Pharmacodynamics testosterone cypionate vs enanthate belongs to the class of kinase inhibitors. testosterone cypionate vs enanthate inhibits abnormal kinase Bcr-Abl, causes the development of chronic myeloid leukemia (XMJI). It was shown that binds testosterone cypionate vs enanthate kinase domain of Bcr-Abl. testosterone cypionate vs enanthate also an inhibitor family kinases Src, including Src, Lyn and Hck. Furthermore, testosterone cypionate vs enanthate has minimal inhibitory activity against PDGF and c-Kit receptor.
Studies in vitro testosterone cypionate vs enanthate inhibit proliferation and viability of cell lines established XML, Ph + acute lymphoblastic leukemia and primary isolates from patients primitive cells XMJI. Furthermore, testosterone cypionate vs enanthate inhibited 16 of 18 resistant to imatinib forms Bcr-Abl, expressed in mouse myeloid cell lines. Against testosterone cypionate vs enanthateom therapy there was a decrease in tumor size with XML from “bare” mice, as well as inhibition of the growth of myeloid tumors in mice expressing imatinib resistant forms of Bcr-Abl. testosterone cypionate vs enanthate also inhibits the tyrosine kinase receptors c-Fms, EphA and B family kinases Trk, Axl family kinase, Tec family kinases, several members of the family ErbB, non-receptor tyrosine kinase Csk, the serine / threonine kinase family kinase Ste20 and two associated with calmodulin.
Pharmacokinetics Absorption After a single dose testosterone cypionate vs enanthatea at a dose of 500 mg during a meal the absorption of the drug has been relatively slow; median time to maximum concentration (t max ) was 6 hours. Mean values of maximum plasma concentration (C max ) and area under “concentration-time” curve (AUC) amounted to 112 ng / mL and 2740 ng * h / mL. Increasing values of AUC and C maxtestosterone cypionate vs enanthatea doses ranging from 200 mg to 800 mg bore dozoproportsionalny character. Food increased the values of C max testosterone cypionate vs enanthatea 1.8 times and AUC testosterone cypionate vs enanthatea 1.7 times compared to his fasting. After 15 days of daily administration testosterone cypionate vs enanthatea tablets in dose of 500 mg during a meal in patients with XMJI mean values C max were 200 ng / ml and the average AUC – 3650 ng * h / ml. Solubility testosterone cypionate vs enanthatea water in vitro depends on pH . Lansoprazole resulted in mitigation testosterone cypionate vs enanthatea (see. Section “Interaction with other medicinal products”). Distribution After a single dose testosterone cypionate vs enanthatea at a dose of 500 mg during a meal the average apparent volume of distribution of the drug was 7700 l (2940 l), indicating the intensity distribution testosterone cypionate vs enanthatea in extravasal tissue. testosterone cypionate vs enanthate largely contacted with human plasma proteins in vitro(94%); This indicator is independent of drug concentration. Metabolism Studies in vitro and in vivo showed that testosterone cypionate vs enanthate (starting material) in humans is metabolized mainly in the liver. After single and multiple dose testosterone cypionate vs enanthatea in doses of 400 mg or 500 mg of the major human metabolites circulating in blood were oksidehlorirovanny (M2) and N-desmethyl (M5) testosterone cypionate vs enanthate; present in smaller quantities testosterone cypionate vs enanthatea N-oxide (MB). Systemic exposure to TV-demethylated metabolite was 25% of the starting material, metabolite oksidehlorirovannogo – 19% of the starting material. The share of all three metabolites accounted for < 5% of the activity at the free testosterone cypionate vs enanthatea proliferation assessment Src-transformed fibroblasts. In faeces testosterone cypionate vs enanthate and N-demetiltestosterone cypionate vs enanthate were the major drug-related components. In studies in vitro using human liver microsomes, it was shown that the major isoenzyme cytochrome P450 involved in the metabolism testosterone cypionate vs enanthatea is CYP3A4. Isozymes CYP1A2, CYP2A6, CYP2B6, CYP2C8, CYP2C9, CYP2C19, CYP2D6, CYP2E1 and CYP3A5 were not involved in the metabolism of testosterone cypionate vs enanthatea. Flavinsoderzhaschie monooxygenase (FMOl, FM03 and FM05) capable of metabolizing testosterone cypionate vs enanthate to form its N-oxide. Excretion When receiving testosterone cypionate vs enanthatea mono-, orally, in the form of pills at a dose of 500 mg at mealtime, the mean half-life in the terminal phase (t ½ ) was 33.8 hours; average clearance (Cl / F) – 197 l / h. Patients treated once orally radiolabeled [ 14 C] testosterone cypionate vs enanthate, for 9 days on average 94.6% of the total allocated administered dose of the labeled product. The primary route of elimination – through the intestine (91.3% of the administered dose); 3.29% of the administered dose is excreted through the kidneys. Excretion of the drug was rapid: 75% of the administered dose is excreted within 96 hours Excretion of unchanged testosterone cypionate vs enanthatea through the kidneys was low, about 1% of the administered dose.. The use of special populations Patients with hepatic impairment has been shown that the values of C maxtestosterone cypionate vs enanthatea patients impaired liver function, class a, B and C according to Child-Pugh classification increased by 2.4 times, 2 times and 1.5 times, respectively, and the AUC values testosterone cypionate vs enanthatea plasma – 2.3 times, 2 times and 1, 9 times, respectively. In addition, in patients with impaired liver function observed elongation values t ½ testosterone cypionate vs enanthatea. Assumed According to a pharmacokinetic modeling that taking testosterone cypionate vs enanthatea in patients with impaired hepatic function a daily dose of 200 mg provides the values of the AUC, similar to those in patients with normal liver function receiving the drug at a dose of 500 mg daily (see. section “dosage and administration”). patients with renal impairment patients with impaired renal secondary function (30 ml / min < creatinine clearance (CC) < 50 ml / min) and severe (creatinine clearance <30 mL / min) AUC was an increase in the degree of the values by 35% and 60%, respectively. Patients with impaired mild renal function were observed changes in the effects of the drug.According to the simulation results of pharmacokinetics, it is assumed that the drug in patients with impaired severe renal function in a daily dose of 300 mg provides values AUC similar to those of patients with normal renal function and receiving the drug at a dose of 500 mg daily (see. section “dosage and administration”). half-life testosterone cypionate vs enanthatea values in patients with impaired renal function in the normal indicators.
testosterone cypionate vs enanthate indicated for the treatment of chronic myeloid leukemia with Philadelphia chromosome positive (XML Ph +), in the chronic phase, accelerated phase or blast crisis in case of intolerance or ineffectiveness of previous therapy with imatinib, nilotinib and dasatinib.
- hypersensitivity to testosterone cypionate vs enanthateu or any auxiliary substance, a part of the drug;
- Avoid concurrent use with strong or moderate inhibitors or inducers of CYP3A isozyme (see “Interaction with other medicinal products” section.)
- pregnancy, breast-feeding;
- Children up to age 18 years (insufficient data on safety and efficacy).
should be used with caution testosterone cypionate vs enanthate simultaneously with weak inhibitors or inducers of isoenzymes of CYP3A, substrates of P-glycoprotein (P-gp), proton pump inhibitors (PPIs).
Caution should be exercised when using testosterone cypionate vs enanthatea in patients with arrhythmias history or predisposing factors a lengthening of the QTc interval, with uncontrolled or severe cardiovascular disease, including recent myocardial infarction, congestive heart failure, unstable angina or clinically significant bradycardia, and in patients taking drugs that may cause prolongation of the interval QT (eg, antiarrhythmic drugs and other substances that may cause lengthening of the interval QT (see. see “The interaction with other drugs”), and in patients with impaired gastrointestinal function (acute or recent state).
Use during pregnancy and during breastfeeding
According to the results of pre-clinical studies, testosterone cypionate vs enanthate able to break the reproductive function and fertility in humans. Pregnancy is not recommended to use testosterone cypionate vs enanthatea during pregnancy and in women with reproductive potential not using contraception. Experience with testosterone cypionate vs enanthatea during pregnancy is limited. There are no adequate and well-controlled studies testosterone cypionate vs enanthatea been conducted during this period. When using testosterone cypionate vs enanthatea during pregnancy or becoming pregnant during therapy should be informed testosterone cypionate vs enanthateom patient about the potential risk of the drug to the fetus. Lactation Women receiving testosterone cypionate vs enanthate should not breast-feed and to give breast milk to children. Because many drugs are excreted into breast milk, it is impossible to eliminate the potential risk to a child who is breastfed.
Dosing and Administration
testosterone cypionate vs enanthatea recommended dose is 500 mg, orally, 1 time per day, during meals. testosterone cypionate vs enanthateom therapy should be continued until disease progression or unacceptable toxicity symptoms of the drug.
