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what is testosterone propionate

Isotonic sterile solution of natural sea salt in water for injection, used in the form of nasal drops (nasal drops) and contains natural minerals and trace elements
What is testosterone propionate helps to maintain the normal physiological state of the nasal mucosa, thinning mucus and normalization of its formation in goblet mucous membrane cells.
Trace elements that are part of the drug, anti-inflammatory effect, stimulate the recovery process, improve the function of ciliated epithelium, which increases the resistance of the mucous membrane of the nasal cavity to the pathogenic bacteria and viruses, it promotes its cleansing.
at allergic and vasomotor rhinitis the drug contributes to washing off and the removal of allergens and haptens from nasal mucosa, reduction of local inflammation.
Morenazal used for hygienic purposes, it helps cleanse the mucosa from the settled her outside and room dust.

Indications
adenoids, acute, allergic, vasomotor rhinitis, chronic diseases of the nasal cavity, nasopharynx, paranasal sinuses, including accompanied by dry nasal mucosa.
Prevention nasal infections in the autumn and winter, changing climate conditions (room with air conditioning and / or central heating), the presence of polluted air (smokers, car drivers, hot and dusty shop).
Preparation the introduction into the nasal cavity of other drugs (to improve their absorption).
Washing the wounds of what is testosterone propionate the nasal cavity and paranasal sinuses before and after surgical interventions.
hygiene of the nasal cavity

Contraindications:
Hypersensitivity.

Dosing and Administration
Intranasal (in the nasal passages).
Drops Morenazal designed for young children (under 6 years), including children under 1 year, but the possibility of their use in children older.
Patients older than 1 year can be assigned Morenazal Spray . nasal With the purpose of treatment nasal drops Morenazal appointed for children under 1 year, 1-3 times a day for 1 to 2 drops in each nostril;Children from 1 year to 7 years – 4 times a day 2 drops in each nostril; children from 7 to 16 years – 4-6 times a day 2 drops in each nostril; adults -. 4-8 times a day 2-3 drops in each nostril course of treatment is 2-4 weeks. It is recommended to repeat the treatment after a month. With hygienic purpose to soften and remove secretions from the nose – drops instilled into each nostril in the required amount by removing the liquid residue resulting from the nose with a handkerchief or with cotton wool. The procedure can be repeated as many times as long as the allocation, accumulated in the nasal passage will not be softened and removed. In children under 1 year is recommended what is testosterone propionate toilet nasal mucosa for preservation of its physiological characteristics in the form of instillation Morenazal drops 2-3 times a day 1-2 drops in each nostril.

Side effects:
Allergic reactions are possible.

The interaction with other drugs
Since the drug has no systemic effect on the body, interactions with other drugs is not registered. kob anavar

testosterone enanthate vs propionate

These important mediators bind proastmaticheskie cysteinyl-leukotriene receptors (CysLT), present in the human airway and bronchospasm responsible for reaction, sputum, vascular permeability and increase in the number of eosinophils.

Testosterone enanthate vs propionate active compound at peroral admission that possesses high affinity and selectivity to the CysLTi-receptors.  Bronchodilatory effect observed within 2 hours after oral administration.

Bronchodilator effect betag-agonists is enhanced while taking montelukast.  Inhibits both early and late stages of bronchospasm caused by exposure to antigens. Montelukast reduces the number of eosinophils in the peripheral blood of adults and children and also significantly reduces the number of eosinophils in the airways. Patients with hypersensitivity to aspirin receiving inhaled and / or oral glucocorticosteroids (GCS), the addition to montelukast therapy provides better control of the disease.

Pharmacokinetics

Absorption
After oral montelukast is rapidly and almost completely absorbed. In adult patients on an empty stomach after ingestion tablets, film-coated tablets, 10 mg average value of the maximum plasma concentration (C max ) reached after 3 h. Bioavailability The mean value – 64%. Values with oral bioavailability and C max is not violated when eating.

Distribution
The binding of montelukast with plasma proteins is 99%. The volume of distribution at equilibrium averages 8-11 liters. Preclinical studies showed minimal penetration of the blood brain barrier montelukast.After 24 hours, after ingestion of Montelukast negligible concentration in other tissues.

Metabolism
Montelukast is extensively metabolised in the liver. When used in therapeutic doses montelukast metabolite concentration in blood plasma at steady state is not determined in adults and children.

In vitro studies have shown that the metabolism of montelukast involved isozymes of cytochrome P450 (ZA4, 2A6 and 2C9), with therapeutic concentrations of montelukast does not inhibit cytochrome P450 isozymes: ZA4, 2C9, 1A2, 2A6, 2C19 and 2D6. The metabolites have little therapeutic effect of montelukast.

