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trenbolone enanthate for sale

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Combined immunostimulatory preparation of bacterial origin for trenbolone enanthate for sale administration. It is a multivalent antigen complex comprising the lysates of bacteria – the most common causative agents of respiratory infections. Lysates were included in Ismigena composition obtained by mechanical action. Ismigen as other bacterial immunostimulants second generation, having nonspecific and specific immunostimulatory effect vaccinated.

Ismigen sublingual tablet has an effect on various parts of the immune system. It stimulates a local cellular and humoral immune responses and systemic immune response. Activates phagocytosis, increases the amount of lysozyme in saliva increases the amount of immunocompetent cells.

As a result, the frequency of treatment Ismigenom reduced the severity and duration of acute respiratory tract infections; there is relief and leveling of symptoms trenbolone enanthate for sale such as fever, cough, shortness of breath, decreased need for antibacterial and anti-inflammatory therapy; patients with chronic diseases of the respiratory tract drug also prevents exacerbation.

Indications

Acute and subacute infections of the upper and lower respiratory tract: bronchitis, tonsillitis, pharyngitis, laryngitis, rhinitis, sinusitis, otitis media, including complications from influenza (treatment in a combination therapy).

Recurrent infections of the upper and lower respiratory tract, chronic bronchitis (relapse prevention).

Contraindications

Hypersensitivity to the active and / or auxiliary components of the drug, pregnancy, lactation, children under 3 years.

 

Pregnancy and lactation

Contraindicated.

Dosing and Administration

Under the language; take on an empty stomach. The tablet should be kept under the tongue until completely dissolved. Sublingual tablets should not dissolve, chew or swallow.

Acute and subacute infections of the upper and lower respiratory tract

1 tablet a day until the disappearance of symptoms (at least 10 days).

Recurrent infections of the upper and lower respiratory tract, prevention of exacerbations of chronic diseases of the respiratory system

1 tablet per day for 10 days. Preventive course trenbolone enanthate for sale comprises three cycles of 10 days with 20-day intervals between them.

Preventive course there should be no more than 1-2 times per year.

 

Omitting receiving another dose should not be her double in the next administration.

 

Side effect

The frequency of side effects is classified according to the recommendations of the World Health Organization: very often – more than 10%; often – more than 1 and less than 10%; infrequently – more than 0.1 and less than 1%; rarely – more than 0.01 and less than 0.1%; very rarely – less than 0.01%.

For the skin: very rarely – urticaria, impetiginozny dermatitis, folliculitis.

Other: very rarely – inflammation of the salivary gland, acute laryngitis, rhinitis.

Overdose

Data on overdose are not available.

Interaction with other drugs

Ismigen can be used in conjunction with other drugs trenbolone enanthate for sale intended for the treatment of acute and chronic respiratory diseases.

Features Ismigena interaction with other drugs has not yet been described.

special instructions

Children aged 3 to 6 years old at the time of receiving each dose, until complete dissolution of the tablet in the oral cavity must be under adult supervision.

 

Effects on ability to drive vehicles and management mechanisms

Does not affect.

release Form

Sublingual tablets 7 mg. 10 tablets in blisters of PVC film and aluminum foil. 1 or 3 blisters with instruction on use in a pack made of cardboard.

Storage conditions

Store at temperatures not above 25 ° C.

Keep out of the reach of children.

Shelf life

3 years.

Do not use beyond the expiration date printed on the package.

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Protector of the corneal epithelium, has a lubricating and softening effect, has a high viscosity, increases the contact time of the solution with the cornea. The refractive index of the solution is similar to natural tears. It rebuilds and reproduces stabilizes the optical trenbolone enanthate results characteristics of the tear film. It extends the effects of other eye drops and protects the cornea from them irritating.
Subjective and objective improvement (epithelialization, reduction of redness and lesions) usually occurs within 3-5 days, a significant improvement or complete cure – for 2-3 weeks.

