oral primobolan

Precautions should use the oral primobolan drug in patients with severe renal insufficiency (creatinine clearance less than 30 mL / min); with hereditary muscular diseases; with hypertension; with expressed metabolic and endocrine disorders (including untreated hypothyroidism); high risk of developing diabetes; alcohol abuse; elderly patients (65 years); while the use of nicotinic acid in the lipid-lowering doses (more than 1 g / day), amiodarone, amlodipine, verapamil, diltiazem, colchicine, fusidic acid, ranolazine, dronedarone (increased risk of myopathy and rhabdomyolysis), grapefruit juice.

Application of pregnancy and during breastfeeding

Due to the fact that inhibitors of oral primobolan 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 adversely affect the fetus when administered in pregnant women (women of childbearing 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 If in the course of treatment became pregnant, the drug should be withdrawn and the woman warned of the possible danger to the fetus.
Cancel lipid-lowering drugs during pregnancy has no significant impact on the long-term treatment of primary hypercholesterolemia.
No data on the allocation of simvastatin in breast milk, therefore the application of the drug during lactation should stop breastfeeding.

Dosing and Administration

The recommended daily doses ranging from 5 mg to 80 mg.
Titration dose It should be carried out at intervals of 4 weeks.
The dose of 80 mg may be used only in patients with severe hypercholesterolemia and high cardiovascular risk. patients with homozygous familial hypercholesterolemia: the recommended daily dose is 40 mg per day, once in the evening. The dose of 80 mg per day is recommended only if the expected benefit of therapy outweighs the potential risk. In such patients, is used in combination with other lipid-lowering treatments (e.g., plasmapheresis) or without such treatment, if it is available. Patients with coronary artery disease or high risk of cardiovascular complicationsstandard initial dose rhigh risk patients with hyperlipidemia or without (if diabetes, stroke or other cerebrovascular diseases in history, peripheral vascular diseases), as well as for patients with coronary heart disease is 40 mg per day. The patients with hyperlipidemia, without the above risk factors: standard starting dose is 20 mg once a day in the evening. patients  concentration in blood serum, a 45% excess of normal values, the initial dose may be 40 mg / day. Patients with mild to moderate hypercholesterolemia therapy with  can begin with an initial dose of 10 mg / day. Concomitant therapy: preparation oral primobolancan be used as monotherapy, or in combination with bile acid sequestrants. For patients taking concomitant fibrates addition fenofibrate , the maximum daily dose is 10 mg of simvastatin. Concomitant use of gemfibrozil is contraindicated. In patients taking concomitant verapamil, diltiazem and dronedarone, the maximum daily dose is 10 mg / day.

For patients, while taking amiodarone, amlodipine, ranolazine, the maximum daily dose of simvastatin 20 mg. Patients with chronic renal failure: in patients with impaired renal and mild to moderate severity function (creatinine clearance 30 mL / min) dose adjustment is required. Patients with impaired-severe renal function (creatinine clearance less than 30 mL / min) or receiving simultaneously fibrates or nicotinic acid (in a dose of 1 g / day), starting dose is 5 mg and the maximum permitted daily dose – 10 mg. In elderly patients (over 65 years) dosage adjustment is necessary. Use in children and adolescents 10 – 17 years with heterozygous familial hypercholesterolemia: the recommended starting dose is 10 mg per day in the evening. The recommended dosing regimen is 10 – 40 mg per day, the maximum recommended dose is 40 mg per day. Selection of oral primobolan doses held individually in accordance with the objectives of the treatment. In the case of the current dose skip the drug should be taken as soon as possible. If it is time for your next dose, do not double the dose.

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