Excretion
half-life of montelukast in healthy young adult volunteers ranges from 2.7 to 5.5 hours. The plasma clearance of montelukast in healthy adult volunteers averages 45 ml / min. Following oral administration of montelukast 86% of the total output through the intestine for 5 days and less than 0.2% – in the kidneys, which along with its bioavailability data confirms removal of Montelukast and its metabolites predominantly in the bile.

Pharmacokinetics in special clinical situations

The pharmacokinetics of montelukast in women and men the same.

Patients of advanced age or patients with hepatic insufficiency, mild to moderate severity is not required montelukast correction mode.

The pharmacokinetics of montelukast in patients with renal insufficiency has not been evaluated. Because montelukast and its metabolites are not excreted by the kidneys, a dose adjustment in these patients is not required. Data on the nature of the pharmacokinetics of montelukast in patients with severe hepatic impairment (more than 9 points on a scale Child-Pugh) do not. When high doses of montelukast (20 and 60 times the recommended dosage for adults) a decrease in the concentration of theophylline in blood plasma.

When taken in the recommended doses of montelukast 10 mg 1 time per day for this effect is not observed.

Indications for use:

Prevention and long-term treatment of asthma in adults and adolescents from 15 years, including:

  • Warning daytime and nighttime symptoms of the disease;
  • treatment of asthma in patients with hypersensitivity to acetylsalicylic acid;
  • bronchospasm prevention of exercise-induced;

The relief of symptoms testosterone enanthate vs propionate of seasonal and perennial allergic rhinitis (in adults and adolescents from 15 years of age).

Contraindications

  • hypersensitivity to the active or any excipient of the drug;
  • Children up to age 15 years;
  • Patients with rare hereditary disease: galactose intolerance, lactase deficiency or glucose-galactose malabsorption.

Application of pregnancy and during breastfeeding

Use of the drug during pregnancy is possible Montelast if the expected benefit to the mother outweighs the potential risk to the fetus. The decision on cancellation of breastfeeding for the period of application of the drug Montelast adopted on the basis of assessment of the expected benefits to the mother and the potential risk for the baby.

Dosage and administration:

The inside is not liquid, with plenty of fluids, regardless of the meal.
Adults and adolescents from 15 years old to take 1 tablet of the drug Montelast 10 mg daily in the evening.

General guidelines
therapeutic effect Montelast drug, allowing to control asthma symptoms is achieved within days after administration. Patients are advised to continue taking the drug as a controlled flow during periods of asthma, and in the period of exacerbation of bronchial asthma.
The drug Montelast should not be taken together with other products containing the same active ingredient – montelukast.

Elderly patients, patients with renal insufficiency and in patients with hepatic insufficiency easy and moderate a special dose adjustment is required. No dose adjustment is required, depending on the sex of the patient.
There is no data on the use of montelukast in patients with severe hepatic impairment.

Montelast drug can be added to the patient’s treatment with bronchodilators and inhaled corticosteroids.

Inhaled corticosteroids: Montelast drug can be prescribed for the treatment of asthma as add-on therapy for patients in whom inhaled corticosteroids and used as necessary beta-agonists of short action do not provide the necessary clinical management of the disease. The drug should not be abruptly replaced Montelast treatment with inhaled corticosteroids.

For the treatment of patients 2 to 15 years are available for different dosage form Tablets Chewable drug.

Side effect

Infectious and parasitic diseases:
upper respiratory tract infection.

Violations of the blood and lymphatic system:
increasing the propensity to bleeding, thrombocytopenia.

Violations of the immune system:
hypersensitivity reactions, including anaphylaxis, hepatic eosinophilic infiltration.

Mental disorders:
abnormal dreams, including nightmares; hallucinations, insomnia, somnambulism, irritability, anxiety, restlessness; agitation including aggressive behavior or hostility; tremor, depression, disorientation, suicidal ideation and behavior (suicidality).

Disorders of the nervous system:
headache, dizziness, somnolence, paresthesia / hypoesthesia, seizures.

Violations of the heart:
palpitations.

Disorders of the respiratory system, organs, thoracic and mediastinal disorders:
epistaxis.

Disorders of the gastrointestinal tract:
diarrhea, dry mouth, dyspepsia, nausea, vomiting, abdominal pain, pancreatitis.

Disorders of the liver and biliary tract:
increased activity of alanine aminotransferase and aspartate aminotransferase, hepatitis (including cholestatic, hepatocellular, and mixed liver injury).

