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Cautions Symptomatic hypotension is most often pronounced decrease in blood pressure occurs with a decrease in fluid volume caused by diuretic therapy, reduction of salt in food, dialysis, diarrhea or vomiting. In patients with chronic heart failure with simultaneous renal failure buy primobolan depot or without her, perhaps marked reduction in blood pressure. It is often diagnosed in patients with severe heart failure as a result of application of high doses of diuretics, hyponatremia or impaired renal function.

In these patients, treatment should start under close medical supervision (with caution in selection of dosage and diuretics).Such rules to follow when assigning patients with ischemic heart disease, cerebrovascular insufficiency, in which a sharp decrease in blood pressure can lead to heart attack or stroke. The transient hypotensive response is not a contraindication for the next dose of the drug. In applying Sinoprila, in some patients with chronic heart failure but with normal or low blood pressure, there may be a decrease in blood pressure, which is usually not a cause for discontinuation of treatment.

Before treatment Sinoprilom on possible, to normalize the concentration of sodium and / or compensate for the lost volume of liquid carefully control action starting dose Sinoprila on blood pressure of the patient. in the case of renal artery stenosis (especially with bilateral stenosis or in the presence of artery stenosis single kidney) and circulatory failure due to lack of sodium buy primobolan depot liquids, Sinopril may lead to renal dysfunction, acute renal failure, which is usually reversible after discontinuation of the drug. in acute myocardial infarction The application of standard therapy (thrombolytics, acetylsalicylic acid, beta-blockers). Sinopril may be used in conjunction with intravenous or using transdermal nitroglycerin systems.

Surgery / general anesthesia. With extensive surgical interventions, as well as the use of other drugs that cause a decrease in blood pressure, lisinopril blocking the formation of angiotensin II of, can cause pronounced unpredictable blood pressure reduction. in elderly patients , the same dose results in a higher drug concentration in the blood, thus requiring special care in determining the dose, despite the fact that the differences in Sinoprila antihypertensive action among the elderly and young people are not detected. Due to the fact that one can not rule out the potential risk of agranulocytosis, requires periodic monitoring of blood picture. In applying the drug in a dialysis polyacryl-nitrile membrane can occur anaphylactic shock, it is recommended that a different type of dialysis membrane or administration of other antihypertensive drugs. Effects on ability to drive vehicles and mechanisms No data on the effect of lisinopril, applied buy primobolan depot in therapeutic doses on the ability to drive vehicles and mechanisms, however, be aware that you may experience dizziness, so be careful.


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Application Sinoprila during pregnancy is contraindicated. In determining the pregnancy should be stopped as soon as possible the preparation technique. Admission of inhibitors in the II and III trimester of pregnancy has adverse effects on the fetus (subject to marked reduction of blood pressure, renal failure, hyperkalemia, hypoplasia of the skull, fetal death). Data about the negative effects of the drug on the fetus when used during the I trimester there. For newborns and infants who have been exposed to  inhibitors in utero, should be closely monitored for timely detection of significant decrease in blood pressure, oliguria and hyperkalemia. Lisinopril crosses the placenta. No data on the penetration of passes into breast milk. For the period of drug treatment should be abolished breastfeeding.

Dosing and Administration
Inside 1 times a day, in the morning, bayer primobolan depot when all the testimony, before or after a meal, always at about the same time of day. Hypertension The recommended initial dose for patients not receiving other antihypertensive agents, it is 10 1 mg once a day. A typical daily maintenance dose – 20 mg, which can be increased to 40 mg per day depending on the dynamics of the blood pressure. The maximum daily dose – 40 mg. If this dose does not give a satisfactory therapeutic effect can additionally assign another antihypertensive drug. For the full development of the effect may require 2-4 week course of treatment with the drug, it should be taken into account when the dose is increased. If the patient previously received diuretic therapy, the use of these drugs should be discontinued for 2-3 days prior to the application .

