Side effect From the digestive system: possible methenolone enanthate abdominal pain, constipation, flatulence, nausea, diarrhea, pancreatitis, vomiting, gastralgia, hepatitis, cholestatic jaundice, increased activity of “liver” enzymes, alkaline phosphatase and creatine phosphokinase. On the part of the central 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 sedimentation rate of red blood cells , fever, arthritis, rash, photosensitivity, flushing of the skin, “tides” of blood to the face, 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. Require symptomatic therapy. It is necessary to monitor liver and kidney function, 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 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 exchangers or, in severe cases, by hemodialysis.
Interaction with other drugs
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Cytotoxic agents, antifungal agents (ketoconazole, itraconazole), fibrates, high doses of nicotinic acid, immunosuppressants, erythromycin, clarithromycin, telithromycin, 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 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 of methenolone enanthate, but can cause myopathy in monotherapy conditions. These and other kakgemfibrozil fibrates (except fenofibrate), and niacin dose> 1 g per day.
Amiodarone and verapamil: risk of myopathy increased when co-administered with verapamil or amiodarone high doses of simvastatin. Diltiazem: risk of myopathy increased slightly in patients receiving diltiazem simultaneously with simvastatin 80 mg. Simvastatin potentiates the action of oral anticoagulants (eg., Phenprocoumon, warfarin) and increases the risk of bleeding, which requires mandatory monitoring of blood coagulation parameters prior to treatment, as well as quite often the initial treatment period. Once reached a stable level indicator prothrombin time or international normalized ratio , 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 according to the above scheme.
Therapy with simvastatin did not cause changes in prothrombin time and the risk of bleeding in patients with anticoagulant unavailable. Increases digoxin in plasma.
Cholestyramine and colestipol reduce methenolone enanthate bioavailability (simvastatin possibly 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 plasma concentration agents metabolized . Increased activity 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. how much to inject for weight loss
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