Disorders of the skin and subcutaneous tissue disorders:
angioneurotic edema, tendency to bruising, urticaria, pruritus, rash, erythema nodosum, erythema multiforme.

Violations of the musculoskeletal and connective tissue disorders:
arthralgia, myalgia including muscle cramps.

General disorders and administration site at:
asthenia / fatigue, malaise, edema, pyrexia, thirst. In very rare cases during treatment with montelukast was reported on the development of the syndrome Chardjui-Strauss (see section Cautions).

Overdose

Symptoms of drug overdose in patients with chronic bronchial asthma patients when used in a dose exceeding 200 mg per day for 22 weeks and 900 mg per day – 1 week, were not identified.

There have been reports of acute overdose of montelukast (upon receipt of not less than 1 g per day) in the post-marketing period and in clinical studies in adults testosterone enanthate vs propionate and children. Clinical and laboratory data at the same time show under the drug safety profile in children, adults and elderly patients. The most common symptoms are thirst, drowsiness, vomiting, agitation, headache, and abdominal pain.

Treatment: symptomatic therapy. Information about the possibility of montelukast excretion by peritoneal dialysis or hemodialysis are absent.

Interaction with other drugs

Patients treated simultaneously phenobarbital, area under the curve “concentration-time” montelukast decreased by approximately 40%, but the correct dosing regimen in these patients is not required.

Since montelukast is metabolized by isoenzyme of CYP3A4, caution should be exercised, particularly in children, when montelukast is used simultaneously with inducers of CYP3A4 isoenzyme, such as phenytoin, phenobarbital and rifampicin. Montelukast can be administered together with other drugs traditionally used for the prevention and long term treatment of asthma and / or allergic rhinitis.

Montelukast at the recommended therapeutic dose did not have a clinically meaningful effect on the pharmacokinetics of the following drugs: theophylline, prednisone, prednisolone, oral contraceptives (ethinyl estradiol / norethynodrel 35/1), terfenadine, digoxin and warfarin.

In studies in vitro found that Montelukast is a potent inhibitor of isozyme CYP2C8. However, in the study of drug interactions in vivo montelukast and rosiglitazone (a marker substrate representative of drugs primarily metabolized by isoenzyme CYP2C8) received montelukast confirm inhibition of CYP2C8 isoenzymes. Thus, in clinical practice, not supposed to influence montelukast SUR2S8-mediated metabolism of certain drugs including paclitaxel, rosiglitazone, repaglinide.

Studies in vitro have shown that montelukast is a substrate of CYP2C8 isoenzymes, and to a lesser extent CYP2C9 isoenzymes and ZA4. These clinical studies of drug interactions in relation to montelukast and gemfibrozil (an inhibitor of CYP2C8 like, and 2C9) demonstrated that the effect of gemfibrozil increases the systemic exposure of montelukast 4.4 times. Joint reception of itraconazole, a strong inhibitor of CYP3A4 isoenzyme, with gemfibrozil and montelukast did not lead to a further increase in the effect of the systemic exposure of montelukast. Effect of gemfibrozil on systemic exposure of montelukast can not be considered clinically significant on grounds of safety when used at doses higher than the approved dose of 10 mg for adults (for example, 200 mg / day for adult patients for 22 weeks, and up to 900 mg / day patients taking the drug for approximately one week, no clinically meaningful adverse effects).

Thus, when co-administered with the dose of montelukast gemfibrozil correction is required. According to studies in vitro, not intended to clinically significant drug-drug interactions with other known inhibitors of CYP2C8 isoenzymes (eg, trimethoprim). In addition, the joint reception of montelukast with itraconazole alone did not lead to a significant increase in the effect of the systemic exposure of montelukast.

Combined treatment with a bronchodilator
drug Montelast is reasonable in addition to bronchodilators alone, if they do not provide adequate control of asthma. Upon reaching the therapeutic effect of the drug treatment  can start a gradual reduction in the dose of bronchodilators.

Combination therapy with inhaled corticosteroids
Treatment with Montelast provides additional therapeutic benefit to patients applying inhaled corticosteroids. In stabilization, you can start a gradual reduction in the dose of GCS under medical supervision. In some cases a complete abolition of inhaled corticosteroids, but a sharp substitution of inhaled corticosteroids on Montelast drug is not recommended.

special instructions

Montelast The drug is not recommended for the treatment of acute asthma attacks. Patients with asthma is recommended to always carry emergency medications. In the event of an acute attack should use an inhaled beta 2 -adrenomimetiki short-acting. Patients should like to consult with your doctor as soon as possible if they need more inhalations of beta 2 -adrenomimetikov short-acting than usual. Do not abruptly replace therapy with inhaled or oral corticosteroids drug Montelast. There is no evidence to prove the possibility of reducing the dose of oral corticosteroids in the background at the same time receiving montelukast.