If this is not feasible, then Sinoprila initial dose should not exceed 5 mg per day. In this case, after the first dose recommended medical supervision for several hours (maximum action is reached after about 6 hours), since it may be marked decrease in blood pressure (see. Specific guidance). When renovascular hypertension or other conditions with increased activity of the renin-angiotensin -aldosteronovoy system appropriate to appoint as a low initial dose – 2.5-5 mg per day, under close medical supervision (blood pressure, kidney function, potassium levels in blood serum). Maintenance dose, continuing strict medical control should be determined depending on the dynamics of AD. In renal failure because the Sinopril excreted through the kidneys, the initial dose should be determined according to the creatinine clearance, then according to the reaction, should establish a maintenance dose of a conditions of frequent monitoring of renal function, potassium, sodium in serum.


  • The most common side effects: dizziness, headache bayer primobolan depot (in 5-6% of patients), fatigue, diarrhea, dry cough (3%), nausea, vomiting, orthostatic hypotension, skin rashes, chest pain (1-3% .)
    Other side effects (frequency <1%): immune system: (0.1%), angioedema (face, upper and lower extremities, lips, tongue, larynx or epiglottis). Since the cardiovascular system: pronounced . decrease in blood pressure, orthostatic hypotension, renal dysfunction From the central nervous system . fatigue, drowsiness, convulsive twitching of the limbs and lips part of the hemopoietic system: leucopenia, neutropenia, agranulocytosis, thrombocytopenia, prolonged treatment – a slight decrease in hemoglobin and hematocrit, erythropenia. Laboratory indicators: hyperkalemia, azotemia, hyperuricemia, hyperbilirubinemia, increased activity of “liver” transaminases, especially with a history of kidney disease, diabetes, and renovascular hypertension. rare side effects (less than 1%): On the part of cardio cardiovascular system: heart rate; tachycardia; myocardial infarction; cerebrovascular stroke in patients with an increased risk of disease, as a result of pronounced reduction in blood pressure. On the part of the digestive tract: dry mouth, anorexia, dyspepsia, changes in taste, abdominal pain, pancreatitis, hepatocellular or cholestatic jaundice, hepatitis. For the skin: hives, increased sweating, itching, alopecia.From the urinary system: renal failure, oliguria, anuria, acute renal failure, uremia, proteinuria. On the part of the immune system: the syndrome, including the acceleration of ESR, arthralgia, and the appearance of antinuclear antibodies. On the side central nervous system: asthenic syndrome, mood lability, confusion, impotence. Other: myalgia. fever, disturbance of fetal development. 

    Overdose Symptoms: marked reduction of blood pressure treatment: . Symptomatic therapy, intravenous fluids, controlling blood pressure, fluid and electrolyte balance and normalize the last Sinopril can be removed from the body by hemodialysis.


    Interaction with other medicinal products require special care while applying the drug with: potassium-sparing diuretics (spironolactone, triamterene, amiloride), potassium, Vice salts containing potassium (increased risk of hyperkalemia, especially with impaired renal function, so they can jointly appoint only . based on the individual judgment of the prescribing physician with regular monitoring of serum potassium levels and renal function Caution may be used together:


  • diuretics: with the additional administration of a diuretic patients undergoing treatment Sinoprilom usually comes an additive antihypertensive effect – the risk of significant decrease in blood pressure;
  • With other antihypertensive agents (additive effect);
  • with non-steroidal anti-inflammatory drugs (indomethacin, etc.), estrogens and adrenostimulyatorov – reduced antihypertensive effect of lisinopril, – lithium (lithium excretion may be reduced, so you should regularly monitor the concentration of lithium in blood serum).
  • with antacids and colestyramine – reduce bayer primobolan depot absorption in the gastrointestinal tract. Sinopril may increase the effect of alcohol.
    Sinopril reduces potassium excretion from the body in the treatment of diuretic.

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If overdose is most frequently observed bleeding diathesis in the form of bruising, bleeding from the nose and gums, prolonged bleeding from superficial wounds, hematuria and menorrhagia.
In the presence of hemorrhagic syndrome and sudden elongation of prothrombin time is recommended intravenously slowly enter 5 – 10 mg of primobolan depot cycle (phytomenadione) effect comes after 6 – 10 hours. In life-threatening bleeding should additionally pour fresh frozen plasma in a volume of 10 – 15 ml per kg body weight or prothrombin complex concentrates, containing .

