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Active Ingredient: Cabergoline.

Analogs of Dostinex:Cabgolin.

Other names for this medication:
Actualene, Agalates, Cabaser, Cabaseril, Cabergolek, Cabergolin, Cabergolina, Cabergolinum, Caberlin, Caberpar, Cabeser, Cabest, Cieldom, Galastop, Kabergolin, Lac stop, Lactamax, Lactovet, Prolastat, Sogilen, Sostilar, Triaspar.

Dostinex is used for treating disorders associated with high levels of the hormone prolactin, either due to tumors in the pituitary gland or to unknown causes.♀

Pharmachologic effect

Dopamine receptor agonist. Cabergoline is a dopaminergic ergoline derivative, characterized by a pronounced and prolonged prolactin-lowering effect. The mechanism of action is associated with direct stimulation of the dopamine D2 receptors of the lactotropic pituitary cells. In doses exceeding those to reduce the level of prolactin in the blood plasma, it has a central dopaminergic effect due to the stimulation of dopamine D2 receptors.

A decrease in the concentration of prolactin in the blood plasma is noted 3 hours after taking the drug and persists for 7-28 days in healthy volunteers and patients with hyperprolactinemia, and up to 14-21 days in women in the postpartum period. Prolactin-reducing action is dose-dependent both in terms of severity and duration of action.

Cabergoline has a strictly selective effect, does not affect the basal secretion of other pituitary and cortisol hormones.

Pharmacological effects of cabergoline, not related to the therapeutic effect, include only a decrease in blood pressure. With a single use of the drug, the maximum hypotensive effect is observed during the first 6 hours and is dose-dependent.

Pharmacokinetics

٭Suction and distribution

After oral administration, cabergoline is rapidly absorbed from the gastrointestinal tract. Cmax in plasma is achieved in 0.5-4 hours. Binding to plasma proteins is 41-42%. Css is achieved after 4 weeks of therapy due to prolonged T1 / 2.

Meal does not affect the absorption and distribution of cabergoline.

٭Metabolism

The main product of cabergoline metabolism identified in the urine is 6-allyl-8β-carboxy-ergoline at a concentration of up to 4-6% of the dose taken. The content in the urine of 3 additional metabolites does not exceed 3% of the dose. Metabolism products have a significantly lower effect in suppressing the secretion of prolactin compared to cabergoline.

٭Removal

T1 / 2, estimated by the rate of excretion by the kidneys, is 63-68 h in healthy volunteers and 79-115 h in patients with hyperprolactinemia.

10 days after taking the drug, 18% and 72% of the received dose are detected in the urine and feces, respectively, and the proportion of unchanged cabergoline in the urine is 2-3%.

Indications
☞prevention of physiological postpartum lactation;

☞suppression of established postpartum lactation;

☞treatment of disorders associated with hyperprolactinemia, including amenorrhea, oligomenorrhea, anovulation and galactorrhea;

☞prolactin-secreting pituitary adenomas (micro- and macroprolactinomas), idiopathic hyperprolactinemia, “empty” Turkish saddle syndrome in combination with hyperprolactinemia.

Dosing regimen📅
Is ingested, during meals.

Lactation prevention: 1 mg (2 tab.) Once on the first day after birth.

Suppression of established lactation: 0.25 mg (1/2 tab.) 2 times / day every 12 hours for 2 days (total dose is 1 mg). In order to reduce the risk of orthostatic hypotension in lactating mothers, a single dose of Dostinex should not exceed 0.25 mg.

Treatment of disorders associated with hyperprolactinemia: the recommended initial dose is 0.5 mg per week in 1 (1 tab.) Or 2 doses (1/2 tab., For example, on Monday and Thursday). Increasing the weekly dose should be carried out gradually – at 0.5 mg with an interval of 1 month to achieve the optimal therapeutic effect. The therapeutic dose is usually 1 mg per week, but can range from 0.25 mg to 2 mg per week. The maximum dose for patients with hyperprolactinemia is 4.5 mg per week.

Depending on tolerance, the weekly dose can be taken once or divided into 2 or more doses per week. The division of the weekly dose into several doses is recommended when prescribing the drug in a dose of more than 1 mg per week.

In patients with hypersensitivity to dopaminergic drugs, the likelihood of side effects can be reduced by starting Dostinex therapy at a lower dose (0.25 mg 1 time per week), followed by a gradual increase until the therapeutic dose is reached. To improve the tolerability of the drug in the event of severe side effects, a temporary dose reduction is possible, followed by a gradual increase, for example, by 0.25 mg per week every 2 weeks.