In case of missing a dose should not take an additional dose of the drug; you must take the usual prescribed dose on the following day. Increasing the dose Dose testosterone cypionate vs enanthatea can be increased to 600 mg 1 time per day in patients who have not achieved a complete hematologic response after 8 weeks of therapy, or will not reach complete cytogenetic response after 12 weeks of therapy, as well as who have not observed the heavy ( > grade 3) adverse reactions. Changing the dose in the development of adverse reactions, dose changes during the development of non-hematological adverse reactions, increase in liver transaminases : with an increase in liver transaminases more than 5 times the upper limit of normal (ULN) to temporarily stop taking testosterone cypionate vs enanthatea to decline to < 2.5 times the ULN, then perhaps the resumption of treatment at a dose of 400 mg 1 time per day. If the recovery takes longer than 4 weeks, you should consider abolishing testosterone cypionate vs enanthatea. An increase in transaminases to more than 3 times the ULN, accompanied by increased bilirubin concentration of more than 2 times the ULN and alkaline phosphatase less than 2 times the ULN, testosterone cypionate vs enanthate should be discontinued (see “Special Instructions” section.). Diarrhea : the development of grade 3-4 diarrhea (increased number of bowel movements per day > 7 times the baseline level before treatment) to temporarily discontinue therapy testosterone cypionate vs enanthateom; after the resolution of an adverse event to a level corresponding to < 1 degree possible resumption of the drug at a dose of 400 mg 1 time per day (see. “Special Instructions” section) With the development of other types of clinically significant hematological toxicity moderate or severe you need to cancel testosterone cypionate vs enanthate ; after the resolution of toxicity possible resumption of the drug at a dose of 400 mg 1 time per day.If clinically possible consideration should be given to re-increase the dose to 500 mg, 1 time per day. Changing the dose with haematological adverse reactions If you develop severe or persistent neutropenia and thrombocytopenia, it is recommended to reduce the dose of the drug, as described below. You may also need a temporary discontinuation of drug and / or reducing the dose in the development of hematologic toxicities (neutropenia, thrombocytopenia) are not associated with the background leukemia (Table 1). Table 1. Changes in dose when neutropenia and thrombocytopenia
|Neutrophils <1,0h10 9 / l
and / or
Platelets <50×10 9 / L
|Pause reception testosterone cypionate vs enanthatea to restore neutrophil counts
to> 1,0×10 9 / l and platelet count
to> 50×10 9 / L.Reactivate testosterone cypionate vs enanthateom therapy at the same dose in the reduction
rates for 2 weeks. If blood counts remained low
for more than 2 weeks, the dose should be reduced to 100 mg and resume therapy.
At relapse cytopenia – to reduce the dose to 100 mg, wait for recovery
Application testosterone cypionate vs enanthatea not studied at doses less than 300 mg per day.
Safety and effectiveness testosterone cypionate vs enanthatea in patients aged below 18 years have not been assessed. Relevant data are not available. Use in patients with impaired hepatic function In patients with impaired liver function mild, moderate and severe Bosulif recommended dose is 200 mg of the drug per day. Clinical data regarding the effectiveness of the drug at a dose of 200 mg 1 time per day in patients with impaired liver function in XML are not available. Use in patients with impaired renal function In patients with impaired renal function moderate (creatinine clearance 30-50 ml / min) the recommended testosterone cypionate vs enanthatea dose is 400 mg per day. In patients with pre-existing severe violation of renal function (creatinine clearance <30 mL / min) the recommended dose of the drug Bosulif is 300 mg per day.