  • Insufficient tearing, lagophthalmos, deformation of the eyelids, ectropion, a condition after blepharoplasty, erosion and trophic ulcers of the cornea, a condition after chemical and thermal burns of the cornea and conjunctiva, bullous degenerative changes in the cornea, keratopathy, micro-defects of the corneal epithelium, the state after keratoplasty, keratoektomii;
  • to extend the action or elimination of irritating other eye drops;
  • Combined treatment of “dry eye” syndrome: Stevens-Johnson syndrome, Sjogren’s syndrome or disease, xerosis, keratosis (often in combination with a therapeutic contact lens);
  • eye irritation caused by smoke, dust, cold, wind, sun, salt water, for allergies;
  • eye strain during prolonged work at a computer, driving a car;
  • conducting diagnostic procedures: Gonioscopy, electroretinography, electrooculography, US eyes.

Contraindications:
Hypersensitivity to the individual components of the drug, infectious diseases of the eye.

Precautions
The acute phase of chemical burns of the cornea and conjunctiva (to complete the removal of toxic substances and necrotic tissue). No data on the use of the drug in children, so the drug should be used only for the purpose of the attending physician, if the expected benefit outweighs the potential risk.

Pregnancy and lactation
Experience with the drug during pregnancy and lactation is not.
Use in pregnant women and nursing mothers may trenbolone enanthate results only prescribed by a doctor, if the expected therapeutic effect is greater than the risk of possible side effects.

Dosing and Administration
In the conjunctival sac instilled 1-2 drops 4-8 times a day can be administered every hour if necessary. The course of treatment – at least 2-3 weeks at nosology, requiring long-term use.

Side effects
Feeling bonding century (due to the viscosity of the solution), temporary discomfort upon instillation of the drug, allergic reactions.

Interaction with other drugs
not compatible with eye drops containing metal salts.

Specific guidance
Immediately after the installation can be blurred vision, so it is recommended to start with driving or operating machinery after 15 minutes after instillation of the drug. Contact lenses are removed before installing the product again and trenbolone enanthate results set no earlier than 30 minutes after instillation.

Product form
Eye drops 0.5%. 5 and 10 ml plastic bottles with dropper dispenser. 1 bottle with instructions for use in a stack of cardboard.

Shelf life
2 years. Opened bottle store no more than 30 days. Do not use after the expiration date printed on the package.

Storage conditions:
The temperature trenbolone enanthate results is not above 25 ° C in a dark place. Keep out of the reach of children.

Terms of vacation
without a prescription.

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trenbolone enanthate

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It has expressed the alpha-adrenergic trenbolone enanthate activity.
The local application in ophthalmology causes mydriasis, improves the outflow of intraocular fluid and constricts blood vessels of the conjunctiva.
Phenylephrine has a strong stimulating effect on the postsynaptic alpha-adrenergic receptors, has very little effect on the beta-adrenergic receptors of the heart.The drug has vasoconstrictor action similar to the action of norepinephrine (noradrenaline), while it has practically no chronotropic and inotropic effect on the heart.Phenylephrine pressor effect is weaker than that of norepinephrine, but is longer. Causes vasoconstriction after 30-90 seconds after installation, the duration of 2-6 hours.
After the installation of phenylephrine reduces the iris dilator muscle and smooth muscle of the arterioles of the conjunctiva, thereby causing mydriasis. Mydriasis occurs within 10-60 minutes after a single trenbolone enanthate instillation. Continues after instillation of 2.5% solution and maintained for 2 hours. Mydriasis, called phenylephrine, is not accompanied by cycloplegic.

Pharmacokinetics of
Phenylephrine easily penetrates the ocular tissue, the peak plasma concentration occurs within 10-20 minutes after topical application. Phenylephrine is excreted by the kidneys as unchanged (<20%) or in the form of inactive metabolites.

Indications

  1. Iridocyclitis (for the prevention of adhesions and rear reduce exudation of the iris).
  2. Pupil dilation during ophthalmoscopy and other diagnostic procedures necessary to monitor the state of the rear segment of the eye, during laser interventions in the fundus and vitreoretinal surgery.
  3. Conducting provocative test in patients with narrow profile of anterior chamber angle and suspected closure glaucoma.
  4. Differential diagnosis of superficial and deep injection of the eyeball.
  5. “Red-eye” syndrome (to reduce redness and irritated mucous membrane of the eye).
  6. Preventing eyestrain and accommodation spasm in patients with high visual load.
  7. Treatment of false myopia (spasm of accommodation) and prevention of the progression of the true myopia patients with a high visual load.