In rare cases, patients receiving anti-asthma medications, including montelukast may develop systemic eosinophilia, sometimes accompanied by clinical signs of vasculitis, the so-called Chardjui-Strauss syndrome, a condition which is eliminated by receiving systemic corticosteroids. These cases are usually associated with a decrease in dose or cancellation of therapy with oral corticosteroids.

It is impossible to establish or eliminate the likelihood that leukotriene receptor antagonists may be associated with the development-Strauss syndrome Chardjuy. Therefore, doctors should be warned of the possibility of eosinophilia, vaskulyarnoi rash, increase the severity of pulmonary symptoms, cardiac complications and / or neuropathy patients. Patients who develop symptoms testosterone enanthate vs propionate of the above, you must be retested and their treatment regimen to reconsider.

Montelast drug treatment does not lead to the prevention of bronchospasm in patients with hypersensitivity to aspirin, when used acetylsalicylic acid and other non-steroidal anti-inflammatory drugs.

The drug contains lactose monohydrate, and it should not be taken in patients with rare hereditary disorders: galactose intolerance, lactase deficiency or glucose-galactose malabsorption.

Effects on ability to drive and use machines
As a general rule, taking montelukast does not affect the ability to drive vehicles or work with other mechanisms, but very rarely, some patients reported drowsiness or dizziness. When you see these symptoms in patients is not recommended to drive and engage in other activities that require concentration and speed of psychomotor reactions. npp steroid

testosterone propionate cream

Vasoconstrictive effect without secondary reactive hyperemia develops within a few minutes and lasts 4-8 hours. When applied topically, low systemic absorption.

Indications
swelling of the conjunctiva, the secondary congestion in allergic diseases of the eye, irritation of the conjunctiva.
Hyperemia and / or swelling of the conjunctiva caused by various non-specific factors: the state after tonometry, dust, cigarette smoke, smog, swimming, reading, driving a car.

Contraindications:
Hypersensitivity to one of the testosterone propionate cream components of the drug, glaucoma, children’s age (up to 6 years), endothelial-epithelial corneal dystrophy, pregnancy and lactation.Precautions : hypertension, arrhythmia, aneurysm, thyrotoxicosis, pheochromocytoma, diabetes, severe organic heart disease and vascular (including ischemic heart disease); During treatment MAO inhibitors, and others. Drugs that increase blood pressure.

Dosing and Administration
Locally. 1-2 drops into each conjunctival sac 2-3 times a day.
If no improvement within 48 hours, a further intake must be stopped and seek medical advice.

Side effect
mydriasis, increased intraocular pressure, reactive hyperemia, tearing, burning sensation in the eye.
Systemic effects (possible with instillation of a large amount of the drug): headache, nausea, drowsiness, weakness, tremor, dizziness, insomnia, palpitations, tachycardia, hyperglycemia, increase in blood pressure, cardiac activity, and allergic reactions.

Overdose symptoms : mydriasis, cyanosis, fever, seizures, arrhythmias, increased blood pressure, pulmonary edema, dyspnoea, cardiac arrest. Excessive total absorption of imidazole derivatives can cause central nervous system depression, accompanied by drowsiness, hypothermia, bradycardia, collapse, apnea and coma. The risk of an overdose of the symptoms associated with drug absorption, high in young children, especially when swallowed. Treatment : unknown antidote. Assign activated charcoal, gastric lavage, oxygen inhalation, antipyretic and anti-epileptics. For lowering blood pressure – 5 mg phentolamine at physiological solution testosterone propionate cream slowly in / or with 100 mg orally.

Cautions
Use within 30 days after opening the bottle.
Avoid long-term use and overdose, especially in children.
If eye disease is not a barrier to wearing contact lenses, they should be removed before instillation of the drug and to set in about 15 minutes. Avoid direct contact of eye drops with soft contact lenses, given the risk of violation of their transparency.
In the period of treatment should refrain from activities potentially hazardous activities that require high concentration and psychomotor speed reactions (possibility of visual impairment).
If within 48 hours the state does not improve or eye irritation and redness persist or grow should stop the drug and seek medical advice. In case of intense pain in the eyes, headache, loss of vision, sudden appearance of “floating” spots before the eyes, redness of eyes, pain when exposed to light or double vision, you should immediately consult a doctor.

