From the digestive system: possible abdominal pain, constipation, flatulence, nausea, diarrhea, pancreatitis, vomiting, hepatitis, increased activity of “liver” enzymes, alkaline phosphokinase, and creatine phosphokinase primobolan for sale. From the nervous system and sensory organs: asthenic syndrome, headache, dizziness, insomnia, muscle cramps, paresthesia, peripheral neuropathy, blurred vision, taste disturbance.
On the part of the musculoskeletal system: myopathy, myalgia, muscle cramps, weakness; rarely – rhabdomyolysis. Allergic and immunopathological reactions: angioedema, polymyalgia rheumatica, vasculitis, thrombocytopenia, increased erythrocyte sedimentation rate, fever, arthritis, rash, photosensitivity, skin redness, flushing, shortness of breath, lupus-like syndrome, eosinophilia.Dermatological reactions: rare skin rash, itching , alopecia, dermatomyositis. 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, to spend symptomatic therapy. It is necessary to control the functions of the liver and kidneys, creatine kinase levels in the blood serum.
With the development of myopathy and rhabdomyolysis with acute renal failure (rare but severe side effects), stop taking the drug and the patient enter a diuretic and sodium bicarbonate (intravenous infusion). If you want to show primobolan for sale hemodialysis.
Rhabdomyolysis can cause hyperkalemia, which can be eliminated by intravenous administration of calcium chloride or calcium gluconate, infusion of glucose with insulin, using the potassium ion exchange sorbents, or, in severe cases, by hemodialysis.
Interaction with other drugs
Cytotoxic agents, antifungal drugs (ketoconazole, itraconazole), fibrates, high doses of nicotinic acid, immunosuppressants, erythromycin, clarithromycin, telithromycin, protease inhibitors, nefazodone increase the risk of myopathy.
Cyclosporin or danazol: risk of myopathy / rhabdomyolysis increases when coadministered cyclosporin or danazol with higher doses of simvastatin.
other lipid-lowering drugs that can cause myopathy development: the risk of myopathy is increased by concomitant use of other lipid-lowering drugs that are not potent inhibitors , but can cause myopathy in monotherapy conditions. Such as gemfibrozil and other fibrates (except fenofibrate), and niacin dose ≥ 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 is slightly increased in patients receiving diltiazem along with simvastatin at a dose of 80 mg.
simvastatin potentiates the action of oral anticoagulants (eg phenprocoumon, warfarin) and increases the risk of bleeding, which requires the need for monitoring indicators of coagulation prior to treatment, as well as quite often in the initial period of therapy . Once reached a stable level indicator prothrombin time or international normalized ratio , a further control be carried out at intervals recommended for patients receiving anticoagulant therapy. If you change the dosage or discontinuation of simvastatin should also conduct monitoring of prothrombin time on the above chart.
Therapy with simvastatin did not cause changes in prothrombin time and the risk of bleeding in patients not taking anticoagulants.
It increases levels of digoxin in the blood plasma.
Cholestyramine and colestipol reduce bioavailability (application simvastatin is possible through 4 hours after administration of the drugs, while noting additive effect).
grapefruit juice contains one or more components which inhibit and can increase the concentration in the blood plasma means, metabolized. Increased activity of primobolan for sale reductase inhibitor 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 reductase inhibitor in blood plasma. In this connection, to avoid consumption of grapefruit juice in large quantities.