Metabolism of estrogens and progestogens may be increased with concomitant use of substances known as inducers isoenzymes drug metabolism, in particular cytochrome what is nandrolone isoenzymes such as antiepileptic drugs (e.g., phenobarbital, phenytoin, carbamazepine) and antibiotics (e.g., rifampicin, rifabutin, nevirapine, efavirenz ).
Despite the fact that ritonavir and nelfinavir are known as potent inhibitors, with the concomitant use of steroid hormones, they exhibit the properties of stimulating the metabolism of estrogen and progestogen. Herbal preparations containing may also stimulate the metabolism of estrogens and progestogens.
Clinically, an increased metabolism of estrogens and progestogens may lead to a decrease in the effectiveness of, and changes in the nature of uterine bleeding. Drugs that inhibit the activity of hepatic microsomal enzymes metabolic drugs such as ketoconazole, may increase the concentration of active drug substances .
When deciding on the need for hormone replacement therapy to treat menopause symptoms, it should be initiated only if the symptoms that reduce the quality of patient life.The frequency of medical examinations of individual, but at least 1 time in 6 months – to assess the need for further .In all cases, at least, continue only as long as the benefits of the drug outweigh the risk of side effects associated with it.
Medical examination / control – Before starting or resumingwhat is nandrolone should study the history of the patient’s disease, and family history. Thus it is necessary to conduct a physical examination (including pelvic organs and breasts) and take into account contraindications and special precautions for use.
During treatment, it is recommended to carry out periodic inspections of the patient, the frequency and the volume of which must be selected for each patient individually.
It is necessary to recommend to women report of the observed changes in the breast a doctor or nurse (see. “breast cancer” section). In accordance with currently accepted screening practices should be carried out the survey, including mammography, adjusted according to the individual clinical indications.
Reasons for immediate withdrawal of treatment – Treatment should be interrupted in the case of contraindications and detection in the following situations:
- Jaundice and abnormal liver function
- Significant increase in blood pressure
- A new type of headache migraine
- PregnancyEndometrial hyperplasia – The risk of endometrial hyperplasia and cancer is increased when estrogens are administered alone for a long period of time (see “Side effects”). The addition of progestogen to women, hysterectomy not been subjected, during at least 10 days per cycle, significantly reduces this risk. The development of bleeding and the appearance of spotting may occur during the first months of treatment. If the development of bleeding, or the appearance of spotting occurs shortly after the beginning of treatment or continued after discontinuation of treatment, it is necessary to investigate the cause of this phenomenon, why do endometrial biopsy to exclude endometrial malignancy.Breast Cancer – A randomized, placebo-controlled study (Women’s Health Initiative study) , as well as epidemiological studies, including the , revealed that there is an increased risk of developing breast cancer in women taking estrogens, estrogen-progestogen combinations or tibolone in for several years (see “Side effects”). In all cases, what is nandrolonefor a few years, exceeding the rate of risk is obvious, and it increases with duration of intake but returns to its original state within a few years (maximum of five) after cessation of treatment.
In the MWS study, the relative risk of breast cancer associated with receiving conjugated equine estrogens and estradiol was higher when the progestagen is added either sequentially or continuously regardless of progestogen. The data on the existence of differences in risk for various ways of administration of the drug are absent.
The WHI study, continuous use of a combination of the drug on the basis of conjugated equine estrogen and medroxyprogesterone acetate was associated with the development of breast cancer that was slightly larger in size and in which more often compared with placebo, there were metastases in regional lymph nodes. With HRT, especially in the combined treatment of estrogen – progestogen, an increase in the density of mammographic images which may complicate the radiological detection of breast cancer.Venous thromboembolism – what is nandrolone is associated with a higher relative risk of developing venous thromboembolism , ie, venous thrombosis or pulmonary embolism.
One randomized controlled trial and epidemiological studies found a two-fold increase risk for patients using compared with those who have not received this treatment. It is found that does not pass the course of treatment of women, the number of cases that takes place over a 5 year period is about 3 per 1000 women aged 50 – 59 years and 8 per 1000 women aged 60 – 69 years. A rough estimate in healthy women who use for 5 years, the number of additional cases over 5 years is 2-6 per 1000 women aged 50-59 years and 5-15 1000 women aged 60-69 years. The onset of this event is more likely in the first year than in the subsequent period. It recognized risk factors are present in a personal or family history of severe degree of obesity and systemic lupus erythematosus. There is no consensus about the possible role of varicose veins in development. Patients with a history or known thrombophilic status are at increased risk may increase the degree of this risk. It is necessary to investigate serious cases of thromboembolism or recurrent spontaneous abortion in cases of personal or family history in order to avoid predisposition to thrombophilia. Until then, until a thorough assessment of thrombophilic factors or anticoagulant treatment initiated, the appointment in such patients should be considered contraindicated. For to women who are already taking anticoagulants, should be carefully weigh the benefit / risk of the use what is nandrolone. The risk may be temporarily increased with prolonged immobilization, major trauma or radical surgery. In the postoperative period should be given careful attention to preventive measures to prevent the occurrence . If the planned operation entails state of prolonged immobilization, in particular, it may occur in abdominal intervention or orthopedic surgery of the lower limbs, consideration should be given to temporarily, for 4-6 weeks before surgery, stop. Treatment should not be reopened as long as the woman does not gain full mobility.
If what is nandrolone develops after initiating treatment, medication should be discontinued. Immediately, as soon as the patient noticed a possible thromboembolic symptom (painful lower limb swelling, sudden chest pain, shortness of breath), he must inform his doctor about it.