Patient interaction
Incompatible with MAO inhibitors, tricyclic antidepressants, maprotiline (possibility of testosterone propionate cream hypertensive crisis), as well as with inhaled anesthetics (eg. Cyclopropane, halotan and other halogenated anesthetics, which can cause ventrikalnuyu fibrillation)

testosterone propionate cycle

Food does not affect the bioavailability and maximum concentration (C max ) in the blood plasma. Oral bioavailability is 64%. After receiving tablets, film-coated tablets, 10 mg, the time to reach maximum concentration (TC max ) -. 3 h  The average volume of distribution of montelukast averages 8-11 liters. Testosterone propionate cycle is extensively metabolised in the liver. When using therapeutic doses of the drug concentration of metabolites of montelukast in plasma at steady state in adults and children is not determined. Because montelukast and its metabolites are excreted through the intestine for patients there is no need with renal insufficiency dose adjustments.

Indications

• Prevention and long-term treatment of asthma, including prevention of daytime and nighttime symptoms of the disease;
• the treatment of asthma in patients with hypersensitivity to acetylsalicylic acid;
• prevention of bronchospasm caused by exercise;
• relief of symptoms of seasonal and perennial allergic rhinitis.

Contraindications

• Hypersensitivity to any component of the drug;
• rare hereditary disorders such as galactose intolerance, lactase deficiency or glucose-galactose malabsorption;
• Children up to age 15 years (for a given dosage form).

Application of pregnancy and during breastfeeding

Application of medication Montelar ® during pregnancy and lactation is possible only if the expected benefit to the mother outweighs the potential risk to the fetus or child.

Dosing and Administration

The  is taken orally 1 time / day regardless of the meal, before going to sleep. For the treatment of bronchial asthma, relief of allergic rhinitis symptoms in children from 15 years and adults . 1 tablet of 10 mg once a day, at bedtime therapeutic effect of montelukast on indicators showing for asthma, developed for the first day. The patient should continue taking montelukast in a period to achieve control of asthma symptoms, and in the period of exacerbation of the disease. To prevent children from 15 years and adults suffering from bronchospasm caused by exercise: 1 tablet 10 mg once a day, at bedtime for 2-4 weeks, in the absence of a satisfactory effect it is necessary to appoint additional or alternative therapy. For older patients, patients with renal failure, patients with mild or moderate hepatic impairment, as well as based on gender specific dose adjustment is required. not Montelukast It is recommended as monotherapy in patients with bronchial asthma of average gravity constant flow.

Side effect

According to the World Health Organization (WHO), undesirable effects are classified according to their rate of development as follows: very common (≥1 / 10), common (of ≥1 / 100 to <1/10), uncommon (from ≥1 / 1,000 to <1/100), rarely (from ≥1 / 10,000 to <1 / 1,000), very rare (<1 / 10,000); the frequency is unknown – according to available data to set the frequency of occurrence was not possible.
As a result, clinical trials of drugs containing montelukast in patients with intermittent or persistent asthma data for the following side effects have been obtained:
Patients aged 15 years and older (two 12-week-old studies; n = 795): On the part of the central nervous system: often: . headache gastro-intestinal tract (GIT): common: abdominal pain.

Post-marketing surveillance Infectious and parasitic diseases: very common: Upper respiratory tract infection. Immune system: rare: hypersensitivity reactions, including anaphylaxis, rarely angioedema, very rare: eosinophilic infiltration of the liver. Skin and subcutaneous tissue: common: rash ; rarely: tendency to the formation of hematoma, urticaria, pruritus; very rare: erythema nodosum, erythema multiforme.On the part of the central nervous system: infrequently: headache, dizziness, somnolence, paresthesia / hypoesthesia, seizures. Psychiatric disorders: uncommon: sleep disorders ( including nightmares), insomnia, somnambulism, irritability, restlessness, agitation including aggressive behavior or hostility), depression, rare: tremor, very rare: hallucinations, confusion, suicidal ideation and testosterone propionate cycle suicidal behavior.Since the cardiovascular system: rarely: palpitations. From the blood and lymphatic system: rare: increased bleeding tendency. On the part of the gastrointestinal tract (GIT): often: . abdominal pain, diarrhea, nausea, vomiting, pancreatitis rare: dyspepsia, dry oral mucosa . on the part of the liver and biliary tract: common: increased activity of “liver” transaminases (alanine aminotransferase (ALT), aspartate aminotransferase, (ACT)); very rare: cholestatic hepatitis, damage to hepatocytes, often against a background of concomitant drug therapy or an existing liver disease ( various forms of hepatitis). On the part of the musculoskeletal and connective tissue disorders: uncommon: arthralgia, myalgia including muscle cramps. The respiratory system: infrequent: epistaxis very rare: Churg-Strauss syndrome. From the senses: otitis media (including including fatigue, malaise, edema, flu-like symptoms, pyrexia.