 

Contraindications

  1. Hypersensitivity to the drug.
  2. Narrow-angle or angle-closure glaucoma.
  3. Arterial hypertension in combination with ischemic heart disease, aortic aneurysm, atrioventricular block I – III degree, arrhythmia.
  4. Tachycardia.
  5. I type I diabetes history.
  6. Continuous intake of monoamine oxidase inhibitors, tricyclic antidepressants, antihypertensive drugs.
  7. Additional mydriasis during surgery in patients with trenbolone enanthate impaired integrity of the eyeball, as well as in violation of tear production.
  8. Reduced body weight in newborns.
  9. Hyperthyroidism.
  10. Hepatic porphyria.
  11. Congenital deficiency of glucose-6-phosphate dehydrogenase.
  12. The period of lactation.

 

Precautions
In patients with trenbolone enanthate type II diabetes – increased blood pressure increase the risk. Elderly patients – increased risk of reactive miosis. Exceeding the recommended dose of a 2.5% solution in patients with injuries, diseases of the eye or its appendages, postoperative, or with decreased tear production can lead to increased absorption of phenylephrine and the development of systemic side effects.
Because the conjunctiva causes hypoxia – in patients with sickle cell anemia, while wearing contact lenses after surgery (healing reduction).
when cerebral arteriosclerosis, a long-term asthma. Pregnancy and lactation In animals in late pregnancy phenylephrine caused fetal growth retardation, and stimulated the early onset of labor.
Action Irifrin ® in pregnant women are poorly understood, so to use the drug in these patients should be only if the expected benefit to the mother outweighs the risk of possible side effects to the fetus. In the case of the appointment of the drug during lactation, breast-feeding should be discontinued.

Dosing and Administration
During the one-time installation ophthalmoscopy using a 2.5% solution Irifrin ® . Typically, enough to create mydriasis administration of 1 drop of 2.5% solution Irifrin ® in the conjunctival sac.
The maximal mydriasis achieved after 15-30 minutes, and remains at a sufficient level for 1-3 hours. If necessary, maintaining mydriasis for a long time after 1 Hour Possibility of re-install Irifrin ® .
To carry out diagnostic procedures:

  • as a provocative test in patients with narrow profile of the anterior chamber angle and angle-closure glaucoma suspected buried 1 drop once the drug. If the difference between the values ??of intraocular pressure before instillation Irifrin ® after pupil dilation is 3 to 5 mm Hg. . Art, the provocative test is considered positive;
  • for the differential diagnosis of injection-type eyeball buried 1 drop of the drug once: if 5 minutes after instillation marked vasoconstriction of the eyeball, the injection is classified as surface, while maintaining the redness of the eyes should be carefully examine the trenbolone enanthate patient for the presence of iridocyclitis or scleritis, as it shows expanding more deep lying vessels.

When iridotsiklitah to prevent the development and tear already formed posterior synechiae and to reduce the exudation into the anterior chamber of the eye drop formulation 1 is dug in the conjunctival sac of the patient’s eyes 2-3 times a day 5-10 days depending on the severity trenbolone enanthate of the disease.
Pupils with mild myopia for the prevention of spasm of accommodation during the period of high visual load 1 drop Irifrin ® buried the evening before bedtime, with progressive myopia moderate, 3 times a week in the evening before going to bed, when emmetropia – during the day, depending on the load.
when hyperopia with a tendency to spasm of accommodation with high visual load bury evening Irifrin ® in combination with a 1% solution of cyclopentolate. In normal visual load bury Irifrin ® 3 times a week in the evening before bedtime. In the treatment of false and true myopia 1 drop Irifrin ® buried the evening before going to bed 2-3 times a week for a month.

 

Side effect Local Conjunctivitis, Keratitis, periorbital edema, eye pain, burning during installation, tearing, blurred vision, irritation, discomfort, increased intraocular pressure, blockage of the angle of the anterior chamber (by narrowing the angle), allergic reactions, reactive hyperemia. Phenylephrine may cause jet cramps the day after the application. Re-installation of the drug at this time can give less pronounced mydriasis than the day before. This effect is often seen in elderly patients. As a result of a significant reduction in iris dilator muscle under the influence of phenylephrine 30-45 minutes after installation the moisture anterior chamber can be detected from the particles of the pigment of the pigment of the iris leaf. The slurry in the chamber moisture must be differentiated manifestations of anterior uveitis or to exposure to blood cells in the moisture of the anterior chamber. Systemic contact dermatitis is the part of the cardiovascular system: heart palpitations, tachycardia, arrhythmia, increased blood pressure, ventricular arrhythmia, reflex bradycardia, occlusion of the coronary arteries, pulmonary embolism.