Side effect
In clinical studies using Dostinex to prevent physiological lactation (1 mg once) and to suppress lactation (0.25 mg every 12 hours for 2 days), approximately 14% of women had adverse reactions. When using Dostinex for 6 months at a dose of 1-2 mg per week, divided into 2 doses, for the treatment of disorders associated with hyperprolactinemia, the incidence of adverse reactions was 68%. Adverse reactions occurred mainly during the first 2 weeks of therapy and in most cases disappeared as therapy continued or several days after discontinuation of the drug Dostinex. Adverse reactions were usually transient, mild or moderate in severity and dose-dependent. At least once during the course of therapy, severe side effects were observed in 14% of patients; due to adverse reactions, treatment was discontinued in approximately 3% of patients.

The most frequent adverse reactions are presented below.

☁Since the cardiovascular system: heartbeat; rarely, orthostatic hypotension (with prolonged use, the drug has a hypotensive effect); asymptomatic decrease in blood pressure during the first 3-4 days after birth (systolic – more than 20 mm Hg, diastolic – more than 10 mm Hg).

☁Nervous system disorders: dizziness / vertigo, headache, fatigue, drowsiness, depression, asthenia, paresthesias, syncope, nervousness, anxiety, insomnia, impaired concentration.

☁On the part of the digestive system: nausea, vomiting, epigastric pain, abdominal pain, constipation, gastritis, dyspepsia, dryness of the oral mucosa, diarrhea, flatulence, toothache, sensation of irritation of the pharyngeal mucosa.

☁Other: mastodynia, nasal bleeding, flushing to the skin of the face, transient hemianopia, vascular spasms of the fingers, muscle cramps of the lower extremities (like other ergot derivatives, Dostinex may have a vasoconstrictor effect), blurred vision, flu-like symptoms, malaise, periorbital and peripheral swelling, anorexia, acne, pruritus, joint pain.

🌞With long-term therapy with the use of the drug Dostinex, deviation from the norm of standard laboratory parameters was rarely observed; in women with amenorrhea, a decrease in hemoglobin level was observed during the first few months after the recovery of menstruation.🌞

☁The following adverse reactions associated with the use of cabergoline were registered in the post-marketing study: alopecia, increased blood CPK activity, mania, dyspnea, edema, fibrosis, abnormal liver function, abnormal liver function, hypersensitivity, rash, respiratory disorders, respiratory failure, valvulopathy, pathological addiction to gambling, hypersexuality, increased libido, aggressiveness, psychotic disorders, pericarditis, bouts of sudden sleep, decrease or increase in body weight, nasal congestion.

Contraindications
🍓Hypersensitivity to cabergoline or other components of the drug, as well as to any ergot alkaloids;

🍓dysfunction of the heart and respiration due to fibrous changes or the presence of such conditions in history;

🍓during long-term therapy: anatomical signs of valvular pathology of the heart (such as thickening of the valve leaflet, narrowing of the valve lumen, mixed pathology of narrowing and stenosis of the valve), confirmed by echocardiography (EchoCG), conducted before the start of therapy;

🍓lactose intolerance, lactase deficiency, glucose-galactose malabsorption;

🍓children and adolescents under 16 years of age (safety and efficacy have not been established).

Dostinex should be administered with caution in the following conditions and / or diseases:

🍓arterial hypertension that developed during pregnancy, for example, preeclampsia or postpartum arterial hypertension (Dostinex is prescribed only in cases where the potential benefit from the use of the drug significantly exceeds the possible risk);

🍓severe cardiovascular diseases, Raynaud’s syndrome;

🍓peptic ulcer, gastrointestinal bleeding;

🍓severe liver failure (the use of lower doses is recommended);

🍓severe psychotic or cognitive impairment (including in history);

🍓simultaneous use with drugs that have a hypotensive effect (due to the risk of orthostatic hypotension).

Use during pregnancy and lactation
Since there have been no controlled clinical trials with the use of the drug Dostinex in pregnant women, the prescription of the drug during pregnancy is possible only in cases of emergency, when the expected benefit to the mother outweighs the potential risk to the fetus.

If pregnancy has occurred on the background of treatment with Dostinex, the feasibility of discontinuing the drug should be considered, also taking into account the benefit / risk ratio.