Overdose

Data on overdose symptoms while taking montelukast patients with asthma in a dose exceeding 200 mg per day for 22 weeks and 900 mg per day for one week, were found.
There are reports of acute overdose Montelukast in children (reception least 1000 mg of the drug per day). Clinical and laboratory data at the same time demonstrate compliance montelukast safety profile in children’s safety profile in adults and elderly patients.
The most common symptoms are thirst, drowsiness, vomiting, mydriasis, hyperkinesia, agitation, headache, and abdominal pain. Treatment: carrying symptomatic therapy. the possibility of elimination of montelukast Data by peritoneal dialysis or hemodialysis is not.

Interaction with other drugs

Montelukast may be administered together with other drugs, traditionally used for prevention and long-term treatment of asthma, such as bronchodilators and inhaled corticosteroids.
The recommended therapeutic dose of montelukast did not have a clinically meaningful effect on the pharmacokinetics of the following drugs: theophylline, prednisone, prednisolone, oral contraceptives (ethinyl estradiol / noretinsteron 35/1), terfenadine, digoxin and warfarin. The index value is the area under the curve “concentration-time» (AUC) decreasing in subjects while receiving phenobarbital (approximately 40%), however, the dosing regime montelukast correction such patients is not required.
In studies in vitro demonstrated that montelukast is a potent inhibitor of isozyme CYP 2S8 cytochrome P450, but the data from clinical studies of the interaction “drug-drug”, involving montelukast and rosiglitazone (a preliminary substrate representative of medicinal products primarily metabolized by CYP isoenzymes 2S8) have shown that the dose of montelukast does not inhibit CYP isoenzymes 2S8 in vivo.
Therefore, montelukast is not significant effect on the metabolism of medicinal products metabolized by this enzyme (eg, paclitaxel, rosiglitazone, and repaglinide).
studies in vitro have shown that montelukast is a substrate of CYP 2C8, 2C9 and 3A4.
these clinical studies of drug interactions in relation to montelukast and gemfibrozil (an inhibitor of both CYP 2C8, and 2C9) demonstrated that the effect of gemfibrozil increases the systemic exposure of montelukast 4.4 times. Joint reception of itraconazole, a potent inhibitor of CYP 3A4, with gemfibrozil and montelukast did not lead to a further increase in the effect of the systemic exposure of montelukast.Effect of gemfibrozil on systemic exposure of montelukast can not be considered clinically significant on grounds of safety when used at doses higher than the approved dose testosterone propionate cycle of 10 mg for adults (for example, 200 mg / day for adult patients for 22 weeks, and up to 900 mg / day patients taking the drug for approximately one week, no clinically meaningful adverse effects). Thus, when co-administered with gemfibrozil montelukast dose adjustment is required. According to the results of studies in vitro is not expected clinically significant drug interactions with other known inhibitors of CYP 2C8 (such as trimethoprim). In addition, co-administration of montelukast with itraconazole alone did not lead to a significant increase in the effect of the systemic exposure of montelukast.
Combined treatment with bronchodilators.
The drug  is a reasonable addition to bronchodilators alone, if they do not provide adequate control of asthma. Upon reaching the therapeutic effect (usually after the first dose) of the drug treatment can start a gradual reduction in the dose of bronchodilators.
The combined treatment with inhaled corticosteroids.
Treatment with provides additional therapeutic benefit to patients applying inhaled glucocorticosteroids. In stabilization, you can start a gradual reduction of the dose of glucocorticosteroid under the supervision of a physician. In some cases a complete abolition of inhaled glucocorticosteroids, but abrupt replacement of inhaled glucocorticosteroids on drug  is not recommended.
Since montelukast is metabolized by isoenzyme CYP 3A4, caution should be exercised, particularly in children older than 15 years if montelukast simultaneously assigned with drugs testosterone propionate cycle that induce CYP isoenzymes 3A4, such as phenytoin, phenobarbital and rifampicin.