Overdose
Overdose symptoms are anxiety, nervousness, dizziness, sweating, vomiting, heart palpitations, weak or shallow breathing.
In the event of systemic effects of phenylephrine to stop undesirable effects can be achieved by the use of alpha-adrenoceptor blocking agents, for example, from 5 to 10 mg of phentolamine intravenously. If necessary, the injection can be repeated.

Interaction with other drugs
Midriatichesky phenylephrine effect is enhanced when used in combination with topical application of atropine. Due to the strengthening of vasopressor action may develop tachycardia.
Application Irifrin ® within 21 days after discontinuation of a monoamine oxidase inhibitor patients and tricyclic antidepressants should be administered with caution, as in this case, there is the possibility of an uncontrolled rise in blood pressure.
Pressor effect of adrenergic agents may potentiate when combined with tricyclic antidepressants, beta-blockers, reserpine, guanethidine, methyldopa and m-holinoblokatorami.
Irifrin ® may trenbolone enanthate potentiate the inhibition of cardiovascular activity during inhalation anesthesia by increasing the sensitivity of the myocardium to sympathomimetics and occurrence of ventricular fibrillation.
The use in conjunction with other sympathomimetic may increase the cardiovascular effects of phenylephrine. The use of phenylephrine may cause weakening of concomitant antihypertensive therapy and lead to an increase in blood pressure, tachycardia. Pre-installation of local anesthetics may increase the systemic absorption and prolong mydriasis.

Product form
Eye drops 2.5% (without preservative). In a 0.4 ml disposable tubes dropper. On 5 tubes, droppers in the package of laminated paper. On 3 packages of laminated paper in the stack of cardboard together with instructions for use.

Shelf life
2 years.
Do not use stated on the package after the expiration date.

Storage:
In the dark place at a temperature no higher than 25 ° C.
Do not freeze.
Keep out of the reach of children.

 

Conditions of supply of pharmacies:

on prescription.

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Semisynthetic derivative of camptothecin, a specific inhibitor of the cellular enzyme topoisomerase I. In tissues the drug is metabolized to the active metabolite which is superior to the activity of Irinotecan. And Irinotecan metabolite complex is stabilized with a side effects of trenbolone enanthate DNA topoisomerase I, which prevents its replication. The pharmacokinetic profile of irinotecan not dose-dependent. Metabolized mainly in the liver by an enzyme karboksiesterazy to the active metabolite. The distribution of the drug in the plasma or di- three-phase. The average half-life of the drug in the first phase of 12 minutes, the second phase – 2.5 hours in the last phase – 14.2 hours. Maximum plasma concentrations of irinotecan and was achieved by the end of intravenous infusion at the recommended dose of ;. With the urine within 24 hours on average, of unchanged drug and as a metabolite . Since bile displayed about of the drug is in an unmodified form, or as a metabolite glucuronide. Contact of blood plasma proteins for irinotecan is approximately , to its active metabolite and calcium folinate does not affect the pharmacokinetics of irinotecan.

Indications for Use
Locally advanced or metastatic cancer of the colon and rectum:

 

  • Increased sensitivity to irinotecan or other ingredients.
  • Chronic inflammatory bowel disease and / or disorder of the intestinal permeability.
  • Severe depression of medullary hematopoiesis.
  • The level of serum bilirubin, exceeding by more than 1.5 times the upper limit of normal (ULN).
  • The general condition of the patients, as measured by the scale of the WHO> 2.
  • Pregnancy and lactation.
  • Children’s age (safety and efficacy data in children side effects of trenbolone enanthate are not available).Precautions : radiotherapy (in history) on the area of the abdomen or pelvis; leukocytosis; female patients (increased risk of diarrhea).