Interaction with other drugs enhance the action atsenokumarola cause: allopurinol, amiodarone, antibiotics (aminoglycosides, cephalosporins, for parenteral administration, macrolides, intravenous penicillin in large doses, quinolones and fluoroquinolones, tetracyclines), azapropazone, quinidine sulfate, chloral hydrate, chlorpromazine, cimetidine, dekstrotiroksin , disulfiram, fenofibrate, phenylbutazone, glucagon, ibuprofen, indomethacin, MAO inhibitors, clofibrate, acetylsalicylic acid (aspirin), ethacrynic acid, mefenamic acid, lovastin, sodium metamizole (analgin), metronidazole, methyldopa, miconazole, naproxen, pentoxifylline, propafenone, . salicylates, anabolic hormones, sulfinpyrazone, long-acting sulfonamides (trimethoprim, sulfamethoxazole), tamoxifen, means for inhalation anesthesia Weakening actionatsenokumarola cause: aminoglutethimide, oral contraceptives, barbiturates, chlordiazepoxide, phenytoin, griseofulvin, haloperidol, carbamazepine, colestipol, meprobamate, mercaptopurine, rifampicin, sucralfate, ascorbic acid (vitamin C), menadione sodium bisulfite (vitamin K), antihistamines. Alcohol, primobolan depot cycle diuretics (eg, furosemide) and ranitidine can both strengthen and weaken the effect of acenocoumarol.atsenokumarola enhances the effect of sulfonylureas ( chlorpropamide, tolbutamide), antiepileptic agents (phenytoin, phenobarbital). Action atsenokumarola weakened after a meal rich in vitamin K (broccoli, cauliflower, green peas, cabbage, lettuce, spinach, liver, grain soy). The best pain reliever for patients receiving acenocoumarol is paracetamol, as non-steroidal anti-inflammatory drugs increase the antithrombotic effect of acenocoumarol. If the patient is taking any medicine that interacts with acenocoumarol, or other drugs with an unknown impact on acenocoumarol, it is often necessary to monitor the prothrombin time with a view to selection of an individual dose.

Special instructions.
It is necessary to monitor the prothrombin level in the blood and prothrombin index (prothrombin time should not exceed 4) Urinalysis (presence of red blood cells in the urine). It should warn patients of the possibility of bleeding and bleeding and the need to coordinate with your doctor other medications. Patients elderly, especially with severe atherosclerosis, and patients with primobolan depot cycle heart failure therapy and laboratory monitoring is possible to reduce the dose of the drug should be held more frequently. Patients treated with acenocoumarol, should be avoided intramuscular injection, if this is not possible, then do intramuscular injections in the upper extremities, where possible bleeding diagnosed faster and easier to apply a pressure bandage. For 2-3 days before the planned surgery or tooth extraction is necessary to stop taking the drug, the prothrombin time should be less than 1.5. If necessary, urgent surgical intervention can enter intravenously 5-10 mg of vitamin K, which usually achieves prothrombin time less than 1.5 for 24 hours.
During therapy acenocoumarol necessary to carefully monitor the general condition of the patient and the changes in the blood coagulation system. When the therapy of bleeding or bleeding acenocoumarol should be abolished.
The need for acenocoumarol increases in hypothyroidism, hyperlipidemia, increased intake of vitamin K from food, nephrotic syndrome, edema.
The need for atsenokumarolle reduced fasting, hypoalbuminemia due to liver and kidney disease, diarrhea syndrome . malabsorption, hyperthyroidism, fever, circulatory failure, congestive
in the case of a significant increase in prothrombin time without hemorrhagic manifestations should refrain from using atsenokumarola daily to check primobolan depot cycle prothrombin time, perhaps the appointment of vitamin K tablets at a dose of 2.5 – 5 mg. steroids for allergies hgh black tops steroids history

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Maximum plasma concentration achieved after 3 hours after dosing. Since plasma protein binds to 98%, In the body of the drug. The half-life of approximately 8-9 hours. Atsenokumarola primobolan depot bayer metabolized in the liver. Approximately 60% of the drug released to the body is excreted in the urine, mainly in the form of metabolites remaining amount excreted in the feces. The degree of elongation of prothrombin time or increase prothrombin index is independent of the concentration in blood acenocoumarol.

Indications for use.
Thrombosis, thrombophlebitis, thromboembolic complications of myocardial infarction, embolism of various organs (prevention and treatment). In surgical practice for the prevention of thromboembolic complications in the postoperative period.