special instructions

It is recommended to continue taking montelukast and after achieving significant improvements.
Montelukast is not recommended for the treatment of acute asthma attacks.
In acute bronchial asthma patients should use drugs emergency cupping (inhaled beta2-agonists short-acting).
Reduction of the systemic dose glucocorticoids ( GCS) in patients receiving anti-asthma agents including leukotriene receptor antagonists, followed in rare cases development of Churg-Strauss syndrome (systemic eosinophilic vasculitis), which manifests itself in the form of eosinophilia, vascular rash, increased severity of pulmonary symptoms, and, in the absence of proper treatment, cardiac complications and / or neuropathy. Although a causal relationship between these adverse events from treatment leukotriene-receptor antagonist has not been established, while reducing the systemic dose corticosteroids in patients taking montelukast, you must be careful and conduct appropriate clinical supervision.
The dose of corticosteroids used together with montelukast, should be reduced gradually under supervision of a physician. We do not recommend sharp replacement therapy with inhaled or oral corticosteroids appointment montelukast. Patients with confirmed allergy to aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) that the period of treatment montelukast avoid contact with these drugs as montelukast, improving pulmonary function in patients with allergic asthma, however, does not prevent the bronchoconstriction due to the action of NSAIDs .
By reducing the dose of systemic corticosteroids in patients taking montelukast, you must be careful to carry out the relevant clinical observation.
Age differences of efficacy and safety profile of montelukast was not revealed.

Special precautions for the destruction of unused medicinal product

No need for special precautions during the destruction of unused medication Montelar ® .

Effects on ability to drive and doing other activities that require concentration and speed of psychomotor reactions .

There is no evidence that receiving montelukast affect the ability to drive a car or moving machinery, is not revealed. However, reports of somnolence and dizziness, so the appearance of these symptoms is not recommended in patients as the management of vehicles and occupation of other activities that require concentration and speed of psychomotor reactions. Running low dose t3 clen cycle trying to lose bodyfat isn’t a real hot idea imo.

testosterone propionate

Quickly and completely absorbed after oral administration. Bioavailability is 90 to 100%.
We describe the development testosterone propionate of tolerance and cross-tolerance with other nitro compounds by prolonged continuous treatment with high doses of isosorbide – 5 -mononitrata. To prevent degradation or loss of effectiveness, to avoid continuous administration of high doses.

 Indications for use:

Prevention of angina attacks in patients with coronary heart disease, including after myocardial infarction;
treatment of chronic heart failure (in combination therapy).

Contraindications:

 

  • hypersensitivity to organic nitrates or other ingredients;
  • acute circulatory disorders (shock, circulatory collapse);
  • acute myocardial infarction with severe arterial hypotension;
  • cardiogenic shock, if you do not provide a sufficiently high end-diastolic pressure in the left ventricle through the use of intra-aortic counterpulsation or by introducing tools that have a positive inotropic effect;
  • toxic pulmonary edema;
  • anemia (severe);
  • marked hypotension (systolic blood pressure less than 90 mmHg and diastolic blood pressure less than 60 mmHg).
  • concomitant use of phosphodiesterase inhibitors, including sildenafil, vardenafil, tadalafil, since they potentiate the effect of nitrates antihypertensive;
  • hereditary galactose intolerance, lactase deficiency or malabsorption syndrome of glucose and galactose;
  • childhood and adolescence to 18 years (effectiveness and safety have been established).Carefully
  • hypertrophic obstructive cardiomyopathy, constrictive pericarditis, pericardial tamponade;
  • low filling pressure in acute myocardial infarction, left ventricular failure. There should be no reduction in systolic blood pressure below 90 mm Hg. Article .;
  • aortic and / or mitral stenosis;
  • tendency to orthostatic vascular disorders of regulation;
  • glaucoma (risk of increased intraocular pressure);
  • severe renal impairment;
  • hepatic insufficiency (risk of methemoglobinemia);
  • hemorrhagic stroke;
  • hyperthyroidism;
  • diseases accompanied by increased intracranial pressure;
  • recently transferred craniocerebral injury.

    Pregnancy and breast-feeding

    For security reasons Monocinque administered ® can be used during pregnancy and lactation only strictly prescribed by a doctor, after a thorough evaluation of the benefits and possible risks, because to date, little is known about the consequences of its use in pregnant women and nursing mothers. If a nursing mother still takes, you need to install parental monitoring for the development of the possible effects of the drug.

     Dosage and administration:

    Inside, after a meal with water, without chewing.
    The frequency of administration and duration of treatment set individually.
    Start therapy tselesooobrazno with 1/2 tablet (20 mg) 2 times a day. Then gradually increase the dose to the therapeutic:. 1 tablet (40 mg) to receive 2-3 times a day at intervals of 7-8 hours
    maximum testosterone propionate daily dose is 120 mg.