    Dosing and Administration
    The drug is intended for adults only.
    Iritis administered as an intravenous infusion lasting at least 30 minutes and no more than 90 minutes.
    When choosing the dose and mode of administration in each individual case should be referred to the literature.
    In monotherapy: Irit used in . a dose of 350 mg / m² every 3 weeks
    in a dose of combination chemotherapy iritis is:

  • with 5-fluorouracil and folinic acid with the weekly administration – 80 mg / m²,
  • when administered by continuous infusion of 1 times a week ² – 180 mg / m²;
  • in combination with a bolus of 5-fluorouracil and calcium folinate -. 125 mg / m weekly
    Dose and mode of administration of 5-fluorouracil and calcium folinate described in detail in the literature.
    Introduction iritis should not be performed as long as the number of side effects of trenbolone enanthate neutrophils in the peripheral blood exceeds 1500 cells / ml, and until they are fully cropped complications such as nausea, vomiting and especially diarrhea. The introduction of the drug to the resolution of all side effects can be delayed for 1-2 weeks.
    With the development during treatment pronounced inhibition of bone marrow hematopoiesis (neutrophil count less than 500 / ml, and / or white blood cell count less than 1000 / mm, and / or platelet count of less than 100,000 / microliter), febrile neutropenia (neutrophil count 1000 / ml of blood or less, combined with an increase in body temperature over 38 ° C), infectious complications, severe diarrhea, or other hematological toxicity grade 3-4, subsequent doses of iritis, and if necessary 5 -ftoruratsila should be reduced by 15-20%. Patients with impaired liver function. When the bilirubin level in blood serum higher than the upper normal limit of no more than 1.5 times, due to the increased risk of severe neutropenia should be carefully monitored blood parameters of the patient . When the bilirubin level more than 1.5 times – Iritenom treatment should be discontinued. Patients with impaired renal function. Is not recommended for treatment Iritenom as data on the use of irinotecan in this category there are no patients.Patients with advanced age. There are no special instructions Usage irinotecan absent in older people. Dose in each case should be selected with care. Instructions for preparation of a solution for infusion . The required amount of formulation diluted with 250 ml of 0.5% dextrose or 0.9% sodium chloride solution and stir the resulting solution by rotating the vial. Before the introduction of the solution should be visually inspected for clarity. In the case of sludge, the drug must be discarded. The solution should be used immediately after dilution. If dilution performed under aseptic conditions (for example, to install the laminar air flow), iritis solution can be used in the case of storage at room temperature, within 12 hours (including the time of infusion) and, in the case of storage at 2-8 ° C for 24 hours after opening the vial with the concentrate.Side effect On the part of hematopoiesis: neutropenia is observed on average 80% of patients, including half of them there is a decrease of neutrophils less than 1,000 cells in 1 mm. Recovery of neutrophils usually occurs 7-20 days after the start of treatment. Anemia varying severity occurs on average 60% ??of patients, and thrombocytopenia – 7% of patients. We describe a case of thrombocytopenia with the formation of anti-platelet antibodies. On the part of the digestive system: Late diarrhea occurring more than 24 hours (on average 5 days) after administration of the drug is a dose-limiting toxicities observed in approximately 87% of patients with severe – at 38%. Nausea and vomiting is usually occurs on the first day of administration or after 24 hours in 85% of patients. It reported the development of dewatering on the background of vomiting and diarrhea, rarely with the development of renal insufficiency, hypotension and cardiac insufficiency. There may be abdominal pain, anorexia, mucositis, constipation. Acute cholinergic syndrome observed in 9% of patients during the first 24 hours after administration of the drug and is manifested by diarrhea, abdominal pain, sweating, cramps, disorder of vision, lacrimation, salivation, decrease in blood pressure , dizziness, fever and general malaise. On the part of the central nervous system: involuntary muscle twitching or convulsions, paraesthesia, asthenia. Allergic reactions: seldom – skin rash, very rarely – anaphylactic shock. Other: dyspnea, alopecia, fever, local reaction.

    Overdose
    main expected manifestations of overdose – neutropenia and diarrhea. A specific antidote is not known to irinotecan. Treatment is symptomatic. In the case of an overdose the patient should be hospitalized and carefully monitor the function of vital organs.

    Interaction with other drugs
    Since irinotecan has anticholinesterase activity may increase the duration of neuromuscular blockade when combined with suxamethonium and antagonism of neuromuscular blockade with regard to the combination of a non-depolarizing muscle relaxants. Iritis should not be mixed with other medications in the same bottle.

