After the disappearance of the symptoms and restore normal activity , it is permissible to consider the resumption of treatment , or the use of an alternative statin drug in the lowest dose and under close medical supervision. Features with other drugs, see. “Interaction” section. diabetes drug primobolan depot increases in plasma glucose concentration, so some patients from the group of risk of diabetes may experience hyperglycemia requiring medical correction. However, reducing the risk of complications by vessels when using statins exceed the risk of hyperglycemia, so when the concentration of glucose in the blood should not interrupt treatment . Use of the drug in patients at risk (in fasting blood glucose concentration of 5.6 – 6.9 mmol / L; body mass index over 30 kg / m², increased plasma concentrations of triglycerides, hypertension) is possible with careful supervision of their doctor.
The effect on liver at the beginning of therapy possibly a transient increase in activity of “liver” transaminases in blood serum. before starting treatment, and then, in accordance with clinical indications, all patients are advised to carry out liver function tests (to monitor the activity of “liver” transaminases prior to dose escalation, then 3 months after the beginning of its application and then 1 every six months during the first year of treatment). Particular attention should be given to patients with increased activity of “liver” transaminases. When a persistent increase in the activity of “liver” transaminases (3 or more times the upper limit of normal) use primobolan depot® should be discontinued. In postmarketing reports reported rarely occurring cases of fatal and non-fatal hepatic failure in patients treated with statins, including simvastatin. If during treatment with simvastatin had serious liver injury with clinical symptoms and / or hyperbilirubinemia or jaundice, you should discontinue treatment immediately. If not found another cause of liver failure, treatment should not be reopened simvastatin.
The drug should be used with caution in patients who abuse alcohol. Patients with thyroid decreased function (hypothyroidism) or the presence of certain diseases of the kidneys (nephrotic syndrome) with increasing cholesterol concentration you must first carry out treatment of the underlying disease. interstitial lung disease long-term use of statins may in rare cases develop interstitial lung disease (dyspnea, dry cough, deterioration in general health – increased fatigue, weight loss, fever). With the development of these symptoms should immediately stop using the product . Reduced function of transport proteins Reduced function of hepatic transport polypeptides of organic anions (Organic Anion .May increase systemic exposure of simvastatin and increase the risk of myopathy and rhabdomyolysis Reduced function may occur a result of the oppression of drug interactions (eg., cyclosporine), or in patients who are carriers of the genotype .patients with allele , encoding a protein less active , subject to greater systemic exposure of simvastatin and an increased risk of of myopathy. The risk of myopathy associated with the administration of high dose (80 mg) Simvastatin, generally, no genetic testing is about 1%. The study , homozygous carriers of allele C (also referred to as SS) receiving 80 mg of simvastatin, the primobolan depot risk of myopathy in one year is 15%, whereas the heterozygous allele , it is equal to 1.5%. Thus in patients with the most common genotype , the figure is 0.3% (see. Section 5.2).