According to available data, the use of Dostinex in a dose of 0.5-2 mg per week for disorders associated with hyperprolactinemia was not accompanied by an increase in the frequency of miscarriages, premature birth, multiple pregnancy and congenital malformations.

There is no information about the release of the drug in breast milk, however, in the absence of the effect of using the drug Dostinex to prevent or suppress lactation, breastfeeding should be abandoned. For disorders associated with hyperprolactinemia, Dostinex should not be prescribed to mothers who do not want to stop lactation.

Application for violations of the liver
With caution, use the drug in severe liver failure (lower doses are recommended).

Use in children
Contraindications: children and adolescents under 16 years of age (safety and efficacy have not been established).

Special instructions
Before prescribing Dostinex for the purpose of treating disorders associated with hyperprolactinemia, it is necessary to conduct a full study of the function of the pituitary gland.

In addition, the state of the cardiovascular system, including echocardiography, should be assessed in order to detect valvular dysfunction asymptomatic.

As with the use of other ergot derivatives, pleural effusion / pleural fibrosis and valvulopathy were observed in patients after long-term administration of cabergoline. In some cases, patients received prior therapy with dopamine ergotonin agonists. Therefore, Dostinex should not be used in patients with existing signs and / or clinical symptoms of dysfunction of the heart or respiration associated with fibrotic changes or with such a history. The drug should be discontinued if there are signs of the appearance or worsening of blood regurgitation, narrowing of the lumen of the valves or thickening of the valve leaflets.

It was found that ESR increases with the development of pleural effusion or fibrosis. If an unexplained increase in ESR is detected, a chest X-ray is recommended. A study of the concentration of creatinine in the blood plasma and an assessment of renal function can also help in the diagnosis. After discontinuation of Dostinex in patients with pleural effusion / pleural fibrosis or valvulopathy, symptoms improved.

It is not known whether cabergoline can worsen the condition of patients with signs of blood regurgitation. Cabergoline should not be used in the detection of fibrous lesions of the valvular apparatus of the heart.

Fibrotic disorders can develop asymptomatically. In this regard, the condition of patients receiving long-term treatment with cabergoline should be regularly monitored and special attention should be paid to the following symptoms:

☞pleural-pulmonary disorders: such as shortness of breath, difficulty breathing, persistent cough or chest pain;

☞renal failure or obstruction of the vessels of the ureters or abdominal organs, which may be accompanied by pain in the side or lumbar region and edema of the lower extremities, any swelling or tenderness in the abdominal region, which may indicate the development of retroperitoneal fibrosis;

☞pericardial fibrosis and fibrosis of the valves of the heart often manifest heart failure. In this regard, it is necessary to exclude fibrosis of the valves of the heart (and constrictive pericarditis) at the onset of symptoms of heart failure.

It should regularly monitor the patient’s condition for the development of fibrotic disorders. The first time EchoCG should be performed 3-6 months after the start of therapy. Then this study should be conducted depending on the clinical assessment of the patient’s condition, paying particular attention to the symptoms described above, at least every 6-12 months of therapy.

The need for other monitoring methods (for example, physical examination, including auscultation of the heart, radiography, computed tomography) is assessed individually for each patient.

With increasing doses, patients should be under the supervision of a physician in order to establish the minimum effective dose that provides a therapeutic effect.

After an effective dosing regimen is selected, it is recommended to regularly (once a month) determine the serum prolactin concentration. Normalization of prolactin concentration is usually observed within 2-4 weeks of treatment.

After discontinuation of Dostinex, there is usually a relapse of hyperprolactinemia, however, in some patients persistent inhibition of prolactin concentration is observed for several months. In most women, ovulatory cycles persist for at least 6 months after discontinuation of Dostinex.

Dostinex restores ovulation and fertility in women with hyperprolactinemic hypogonadism. Since pregnancy can occur before menstruation is restored, it is recommended that pregnancy tests be performed at least once every 4 weeks during the amenorrhea period, and after menstruation is restored – every time there is a delay in menstruation for more than 3 days. Women who want to avoid pregnancy should use barrier methods of contraception during treatment with Dostinex, as well as after discontinuation of the drug before repeating anovulation. Women who have become pregnant should be supervised by a physician in order to identify the symptoms of an increase in the pituitary gland in a timely manner, since an increase in the size of existing pituitary tumors is possible during pregnancy.

Dostinex should be administered in lower doses to patients with severe hepatic insufficiency (Child-Pugh class C), who have been given prolonged therapy with the drug. With a single dose of 1 mg in these patients, an increase in AUC was observed compared with healthy volunteers and patients with less severe hepatic insufficiency.