     Side effect:

    Before the drug at therapeutic doses, no – no significant side effects usually do not develop. Very often (≥10%): “Nitrate” headache can occur in the beginning of the treatment, and with continued therapy usually lasts for several days. Often (≥1% – <10%): after the first dose or after increasing the dose of the drug can occur lowering blood pressure and / or the development of orthostatic hypotension, which may be accompanied by tachycardia, dizziness, and weakness. From the nervous system: stiffness, drowsiness, blurred vision, decreased ability to rapid mental and motor reactions (especially at the beginning of treatment). Rarely (≥0,1% – <1%): There may be nausea, vomiting, possibly feeling light burning tongue, dry mouth. . facial flushing and skin allergic reactions . Marked reduction in blood pressure is accompanied by worsening angina (a paradoxical reaction to nitrates) Cases of collaptoid states, sometimes with bradyarrhythmia and syncope. Individual cases (<0.01%): exfoliative dermatitis.

    Overdose:

    Symptoms:
    Lowering blood pressure with orthostatic dysregulation, reflex tachycardia, and headache. It may appear weakness, dizziness, “tides” of heat, nausea, vomiting and diarrhea.
    Should expect methemoglobinemia, cyanosis, dyspnea and tachypnea due to the formation of nitrite ions as a result of the metabolism of isosorbide mononitrate in high doses (20 mg / kg body weight) .
    Very high doses can lead to increased intracranial pressure with the appearance of cerebral symptoms.
    in chronic overdose may cause a higher level of methemoglobin, although the clinical significance of this has not been definitively established. Therapy: in addition to general recommendations, such as gastric lavage and laying the patient in a horizontal position (legs raised high), should monitor the main indicators of vital signs and adjust if necessary. Patients with severe hypotension and / or shock should be administered liquid; in exceptional cases, to improve blood circulation can be performed infusion noradrenaline (norepinephrine), and / or dopamine. Introduction of epinephrine (adrenaline) and related compounds is contraindicated. Depending on testosterone propionate the severity, the following safeners are used in cases of methemoglobinemia:

    1. Vitamin C 1 g orally or in the form of the sodium salt intravenously
    2. methylene blue: 50 ml of a 1% solution of methylene blue intravenously
    3. toluidine blue: initially 2.4 mg / kg body weight intravenously; then, if necessary, may be repeated administration of 2 mg / kg body weight with an interval between doses in one hour.
    4. Oxygen therapy, hemodialysis, exchange transfusion

    Interaction with other drugs

    When applied with other vasodilators, antihypertensive agents, angiotensin-converting enzyme (ACE) inhibitors, beta-blockers, blockers “slow” calcium channel (BCCI), diuretic, antipsychotic agents (neuroleptics) or tricyclic antidepressants, inhibitors of phosphodiesterase, including sildenafil, vardenafil, tadalafil, as well as with ethanol may increase antihypertensive action Monocinque administered drug® .
    barbiturates accelerate metabolism and reduce the concentration of isosorbide mononitrate in the blood.
    Reduces the effect of vasopressors.
    in combination with amiodarone, propranolol, BCCI (verapamil, nifedipine, etc.) may strengthening anti-anginal effect.
    Under the influence of beta-agonists, alpha-blockers (dihydroergotamine, etc.) may reduce the antianginal effects (tachycardia and excessive reduction of blood pressure).
    The combined use with M-holinoblokatorami (atropine, and others.) increases the likelihood of increased intraocular pressure.
    Adsorbents, binders and overlying drugs reduce the absorption of isosorbide mononitrate of the gastrointestinal tract.
    The therapeutic effect of norepinephrine (noradrenaline) decreases while admission to nitro compounds.

    special instructions

    Monocinque ® should not be used for the relief of acute attacks of angina and acute myocardial infarction.
    During therapy requires control of blood pressure and heart rate.
    Avoid abrupt discontinuation of the drug (dose reduced gradually).
    Perhaps the development of tolerance to monocinque ® or cross-tolerance to other nitro compounds (reducing the effectiveness of the drug as a result of previous use of other nitro compounds). To prevent the development of tolerance to the action Monocinque administered ® , should be avoided in the continuous administration of high doses.
    For patients with circulatory lability may develop symptoms of acute circulatory failure even when receiving the first formulation. “Nitrate” Headaches can be largely prevented if at the beginning of therapy, take 1/2 tablet Monocinque administered ® in the morning and in the evening:
    During the period of treatment should be to exclude the use of ethanol.

    Effects on ability to drive and use machines
    During treatment is not recommended to drive vehicles and doing other potentially hazardous activities that require a rapid psychomotor reactions.

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