The frequency of adverse reactions is represented by the following classification:
|Very frequent||> 10%|
|Frequent||> 1% and <10%|
|Infrequent||> 0.1% and <1%|
|few||> 0.01% and <0.1%>|
Since the cardiovascular system : frequent – pericardial effusion. On the part of the organ of hearing : frequent – ringing in the ears. From the digestive system : very often – diarrhea, vomiting, abdominal pain (including pain in the upper and lower abdomen, abdominal discomfort, pain in the abdomen, pain in the gastrointestinal tract), nausea, frequent – gastritis, gastrointestinal bleeding (including stomach bleeding, bleeding from the upper gastrointestinal tract); infrequent – acute pancreatitis. from the hepatobiliary system : frequent – hepatotoxicity (including toxic hepatitis, cytolytic hepatitis), abnormal liver function; infrequent -Damage liver cells. Laboratory findings : very often – increasing the activity of alanine aminotransferase (ALT), aspartate aminotransferase (the ACT); frequent – an increase of lipase activity , amylase in the blood, activity of improving gammaglutamiltranspeptidazy (GGT), creatine kinase in the blood plasma, increased bilirubin concentration in plasma, prolonged QT interval on an electrocardiogram (ECG), an increase krёatinina plasma concentration. From the side of hematopoiesis : very often – thrombocytopenia, anemia, neutropenia, frequent – leukopenia, infrequent– febrile neutropenia, granulocytopenia. immune system : frequent e – drug hypersensitivity; infrequent – anaphylactic shock. infectious and parasitic diseases : very frequent – infectious diseases (including infections of the upper and lower respiratory tract, viral respiratory tract infection); frequent – Pneumonia (including bronchopneumonia, primary atypical pneumonia), flu, bronchitis, nasopharyngitis. On the part of metabolism : very often – loss of appetite, frequent -giperkaliemiya, hypophosphataemia, dehydration. From the nervous system : very often – headache; frequent – dizziness, dysgeusia. The respiratory system : very often – dyspnea, cough, frequent -plevralny effusion; infrequent – acute pulmonary edema, respiratory failure, pulmonary hypertension. For the skin : very often – rash (including maculopapular, itchy rash, generalized rash, papular rash), often – urticaria, pruritus, acne, infrequent – erythema multiforme, exfoliative rash, drug dermatitis. From the urinary system: frequent – renal failure (including acute). From the musculoskeletal musculoskeletal system: on the list of frequent – joint pain, frequent – back pain, myalgia. Other : very often – fatigue (including malaise), pyrexia, edema (including facial edema, local edema, peripheral edema); frequent – fatigue, pain in the chest (including discomfort in the chest), and pain.
Experience of treatment testosterone cypionate vs enanthatea overdose in clinical studies is limited to isolated cases. Posts on the development of serious adverse events associated with overdose have been reported. In case of overdose the patient must be testosterone cypionate vs enanthatea surveillance and appropriate supportive therapy.
Interaction with other drugs The influence of other drugs on testosterone cypionate vs enanthate inhibitors of isoenzyme CYP3A Avoid the simultaneous application testosterone cypionate vs enanthatea with potent inhibitors of isoenzyme CYP3A (eg, ritonavir, indinavir, nelfinavir, saquinavir, ketoconazole, itraconazole, voriconazole, posaconazole, troleandomycin, clarithromycin, telithromycin, mibefradilom , nefazodone, konivaptanom) or moderate (e.g., fluconazole, darunavir, erythromycin, diltiazem, dronedarone, atazanavir, aprepitant, amprenavir, imatinib, verapamil, products containing grapefruit tofizopamom, ciprofloxacin, cimetidine), as this may lead to increased testosterone cypionate vs enanthatea concentration in the blood plasma. It should be used with caution testosterone cypionate vs enanthate simultaneously with weak inhibitors of isoenzyme CYP3A. It is also recommended that the selection of alternative concomitant therapy, characterized by lack of inhibitory effect or minimal inhibitory effect on enzymes. If necessary, the simultaneous application of testosterone cypionate vs enanthatea with strong or moderate inhibitors of isoenzyme CYP3A should consider testosterone cypionate vs enanthatea of dose reduction. When the joint application of ketoconazole five times, at a dose of 400 mg per day, with testosterone cypionate vs