
    During therapy with Holoxan may experience nausea and vomiting, as well as the phenomenon of encephalopathy that It may affect the ability to drive a car or work with other mechanisms. Therefore, low testosterone treatment you should refrain from driving and other vehicles! It should also work with power tools and machinery!

 

androgel

After intravenous administration, the active substance is a prodrug (inactive form of transport), it is metabolized to pharmacologically active metabolite 4-gidroksiifosfamid. Activated enzyme (fosfoamidazy) liver and tumor tissue. In patients with impaired liver function activation slow down and even cut. After a single intravenous administration plasma concentration decreases biexponential manner with a half-life of terminal phase – 15 hours, and elimination of 61% of the dose in unchanged form; at lower monoexponential elimination takes place, with a half-life of about 7 hours, deca steroids with the proportion of unchanged drug androgel in urine is reduced by 4-5 times (12-18% of the dose).

Indications for use Germ cell tumors, ovarian cancer, malignant testicular tumor, lung cancer, breast cancer, pancreas cancer, endometrial cancer, cervix cancer, malignant lymphoma, soft tissue sarcoma, osteogenic sarcoma, Wilms’ tumor, Ewing’s sarcoma.

Contraindications

  • Increased sensitivity to ifosfamide;
  • Severe depression of bone marrow function;
  • Severe renal impairment;
  • Obstruction of the androgel urinary tract;
  • Cystitis;
  • Pregnancy and lactation;Precautions hypoproteinemia (hypoalbuminemia), electrolyte imbalance, advanced age, immunosuppression, diabetes mellitus, chronic liver failure, brain metastases, cerebral symptoms, chicken pox (including recently transferred or after contact with sick), herpes zoster , acute infectious diseases

    Dosage and administration. Ifosfamide is part of many chemotherapy regimens, and therefore when you select and dose in each individual case should be guided by the data of literature. The drug is administered intravenously over 30 minutes or as a 24-hour infusion. Use a solution with a concentration of not more than 4%. 5.8 g / m 2 as a 24-hour infusion every 1 or 3-4 weeks at 3.2 g / m 2 per day in the form of a 5-day continuous infusion at intervals of 3-4 weeks to reduce the likelihood of hemorrhagic cystitis simultaneously with ifosfamide drug mesna is used npp100 in a total dose of 60% of the dose ifosfamide (see for preimeneniyu mesna preparation instructions).

    Preparation of solution for intravenous administration. The powder androgel in vials was dissolved in water for injection to a concentration of 40 mg / 1 ml. For intravenous injection for 30 minutes, the resulting solution was diluted with 500 ml of 0.9% sodium chloride solution, Ringer’s solution or 5% dextrose solution. For administration as a 24 hour infusion of the drug resulting solution is diluted in 3 liters of 0.9% sodium chloride solution or 5% dextrose solution.Ifosfamide and mesna may be mixed in the same solution for infusion.

    Side effect From hemopoiesis system: a leukopenia, thrombocytopenia, anemia. The lowest level of white blood cell count and platelets observed after 7-14 days, the restoration of blood picture is usually 21 days after completion of the course. From the digestive system: nausea and vomiting. Rarely – stomatitis, abnormal liver function, usually manifests itself in the form of increased liver enzymes and / or serum bilirubin. From androgel the urinary system: hemorrhagic cystitis, dysuria, frequent urination and other symptoms of inflammation of the bladder (blood in the urine, painful urination .), renal dysfunction (increased concentration of creatinine and urea in serum proviron, decreased creatinine clearance, glucosuria) can also be observed proteinuria and metabolic acidosis. From the nervous system: disorientation, confusion, hallucinations, agitation fatigue, encephalopathy; less often – dizziness; rarely – seizures, coma, peripheral neuropathy. Reproductive system: dysfunction of the sex glands (azoospermia, amenorrhea). Skin and skin appendages: reversible alopecia, photosensitivity Local reactions: redness, swelling or pain at the injection site Other: cardiotoxic action, immunosuppression, infectious complications, slowing the rate of healing of wounds, pulmonary symptoms (cough or shortness of breath), fever, allergic reactions.