    Precautions
    Iritenom Treatment should be carried out in specialized chemotherapy wards under the supervision of a physician who has experience with anticancer drugs.
    Patients receiving iritis, it is necessary to make weekly detailed clinical analysis of blood and monitor liver function.
    Diarrhea that arises as a consequence of the cytotoxic action of the side effects of trenbolone enanthate , usually It celebrated not earlier than 24 hours after administration of iritis (the majority of patients at a mean of 5 days). When the first episode of loose stools assignment must abundant drink containing electrolytes and the immediate holding antidiarrheal therapy comprising loperamide receiving high doses (4 mg and the first reception then 2 mg every 2 hours). This therapy is continued for at least 12 hours after the last episode of loose stools, no more than 48 hours because of the possibility of intestinal paresis. If diarrhea is regarded as severe (more than 6 episodes of loose stools within a day or severe tenesmus), and if it is accompanied by vomiting or fever, the patient should be urgently hospitalized in the intensive care unit for the comprehensive treatment, including the introduction of broad-spectrum antibiotics. In moderate or mild diarrhea (less than 6 episodes of loose stools during the day and moderate tenesmus), which is not stopped during the first 48 hours you need to start taking broad-spectrum antibiotics in.
    With the simultaneous occurrence of diarrhea and neutropenia (white blood cell count less than 500 cells / mm ) in addition to the antidiarrheal therapy prophylactically inside appointed broad-spectrum antibiotics.
    Loperamide should not be given prophylactically, including patients who have diarrhea was observed during previous administrations iritis.
    The patient should be forewarned about the possibility of his delayed diarrhea. Patients should immediately inform your doctor of the occurrence of diarrhea and immediately begin the appropriate treatment.
    With inadequate treatment of diarrhea condition may develop, threatening the patient’s life, especially if diarrhea developed against the backdrop of neutropenia.
    Patients with febrile neutropenia (body temperature> 38 ° C and neutrophil count <1000 / mm) must be immediately initiated the introduction of broad-spectrum antibiotics in the hospital.
    Acute cholinergic syndrome usually occurs during administration of the drug trenbolone enanthate uk or in the first 24 hours after administration to quickly and effectively stopped by subcutaneous administration of 0.25 mg of atropine (caution in patients bronchial asthma).
    a dosage form as a drug adjuvant comprises sorbitol, and therefore can not be used iritis patients with hereditary fructose intolerance. During treatment Iritenom and, at least for three months after discontinuation of therapy should be applied reliable contraceptive measures.
    If you get a solution iritis or infusion solution to the skin or mucous membranes of the skin, immediately wash with soap and water, mucous membranes just water.
    Patients necessary to prevent the possibility of occurrence during treatment Iritenom dizziness and visual disorders that develop within 24 hours after dosing. If you have these symptoms, patients are advised to refrain from driving and other activities potentially hazardous activities that require high concentration and psychomotor speed reactions.

    Form release
    Concentrate for solution for infusion 100 mg / 5 mL and 40 mg / 2 ml vials of dark glass. 1 bottle with the attached instructions for use in a carton box. In 5 or 10 vials with instructions for use in a carton box with partitions or special jacks.
    By 50. 85 or 100 vials with instructions for use, one for 10 bottles in a box made ??of cardboard (for hospitals).

    Storage conditions
    List B. The temperature side effects of trenbolone enanthate is not above 25 ° C, protected from light and the reach of children.

    Shelf life
    2 years.
    Do not use after expiry date stated on the package.

    Conditions of supply of pharmacies
    by prescription.

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Selective inhibitor of tyrosine trenbolone enanthate 200 kinase epidermal growth factor receptor expression is observed in many solid tumors, inhibits tumor growth, metastasis and angiogenesis, and accelerates apoptosis of tumor cells. Inhibits the growth of different human tumor cell lines and enhances the antitumor activity of chemotherapeutic drugs, radiation and hormonal therapy.

Clinical data indicate that has the objective antitumor effect, a statistically significantly increase the time to disease progression in patients with locally advanced or metastatic non-small cell lung cancer. Phase III INTEREST study showed that , compared with docetaxel, provides a similar overall survival, a more favorable tolerability profile and superior quality of life in previously treated patients with advanced non-small cell lung cancer.