enanthateom a dose of 100 mg once daily, there was an increase values C max testosterone cypionate vs enanthatea 5.2 times and AUC testosterone cypionate vs enanthatea- 8.6 times in comparison with the the corresponding figures when taking testosterone cypionate vs enanthatea monotherapy (fasting). Inductors isoenzyme CYP3Asimultaneous application testosterone cypionate vs enanthatea should be avoided with the powerful (eg, rifampicin, phenytoin, carbamazepine, drugs grass Hypericum perforatum, rifabutin, phenobarbital) or moderate (eg, bosentan, nafcillin efavirenz, modafinil , etravirine) inducers of isoenzymes of CYP3A. Due to a sharp decline in the values of exposure testosterone cypionate vs enanthateu registered under his simultaneous administration with rifampicin, increasing the dose testosterone cypionate vs enanthatea during concomitant use with strong or moderate inducers of isoenzymes of CYP3A, may not allow sufficiently compensate for the decline in the values of the exposure. it is a Be wary of testosterone cypionate vs enanthate simultaneously with weak inducers of the isoenzyme CYP3A. in single dose testosterone cypionate vs enanthatea at a dose of 500 mg at a time with a six-fold receiving rifampicin at a daily dose of 600 mg, a decrease exposures (C max and AUC in plasma) testosterone cypionate vs enanthateu 14% and 6%, respectively in comparison with the same values when receiving testosterone cypionate vs enanthatea 500 mg monotherapy after ingestion. proton pump inhibitors (PPIs) testosterone cypionate vs enanthate should be used with caution during concomitant use of PPIs. The antacids should be considered as a short-acting alternative to STI, but in all cases, where possible, should be taken antacids testosterone cypionate vs enanthate and at different times (ie take testosterone cypionate vs enanthate morning and antacids -.. In the evening). In single dose testosterone cypionate vs enanthatea oral dose of 400 mg at a time with multiple dose of lansoprazole orally at a dose of 60 mg (both drugs are taken on an empty stomach), a decrease of values C max and AUC testosterone cypionate vs enanthatea relative to values observed during monotherapy testosterone cypionate vs enanthateom 400 mg, 54% and 74 %, respectively. The effect of testosterone cypionate vs enanthatea other drugs should be careful while applying testosterone cypionate vs enanthatea substrates with P-gp. In a study in vitro , it was suggested that the reception testosterone cypionate vs enanthatea able to lead to increased concentrations of substrates P-gp (such as digoxin) in the blood plasma. In a study in vitro , it was shown that the clinical drug interaction caused substrates metabolic induction isozymes CYP1A2 , CYP2B6, CYP2C9, CYP2C19 and CYP3A4 testosterone cypionate vs enanthateom is unlikely. In a study in vitro has also been shown that clinical drug interactions due to inhibition of metabolic substrates isozymes CYP1A2, CYP2A6, CYP2C8, CYP2C9, CYP2C19, CYP2D6 and CYP3A4 / 5 testosterone cypionate vs enanthateom unlikely. antiarrhythmic drugs and other means of prolonging the QT interval caution should be exercised when using testosterone cypionate vs enanthatea in patients in whom there is or possibly lengthening the interval QT, including patients receiving antiarrhythmic drugs such as amiodarone, disopyramide, procainamide, quinidine and sotalol or other drugs which can lead to a lengthening of QT interval (e.g., chloroquine, halofantrine, clarithromycin, domperidone, haloperidol, methadone and moxifloxacin).
Abnormal liver function
increased activity of aminotransferases may develop on the background testosterone cypionate vs enanthateom therapy (AJIT, ACT) in the blood serum. Among patients who have noted increased activity of aminotransferases any degree, more than 80% of patients with a first episode of this adverse reaction was observed during the first 3 months of therapy.
The simultaneous increase in the activity AJIT to the level of more than 3 times the ULN, and increasing the concentration of total bilirubin more than 2 times the ULN, without a concomitant increase in alkaline phosphatase activity less than 2 times the ULN were observed in less than 0.1% of patients (see. sections “dosage and administration”, subsection “Change the dose at non-hematological adverse reactions” and ” Side effect”). This result was obtained in the study by combining testosterone cypionate vs enanthatea with letrozole.
