testosterone cypionate vs enanthate
Overdose is usually manifested symptoms of the testosterone cypionate vs enanthate, cardiovascular and respiratory systems.
In case of overdose, the following symptoms and complaints: Central nervous system : depression of the central nervous system; disorientation, drowsiness, agitation, hallucinations, coma; blurred vision, slurred speech, dysarthria, nystagmus, ataxia, dyskinesia, hyperreflexia (first), hyporeflexia (later); convulsions, psychomotor disturbances, myoclonus, hypothermia, mydriasis. Respiratory system: respiratory depression, pulmonary edema. Cardiovascular system : tachycardia, hypotension, at times hypertension, conduction abnormalities with the extension of the complex; . cardiac arrest and syncope caused by heart failure Gastrointestinal : vomiting, delayed passage of food from the stomach, decreased motility of the colon.
The urinary system : urinary retention, oliguria or anuria; fluid retention; water intoxication (hyponatremia dilution) due to the effect of carbamazepine, similar to the action of antidiuretic hormone. The changes in the laboratory parameters :. hyponatremia, metabolic acidosis is possible, it is possible hyperglycemia, increased muscle creatine phosphokinase fraction Treatment specific antidote is available. Initially, treatment should be based on the clinical condition of the patient; hospitalization. To carry out certain carbamazepine plasma concentrations for confirmation of poisoning with this agent and assess the degree of overdose. Implemented by the evacuation of gastric contents, gastric lavage, administration of activated charcoal. Late evacuation of gastric contents may result in delayed absorption, and the re-emergence of symptoms of intoxication during the recovery period. Used symptomatic supportive care in the intensive care unit, monitoring the functions of the heart, careful correction of fluid and electrolyte balance.
With the development of arterial hypotension shown in the introduction of dopamine or dobutamine; in the development of cardiac rhythm disorders – treatment of selected individually; the development of seizures, – introduction of benzodiazepines, such as diazepam or other anticonvulsants, such as phenobarbital (with caution due to increased respiratory depression), or paraldehyde; the development of hyponatremia (water intoxication) – limiting fluid administration and careful in / in a 0.9% sodium chloride solution, which can help prevent the development of brain lesions. It recommended holding hemosorption on coal sorbents. It has been reported about the ineffectiveness of forced diuresis, hemodialysis and peritoneal dialysis. Perhaps re-strengthening of overdose symptoms on the 2nd and 3rd day after its inception, due to depot carbamazepine.
Interaction with other medicinal products and other forms of interaction
Cytochrome testosterone cypionate vs enanthate is the main enzyme providing formation of carbamazepine-10,11-epoxide (active metabolite). The simultaneous use of inhibitors Tegretol isoenzyme may lead to increased plasma concentrations of carbamazepine, which in turn can cause adverse reactions. The combined use of inductors may accelerate carbamazepine metabolism and thus to a possible reduction of its plasma concentration and thus to a possible decrease in the severity of the therapeutic effect of the drug.
Cancel simultaneously received inductors may decrease the rate of biotransformation of carbamazepine, and as a consequence, lead to higher blood levels of carbamazepine plasma.Carbamazepine is a potent inducer of and hepatic enzyme systems of the first and second phase and while the use of drugs metabolized by testosterone cypionate vs enanthate, may cause induction of metabolism and reducing their concentration in the plasma. Since the conversion of carbamazepine-10,11-epoxide, carbamazepine-10,11- transdiol occurs using microsomal epoxide hydrolase enzyme, Tegretol use with epoxide hydrolase inhibitors can lead to increased plasma concentrations of carbamazepine-10,11-epoxide. Drugs that may increase the concentration of carbamazepine in the blood plasma,dextropropoxyphene, ibuprofen, danazol, macrolide antibiotics (e.g., erythromycin, troleandomycin, josamycin, clarithromycin); fluoxetine, fluvoxamine, nefazodone, paroxetine, trazodone, viloksazin, stiripentol, vigabatrin, azoles (eg itraconazole, ketoconazole, fluconazole, voriconazole), loratadine, terfenadine, olanzapine, isoniazid, viral protease inhibitors for HIV treatment (eg ritonavir) , acetazolamide, verapamil, diltiazem, omeprazole, oxybutynin, dantrolene, ticlopidine, nicotinamide (adults only in high doses) may – cimetidine, desipramine.