Pharmacokinetics
Following oral administration, absorption is relatively slow. The equilibrium concentration is reached after taking 7-10 doses. Regular use of the drug gefitinib 1 time per day leads to an increase in concentration of 2-8 fold compared to a single dose. Maximum plasma concentration of the drug attained within 3-7 hours.Mean absolute bioavailability in patients up to 59%. Food does not affect the bioavailability. With average gastric pH above 5, gefitinib bioavailability is reduced by 47%.

The volume of distribution of gefitinib when the equilibrium concentration is 1400 liters, which indicates extensive tissue distribution of the drug. Communication with plasma proteins (serum albumin and alpha-1 glycoprotein) amounts to approximately 90%.

Gefitinib undergoes oxidative metabolism by CYP3A4 isoenzyme of cytochrome P450.

In vitro studies showed that slightly gefitinib inhibits CYP2D6 enzyme. When assigning gefitinib together with metoprolol (substrate for CYP2D6) resulted in a slight increase (35%) concentrations of metoprolol, which is not clinically significant.

Gefitinib metabolism occurs in three ways: N-metabolism propilmorfolinovoy group, demethylating a methoxy group on the quinazoline portion and oxidative dephosphorylation trenbolone enanthate 200 halogenated phenyl group.

The primary metabolite in the plasma is determined krovi- O desmetilgefitinib which has 14 times less pharmacologically active than gefitinib in relation to cell growth stimulated by epidermal growth factor, making it unlikely that a substantial impact on the clinical activity of gefitinib. The total plasma clearance of gefitinib – about 500 ml / min. The average half-life of 41 hours. The drug is derived mainly from the faeces. The kidneys remove less than 4% of the administered dose.

Relations between the lower level of the equilibrium concentration of the drug and the age, body weight, gender, ethnicity or creatinine clearance is not revealed. Amid daily reception presses 250 mg, the time to reach equilibrium concentration of the total plasma clearance and the equilibrium concentration groups were similar for patients with normal hepatic function and moderate hepatic impairment. Data for 4 patients with severe liver failure due to: liver metastasis suggest that the equilibrium concentration in these patients is similar to that of patients with normal liver function. Features action presses in patients with hepatic impairment due to cirrhosis or hepatitis C has not been studied.

Indications for Use
Locally widespread or metastatic non-small cell lung cancer, refractory to chemotherapy regimens containing platinum derivatives.

Contraindications
: Hypersensitivity to gefitinib or other components of the preparation. Pregnancy and lactation. Children and teens (safety and efficacy in this group of patients not evaluated).

Precautions: idiopathic pulmonary fibrosis, interstitial pneumonia, pneumoconiosis, pneumonia, post-radiation, drug pneumonia (marked by an increased mortality rate from these diseases during treatment with the press); with an increase in activity of “liver” transaminases.

Dosing and Administration
Inside, 250 mg 1 time per day regardless of the meal.

The tablet may also be dissolved in 100 ml of drinking (non-carbonated) water. Others can not use the liquid. For proper tablet dissolution should be lowered in water without kneading, stirring until completely dissolved (approximately 10 minutes) and then the resulting solution to drink. More Pour half a glass of water, washing the walls and enjoy the resulting solution. Iressa solution may also be administered through a naso-gastric tube.

You do not need dose adjustment Iressa depending on patient age, weight, ethnicity, gender, renal function, as well as in moderate and severe hepatic impairment due to liver metastases. Dose adjustment:in patients with poorly cropped diarrhea during treatment or side reactions of the skin can break the short-term treatment (14 days), followed by resumption of treatment iressa 250 mg / day.

Side effects
The most common side effects observed in more than 20% of the cases, were diarrhea, skin and acne, itching, dry skin. Typically, adverse reactions occur within the first month of the drug and is usually reversible. Approximately 8% of patients had severe adverse reactions (Grade 3-4 toxicity in accordance with the common criteria).

However, only 1% of patients discontinued therapy due to side reactions. Observed adverse reactions are shown below. Determining the frequency of adverse reactions: very trenbolone enanthate 200 common (> 10%); common (> 1 – <10%); uncommon (> 0.1 – <1%); rarely (> 0.01 – <0.1%); very rare (<0.01%).

From the blood coagulation system: often – hematuria and epistaxis; infrequently – anticoagulation and / or an increase in the frequency of bleeding in patients receiving warfarin.

