Side effects Digestive system : possible abdominal pain, constipation, flatulence, nausea, diarrhea, pancreatitis, vomiting, hepatitis, increased activity of “liver” enzymes, alkaline phosphokinase, and creatine phosphokinase buy primobolan. The nervous system and sensory organs : asthenic syndrome, headache , dizziness, insomnia, muscle cramps, paresthesia, peripheral neuropathy, blurred vision, taste disturbance. Allergic and immunopathological reactions : angioedema, polymyalgia rheumatica, vasculitis, thrombocytopenia, increased erythrocyte sedimentation rate, fever, arthritis, rash, photosensitivity, skin flushing, hot flushes , shortness of breath, lupus-like syndrome, eosinophilia. Dermatological reactions : rare skin rash, pruritus, alopecia, dermatomyositis.
From the musculoskeletal system: myopathy, myalgia, muscle cramps, weakness; rarely – rhabdomyolysis. Other : anemia, palpitation, acute renal failure (due to rhabdomyolysis), reduced potency.
None of the few known cases of overdose (maximum dose of 450 mg adopted) specific symptoms have been identified.
Treatment: Induce vomiting, take activated charcoal. Symptomatic therapy.
It should monitor liver and kidney function, creatine kinase levels in the blood serum.
With the development of myopathy with rhabdomyolysis and acute renal failure (rare but severe side effects), stop taking the drug and put the patient a diuretic and sodium bicarbonate (intravenous infusion).If you want to show hemodialysis.
Rhabdomyolysis can cause hyperkalemia, which can be eliminated by intravenous administration of calcium chloride or calcium gluconate, infusion of buy primobolan glucose with insulin, using the potassium ion exchangers or, in severe cases, by hemodialysis.
Interaction with other drugs Cytotoxic agents, antifungal agents (ketoconazole, itraconazole), fibrates, high doses of nicotinic acid, immunosuppressants, erythromycin, clarithromycin, telithromycin, HIV protease inhibitors, nefazodone increase the risk of myopathy. Cyclosporine or Danazol : the risk of myopathy / rhabdomyolysis increased by a joint appointment of cyclosporine or danazol with higher doses of simvastatin. other gipolipidemteskie agents can cause myopathy development : the risk of myopathy is increased by concomitant use of other lipid-lowering drugs that are not potent inhibitors of , but can cause myopathy in monotherapy conditions. Such as gemfibrozil and other fibrates (except fenofibrate), and niacin (nicotinic acid) in a dose of > 1 g per day.
Amiodarone and verapamil : risk of myopathy is increased by coadministration of amiodarone or verapamil with high doses of simvastatin. Diltiazem : risk of myopathy slightly increased in patients receiving diltiazem along with simvastatin at a dose of 80 mg. simvastatin potentiates the action of oral anticoagulants (eg., fepprokumon, warfarin) and increases the risk of bleeding, which requires the need for monitoring indicators of coagulation prior to treatment, and often enough in the initial period of therapy. Once reached a stable level indicator prothrombin time or international normalized ratio (MHO), it should be carried out further inspections at the intervals recommended for patients receiving anticoagulant therapy. If you change the dosage or discontinuation of simvastatin should also conduct monitoring of prothrombin time or MHO according to the above scheme. Therapy with simvastatin did not cause changes in prothrombin time and the risk of bleeding in patients not taking anticoagulants. It increases the level of digoxin in the blood plasma.Cholestyramine and colestipol reduce bioavailability (application simvastatin possibly through 4 hr. after administration of these drugs, while noting additive effect). grapefruit juice contains one or more components which inhibit and can increase the concentration in blood means a plasma metabolized .
Increased activity buy primobolan reductase inhibitors after consuming 250 ml juice per day is minimal and has no clinical significance. However, the consumption of a large volume of juice (more than 1 liter per day) while taking simvastatin significantly increases the level of inhibitory activity against buy primobolanreductase inhibitor in blood plasma. In this connection, to avoid consumption of grapefruit juice in large quantities.
At the beginning of therapy possibly a transient increase in “liver” enzymes.
Before starting therapy and then regularly liver function tests (to monitor the activity of “liver” enzymes every 6 weeks during the first 3 months., And then every 8 weeks during the remaining the first year and then every six months 1) and with increasing doses of test should be conducted to determine liver functions. By increasing the dose to 80 mg of the test should be carried out every 3 months. When persistent elevations of transaminases (3 times as compared to baseline) reception Simvastol ® should be discontinued. Reductase inhibitors, should not be applied at an elevated risk of rhabdomyolysis and renal insufficiency (on background severe acute infection, hypotension, planned major surgery, trauma, severe metabolic disorders).
Cancel lipid-lowering drugs during pregnancy has no significant impact on the long-term treatment of primary hypercholesterolemia. Due to the fact that inhibitors reductase inhibitors inhibit the synthesis of cholesterol and cholesterol and other products of its synthesis are essential in fetal development including synthesis of steroids and cell membranes, simvastatin may have adverse effects on the fetus when assigning it to pregnant women (women reproductive age should avoid conception). If in the course of treatment became pregnant, the drug should be withdrawn and the woman warned of the possible danger to the fetus.
Application is not recommended for women of childbearing age who do not use contraceptives.
In patients with low thyroid function (hypothyroidism), or if there is some kidney disease (nephrotic syndrome) with an increase in cholesterol levels should first carry out treatment of the underlying disease.
With caution buy primobolan appoint persons who abuse alcohol and / or have a history of liver disease.
Before and during treatment the patient should be on hypolipidemic diet. Simultaneous administration of grapefruit juice may enhance the severity of side effects associated with taking , so avoid their simultaneous reception.
The risk of myopathy is also increased in patients with severe renal insufficiency. All patients who start therapy , as well as patients who need to increase the dose of the drug should be warned of the possibility of myopathy and need immediate treatment to the doctor in case of unexplained pain, pain in the muscles, weakness or muscle weakness, particularly if accompanied by malaise or fever. Drug therapy should be discontinued immediately if myopathy is diagnosed or suspected. In order to diagnose myopathy is recommended to conduct regular measurements of the . In the treatment of the drug may increase the content of serum , which should be considered in the differential diagnosis of chest pain. Drug withdrawal criterion is an increase in serum more than 10 times the upper limit of normal. Patients with myalgia, myasthenia and / or marked increase in buy primobolan drug treatment is stopped. The drug is effective as a monotherapy, or in combination with bile acid sequestrants. In case of missing the current drug dose must be taken as soon as possible. If it is time for your next dose, do not double the dose. Patients with severe renal insufficiency ^ treatment is carried out under the control of renal function. The duration of the drug is determined by the physician individually.