Patients receiving testosterone cypionate vs enanthate, for the first 3 months of therapy, as well as with appropriate clinical indications, requires monthly monitoring of liver function. An increase in transaminases possible suspension testosterone cypionate vs enanthateom therapy, decrease the dose and / or complete removal of the drug (see. Sections “Dosage and Administration” and “Side Effects”). Diarrhea / Vomiting The therapy testosterone cypionate vs enanthateom may develop diarrhea, nausea, vomiting and pain in the abdomen. If adverse reactions data held standard therapy, including antidiarrheal, antiemetic drugs, and / or infusion therapy. In addition to this are also possible temporary cessation of therapy testosterone cypionate vs enanthateom, decrease the dose and / or complete removal of the drug (see. Sections “Dosage and Administration” and “Side Effects”), antiemetics, domperidone may cause an increase in the QT interval and induce arrhythmia ventricular tahisistolichiskuyu type “pirouette» (torsade de pointes). In this connection it should avoid the simultaneous use testosterone cypionate vs enanthatea and domperidone.It may be used only if the other agents are ineffective. In this situation it is necessary to weigh the risk-benefit for the patient, and should be performed ECG monitoring for prolongation of the QT interval.Myelosuppression Therapy testosterone cypionate vs enanthateom may be associated with the development of myelosuppression (anemia, neutropenia and thrombocytopenia). Patients with XML Ph +, received previous anti-tumor therapy , while taking testosterone cypionate vs enanthatea necessary to satisfy the full blood count 1 time per week during the first month of therapy and then 1 time per month (or in the presence of appropriate clinical indications). in developing myelosuppression possible suspension testosterone cypionate vs enanthateom therapy, decrease the dose and / or complete removal of the drug (see. sections “dosage and Administration” and “Side effects”). fluid retention Therapy testosterone cypionate vs enanthateom may be associated with the development of fluid retention, including pericardial, pleural effusion, pulmonary edema and / or peripheral edema. It is necessary to conduct appropriate patient monitoring and, if necessary, conduct a standard therapy. In addition, under these adverse events are possible suspension testosterone cypionate vs enanthateom therapy, decrease the dose and / or complete removal of the drug (see. Sections “Dosage and Administration” and “Side Effects”). Increased lipase plasma Caution must be exercised when applying testosterone cypionate vs enanthatea patients with a history of pancreatitis. If the increase of lipase in blood plasma is observed in conjunction with clinical symptoms, should stop taking testosterone cypionate vs enanthatea and conduct diagnostic search to exclude pancreatitis. Infections Application testosterone cypionate vs enanthatea may predispose to the development of fungal, viral infections or protozoal infections. Proarrhythmic potential Cases of prolongation of the QTc interval, registered on the ECG, with no signs of arrhythmia.caution must be exercised when applying testosterone cypionate vs enanthatea in patients with arrhythmias history or predisposing factors to a lengthening of the QTc interval, with uncontrolled or severe cardiovascular disease, including recent myocardial infarction, congestive heart failure, unstable angina or clinically significant bradycardia and in patients taking drugs that may cause lengthening of the interval QT (for example, antiarrhythmic drugs and other substances that may cause lengthening of the interval QT (cm. See “Interaction with other medicinal products”)). Hypokalemia and hypomagnesemia may aggravate this effect.It is recommended to carry out a study of ECG before treatment and periodically during therapy for QTc prolongation. Hypokalemia and hypomagnesemia must be corrected prior to initiating therapy and during therapy should be periodically monitoring the concentration of potassium and magnesium in the blood plasma. testosterone cypionate vs enanthate not QT interval lengthens in its reception at the recommended dose (500 mg per day, during a meal) and under conditions conducive to the creation supraterapevticheskih concentrations of drug in blood plasma. Cases of QT prolongation> 450 msec or increase of this index from baseline by> 30 ms in patients taking testosterone cypionate vs enanthate testosterone cypionate vs enanthate or simultaneously with ketoconazole, have been reported. Inhibitors of CYP3A isoenzyme , when taken concomitantly with inhibitors of isoenzyme CYP3A may increase exposure values testosterone cypionate vs enanthateu. Avoid using testosterone cypionate vs enanthatea simultaneously with moderate or strong inhibitors of CYP3A isoenzyme (see. Section “Interaction with other medicinal products”). Inducers of CYP3A isoenzyme , when taken concomitantly with inducers of CYP3A isoenzymes may reduce the exposure value testosterone cypionate vs enanthateu. Avoid using testosterone cypionate vs enanthatea simultaneously with moderate or potent inducers of CYP3A isoenzyme (see. Section “Interactions with other drugs) Abnormal liver function in patients with hepatic impairment showed an increase values testosterone cypionate vs enanthateu exposure. Patients with impaired hepatic function ranging from mild to severe (at baseline), the use of testosterone cypionate vs enanthatea recommended at the initial dose (see. Sections “Dosage and Administration” and “Pharmacological properties”). Impaired Renal Function In patients with impaired renal function was an increase in exposure values testosterone cypionate vs enanthateu. In patients with impaired renal function, severe (at baseline) testosterone cypionate vs enanthatea recommended to use a smaller initial dose (see. Sections “Dosage and Administration” and “Pharmacological properties”).
Effects on ability to drive vehicles and mechanisms
Research testosterone cypionate vs enanthatea influence on the ability to drive a car and operating machinery has not been. Patients in patients receiving testosterone cypionate vs enanthatea noted the development of dizziness, fatigue, visual impairment or other undesirable effects, characterized by a potential impact on the ability to control the car and work with mechanisms, should refrain from these activities during the period of preservation of the undesirable effects of data. legal steroids