On the part of the digestive system: very often – diarrhea (in some cases – severe), nausea; often – vomiting, anorexia, stomatitis, dehydration, asymptomatic increased activity of “liver” transaminases;rarely – pancreatitis.

From the side of view: often – conjunctivitis, blepharitis; rarely – reversible corneal erosion, disturbance of growth of eyelashes.

From the respiratory system: rarely – interstitial pneumonia (grade 3-4 toxicity, or death).

Skin and skin: very often – rash (pustular), pruritus, dry skin on the background of erythema; often – nail changes, alopecia; very seldom – toxic epidermal necrolysis and erythema multiforme exudative.

Allergic reactions: seldom – angioedema, urticaria

Other: often – fatigue, fever.

Overdose
Possible symptoms – increase in the frequency and severity of some adverse events, mainly diarrhea and skin rash. Treatment is symptomatic. The antidote is not known.

The interaction with other drugs.
Co-administration of gefitinib and rifampicin (a potent inducer isoenzyme CYP3A4) reduces the mean values ??of “area under curve» (AUC) for gefitinib 83%. Simultaneous administration of gefitinib and itraconazole (an inhibitor of isozyme CYP3A4) leads to an increase of 80% AUC of gefitinib that can be clinically significant because undesirable effects depend on the dose and concentration. Co-administration of gefitinib and products that contribute to a significant and sustained increase in gastric pH, decreased the AUC of gefitinib by 47%.

In a joint application of gefitinib and vinorelbine may trenbolone enanthate 200 increase neutropenic action vinorelbine.

Drugs that induce isoenzyme CYP3A4, can increase the metabolism of gefitinib and reduce the concentration in the blood plasma. Thus, co-administration with drugs gefitinib, isoenzyme inducers of CYP3A4, such as phenytoin, carbamazepine, barbiturates, St. John’s wort tincture may reduce the effectiveness of gefitinib.

Cautions
Sometimes patients taking Iressa, noted interstitial lung disease, in some cases fatal. With an increase in symptoms such as shortness of breath, cough, fever, use of the drug should be discontinued immediately and surveyed. If the patient has confirmed the presence of interstitial lung disease, receiving press is stopped and the patient following treatment.

Most often develop interstitial lung lesions were observed in Japan (approximately 2% of the cases at 27,000 patients taking Iressa) as compared to other countries (in 0.3% of cases among 39000 patients).

Among the factors that increase the risk of interstitial lung disease have been noted: smoking, severe general condition (PS> 2), normal lung tissue according to CT <50%, the duration of the disease (NSCLC) <6 months, interstitial pneumonia history, older age (> 55 years), concomitant cardiovascular disease.

Against reception Press noted asymptomatic increase in activity of “liver” transaminases, in this connection, it is recommended to periodically assess liver function. In marked increase in transaminases taking the drug should be discontinued.

Patients taking warfarin, you should regularly monitor the prothrombin time.

In case of any symptoms of the eyes or in the development of severe or prolonged diarrhea, nausea, vomiting or anorexia, the patient should seek immediate medical attention.

In the application of Iressa in combination with radiation therapy as first-line therapy in children with glioma brain stem glioma or incompletely removed supratentorial localization reported 4 cases (one fatal) bleeding into the brain. Another case of bleeding in the brain was observed in a child with ependymoma with Iressa monotherapy. In adult patients with NSCLC in the treatment of Iressa such side effects are not fixed in any way.

Men and women of childbearing age during treatment trenbolone enanthate 200 with Iressa and, at least for 3 months after you should use reliable methods of contraception. Because during therapy with Iressa may develop side effects such as the fatigue, nausea and vomiting, you must be careful when driving and busy with other potentially hazardous activities that require high concentration and psychomotor speed reactions.

Patients with rare hereditary conditions such as lactose intolerance, lactase deficiency or malabsorption syndrome Iressa ® should be administered with caution, due to the presence of lactose.

Composition
Coated tablets of 250 mg. 10 tablets in a blister of PVC and aluminum. 3 in the blister package of aluminum foil. The package is placed in a cardboard box with the instructions for medical use.

Storage conditions
In original packaging at a temperature not higher than 30 ° C, out of reach of children.

Shelf life
2 years.
Do not use beyond the expiration date printed on the package.

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