Haemorrhagic diathesis and other diseases accompanied by reduced blood clotting, kidney failure, marked disturbances of liver function, hypertension, cancer, diabetic retinopathy, physical exhaustion, hypoprothrombinemia (less than 70%), hypovitaminosis , bleeding from open wounds, gastric ulcer and duodenal ulcer, ulcerative colitis, hemorrhagic stroke (first 2 months), pregnancy, lactation, threatening miscarriage, postpartum eclampsia and pre-eclampsia, chronic endocarditis, pericarditis, dissecting aortic aneurysm, immediately after surgery in ophthalmology, neurology and primobolan depot bayer dentistry after lumbar puncture biopsies of organs or aortic puncture for 4 days.

Dosage and administration.
The drug is used inside. The dose is determined individually, depending on the parameters of blood clotting. On the first day, the dose is 6 – 8 mg per day, followed by 4 mg per day under the control of the prothrombin time, which should be in the range of 2.0 – 3.5 seconds. Reception frequency – once daily at one and the same time.

Side effects.
Nausea, diarrhea, alopecia, headache, allergic reactions such as skin rash and angioedema bleeding, skin hemorrhages, and mucous membranes (in the degree of reduction of the frequency of occurrence): hematuria, bleeding from the gums, petechiae, traumatic hematoma, melena, metrorrhagia, hemarthrosis, a hemorrhagic stroke. Very rarely can develop a syndrome of purple feet and necrosis of the skin and subcutaneous tissue. The cause of the purple feet syndrome are probably primobolan depot bayer microthrombuses cholesterol. This complication appears after several weeks of treatment and appears bluish hyperpigmentation feet and big toes, and pain in the big toes. Hyperpigmentation disappears when pressing and lifting the limb. Skin necrosis initially takes the form of erythema or rash papular pyatnisto- that appears on the chest, thighs and buttocks, may also be in the upper extremities, face and genitals. In the case of the first skin necrosis symptoms should immediately remove the drug and prescribe vitamin K or heparin, which may prevent the development of complete necrosis.
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At the beginning of therapy Sinkardom possible transient increase in the level of “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, then every 8 weeks for the remainder of the first year and then one every six months) and at higher doses of the 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 enzyme activity (3-fold compared with baseline) reception Sinkarda should be discontinued.
Sinkard, like other inhibitors of methenolone enanthate side effects reductase inhibitors, should not be applied at an elevated risk of rhabdomyolysis and renal failure (on the background of 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.
Application Sinkarda not recommended for women of childbearing potential not using contraception.
patients with reduced thyroid function (hypothyroidism), or in the presence of certain diseases of the kidneys (nephrotic syndrome), with an increase in cholesterol levels should first carry out treatment of the underlying disease.
Sinkard with caution appoint persons who abuse alcohol and / or have a history of liver disease.
Prior to and during treatment the patient should be on hypolipidemic diet.
Co-administration of grapefruit juice may enhance the severity of side effects associated with taking Sinkarda, so avoid their simultaneous reception.
Sinkard not granted in cases of hypertriglyceridemia.
treatment with simvastatin may cause myopathy, methenolone enanthate side effects leading to rhabdomyolysis and renal failure. The risk of this disease increases in patients receiving simultaneously with simvastatin one or more of the following drugs: fibrates (gemfibrozil, fenofibrate), cyclosporine, nefazadon, macrolides (erythromycin, clarithromycin), antifungal agents of “azole” group (ketoconazole, itraconazole) and  protease inhibitors (ritonavir). The risk of myopathy is also increased in patients with severe renal insufficiency.
All patients who start therapy with simvastatin and 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 muscle flaccidity 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 .
In the treatment with simvastatin 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 methenolone enanthate side effects more than 10 times the upper limit of normal. Patients with myalgia, myasthenia and / or marked increase in drug treatment is stopped.
The drug is effective as a monotherapy, or in combination with bile acid sequestrants.
Patients with severe renal insufficiency treatment is carried out under the control of renal function.
The duration of the drug is determined by the attending the doctor individually.
Effects on ability to drive and use machines
on the adverse effects of simvastatin on the ability to drive and work with the mechanisms have not been reported.

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