Before the treatment Simgalom patient must masteron propionate assign a standard hypolipidemic diet, which should be respected during the entire course of treatment. Simgal taken orally 1 time a day in the evening, drinking plenty of water. Time of the drug should not be linked with the meal. Recommended Simgal dose for the treatment of hypercholesterolemia varies from 10 to 80 mg 1 time per day in the evening. The recommended starting dose for patients with hypercholesterolemia is 10 mg. The maximum daily dose -. 80 mg changes (selection) the dose should be performed at intervals of 4 weeks.In most patients, the optimal effect is achieved while taking the drug at doses up to 20 mg per day. in patients with homozygous familial hypercholesterolemia recommended daily intake is 40 mg Simgal 1 time per day in the evening or three 80 mg doses (20 mg in the morning, afternoon, and 20 mg to 40 mg in the evening). In the treatment of patients with coronary heart disease or at high risk , effective doses Simgal are 20-40 mg per day.
Therefore, the recommended initial dose in these patients – 20 mg per day. Change (selection) of the dose should be performed at intervals of 4 weeks, if necessary dose can be increased to 40 mg per day. If the content of less than 75 mg / dl (1.94 mmol / l), total cholesterol – less than 140 mg / dl (3.6 mmol / L), the dose should be reduced. In elderly patients and patients with mild or moderate severe degree of renal failure dosage formulation changes are required. in patients with chronic renal failure (creatinine clearance less than 30 mL / min) or receiving cyclosporin, danazol, gemfibrozil or other fibrates (except fenofibrate), lipid-lowering doses of niacin (≥1 g / day ) in combination with simvastatin, the maximum recommended should not exceed 10 mg per day. in patients taking amiodarone or verapamil simultaneously should not exceed 20 mg.
When using the therapy recommended doses Simgal usually well tolerated. The digestive system: possible abdominal pain, constipation, flatulence, nausea, diarrhea, pancreatitis, vomiting, hepatitis, increased activity of “liver” enzymes alkaline phosphokinase, and creatine phosphokinase (. Nervous System and senses: asthenic syndrome, headache, dizziness, insomnia, muscle cramps, paresthesia, peripheral neuropathy, blurred vision, taste disturbance. Allergic and immunopathological reactions: angioedema, polymyalgia rheumatica, vasculitis, thrombocytopenia, increased erythrocyte sedimentation rate, fever, arthritis , rash, photosensitivity, skin redness, flushing, shortness of breath, lupus-like syndrome, eosinophilia. Dermatological reactions: skin rash, pruritus, alopecia, dermatomyositis. From the musculoskeletal system: myopathy, myalgia, muscle cramps, weakness; rarely – rhabdomyolysis. Other: anemia, palpitation, acute renal failure masteron propionate (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. Symptomatic therapy. It is necessary to control the functions of the liver and kidneys, 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 Cytotoxic agents, antifungal agents (ketoconazole, itraconazole), fibrates, high doses of nicotinic acid, immunosuppressants, erythromycin, clarithromycin, telithromycin, HIV protease inhibitors, nefazodone: increase the risk of myopathy. Cyclosporine or Danazol: the risk of myopathy / rhabdomyolysis is increased by concomitant use 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 , but can cause myopathy in monotherapy conditions. Such as gemfibrozil and other fibrates (except fenofibrate), and niacin (nicotinic acid) ≥1 g dose per day. Amiodarone and verapamil: risk of myopathy is increased by coadministration of amiodarone or verapamil with high doses of simvastatin. Diltiazem: risk of myopathy slightly increased in patients receiving diltiazem along with simvastatin at a dose of 80 mg. simvastatin potentiates the action of oral anticoagulants (eg., phenprocoumon, warfarin) and increases the risk of bleeding, which requires the need for monitoring indicators of coagulation prior to treatment, and often enough in the initial period of therapy. Once reached a stable level indicator prothrombin time or international normalized ratio masteron propionate, it should be carried out further inspections at the intervals recommended for patients receiving anticoagulant therapy. When dosage modification or discontinuation of simvastatin should also carry out monitoring of the prothrombin time according to the above scheme.
Therapy with simvastatin did not cause changes in prothrombin time and the risk of bleeding in patients not taking anticoagulants. It increases the level of digoxin in the blood plasma.Cholestyramine and colestipol: reduce 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 concentration in the blood plasma means, 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 masteron propionate inhibitory activity against reductase inhibitor.