Since raising carbamazepine in serum can result in adverse reactions (eg, dizziness , somnolence, ataxia, diplopia), in these situations should be adjusted dose and / or regularly to determine the concentration of carbamazepine in plasma. Drugs that may increase the concentration of carbamazepine-10,11-epoxide in the blood plasma, loxapine, quetiapine, primidone, progabid , valproic acid, and valnoctamide valpromid. Since the raising of carbamazepine-10,11-epoxide in the blood plasma can cause side reactions (such as dizziness, somnolence, ataxia, diplopia), in these situations should be corrected Tegretol dose and / or regularly to determine the concentration of a carbamazepine-10,11 epoxide plasma. Drugs that may reduce the concentration of plasma carbamazepine : felbamate, mezuksimid, oxcarbazepine, phenobarbital, fensuksimid, fosphenytoin and phenytoin, primidone, theophylline, aminophylline, isotretinoin, rifampicin, cisplatin or doxorubicin, herbal preparations containing St. John’s wort (Hypericum perforatum), and although the data partly contradictory, possibly also clonazepam. In an application with the above drugs may require dose adjustment Tegretol. Effect of carbamazepine on the plasma concentration of drugs used as concomitant therapy. In a joint application with carbamazepine may decrease plasma concentrations, a decrease or even a complete cessation of the action of certain drugs. In an application with carbamazepine may require correction doses of the following drugs: methadone, paracetamol, phenazone (antipyrine), tramadol doxycycline, oral anticoagulants (warfarin, phenprocoumon, dikumarol and acenocoumarol), bupropion, citalopram, trazodone, tricyclic antidepressants (imipramine, amitriptyline, nortriptyline, clomipramine.) clobazam, clonazepam, ethosuximide, felbamate, lamotrigine, oxcarbazepine, primidone, tiagabine, topiramate, valproate, zonisamide, itraconazole, praziquantel, imatinib, clozapine, haloperidol, bromperidol, olanzapine, quetiapine, risperidone, ziprasidone, used in the treatment of HIV infection ( indinavir, ritonavir, sakvynavir), alprazolam, midazolam, theophylline, calcium channel blockers group of dihydropyridines (eg felodipine), digoxin, oral contraceptives (requires selection of alternative contraceptive methods) glyukokortikosteroydy (e.g., prednisolone, dexamethasone), tacrolimus, everolimus, levothyroxine . preparations containing estrogen and / or progesterone. It has been reported that in patients receiving carbamazepine phenytoin plasma levels may either rise or fall, and mefenitoina -Improves level (in rare cases). Combinations to be taken into account the appointment of carbamazepine with levetiracetam in some cases, there is a growing toxic effect of carbamazepine.
There are reports of enhancing hepatotoxicity induced by isoniazid, in cases where it is applied simultaneously with carbamazepine.
Combined use of carbamazepine and lithium or metoclopramide, and carbamazepine and neuroleptics (haloperidol, thioridazine) may lead to higher rate of adverse neurological reactions (in the case of last combination -. even at therapeutic concentrations of active substances in the blood plasma)
Simultaneous application of carbamazepine with some diuretics (hydrochlorothiazide, furosemide) may lead to hyponatremia, accompanied by clinical manifestations.
carbamazepine may antagonize the action of non-depolarizing muscle relaxants (such as pancuronium bromide). In the case of this combination of drugs may be testosterone cypionate vs enanthate necessary to increase these doses relaxants;should be carried out careful monitoring of patients, since it is possible more rapid than expected, termination of muscle relaxants.
reported occurrence in women bleeding between menstrual periods when both used oral contraceptives. The drug may reduce the therapeutic effect due to oral contraceptive preparations induce microsomal enzymes.
Carbamazepine, as well as other psychotropic drugs may reduce alcohol tolerance. In this regard, the patient is recommended to refrain from alcohol consumption.
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