The use of cabergoline causes drowsiness. In patients with Parkinson’s disease, the use of dopamine receptor agonists can cause sudden sleep. In such cases, it is recommended to reduce the dose of the drug Dostinex or discontinue therapy.

Studies on the use of the drug in elderly patients with disorders associated with hyperprolactinemia, was not conducted.

Use in Pediatrics

The safety and efficacy of the drug in children and adolescents under 16 years of age has not been established.

Influence on ability to drive motor transport and control mechanisms

Patients taking the drug Dostinex should refrain from driving vehicles and mechanisms and other potentially dangerous activities requiring concentration of attention and speed of psychomotor reactions.

Overdose

Symptoms (more likely, symptoms of dopamine receptor hyperstimulation): nausea, vomiting, dyspeptic symptoms, orthostatic hypotension, confusion, psychosis, hallucinations.

Treatment: should carry out activities aimed at removing the drug (gastric lavage) and to maintain blood pressure. The use of dopamine antagonists is recommended.

Drug interaction

Information about the interaction of cabergoline and other ergot alkaloids is absent, therefore the simultaneous use of these drugs during long-term therapy with Dostinex is not recommended.

Since cabergoline has a therapeutic effect by direct stimulation of dopamine receptors, the drug cannot be administered simultaneously with drugs acting as dopamine antagonists (including phenothiazines, butyrophenones, thioxanthenes, metoclopramide), because they can weaken the effect of cabergoline, aimed at reducing the concentration of prolactin.

Like other ergot derivatives, cabergoline cannot be used simultaneously with macrolide antibiotics (for example, with erythromycin), since this can lead to an increase in the system bioavailability of cabergoline.

Terms and conditions of storage
The drug should be stored out of reach of children at a temperature not exceeding 25 ° C. Shelf life – 2 years.

Pharmacy sales terms
The drug is available without a prescription.

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Active Ingredient: Anastrozole.

Arimidex is used for treating breast cancer in women who have been through menopause, including women with disease progression after tamoxifen therapy. ⇜

Other names for this medication:
Anastrol, Anastrozolo, Anastrozolum, Armidex.

Clinico-pharmacological group
Antitumor drug. Aromatase Inhibitor.

Pharmachologic effect
Highly selective nonsteroidal aromatase inhibitor. Aromatase is an enzyme with which in postmenopausal women, androstenedione in peripheral tissues is converted into estrone and then into estradiol. Reducing circulating estradiol has a therapeutic effect in patients with breast cancer. In postmenopausal medication in a daily dose of 1 mg causes a decrease in estradiol levels by 80%.

Arimidex does not possess progestogenic, androgenic and estrogenic activity.

Arimidex in a daily dose of up to 10 mg has no effect on the secretion of cortisol and aldosterone (therefore, the use of the drug does not require the replacement of corticosteroids).

Pharmacokinetics

Suction
After oral administration, anastrozole is rapidly absorbed from the gastrointestinal tract. Cmax in plasma is reached within 2 hours (on an empty stomach). Food somewhat reduces the rate, but not the degree of absorption. Small changes in the rate of absorption do not lead to a clinically significant effect on the Css of the drug in plasma with a daily intake of 1 tab. Arimidex.

Distribution
Anastrozole is associated with plasma proteins by 40%. Approximately 90-95% of Сss is achieved after 7 days of taking the drug. There is no information about the cumulation of the drug and the dependence of the pharmacokinetic parameters of anastrozole on time and dose.

Metabolism
Anastrozole is metabolized by N-dealkylation, hydroxylation and glucuronization. Triazole, the major metabolite detected in plasma, does not inhibit aromatase.

Removal
Anastrozole is displayed slowly, T1 / 2 – 40-50 h.

Anastrozole and its metabolites are excreted mainly with urine (less than 10% of the excreted dose – unchanged), within 72 hours after taking the drug.

Pharmacokinetics in special clinical situations

The determined clearance of anastrozole after oral administration in volunteers with stabilized liver cirrhosis or renal dysfunction does not differ from clearance determined in healthy volunteers.

Anastrozole pharmacokinetics does not depend on age in postmenopausal women.

Indications
☞adjuvant therapy for early hormone-positive breast cancer in postmenopausal women;

☞treatment of advanced breast cancer in postmenopausal women;

☞adjuvant therapy for early hormone-positive breast cancer in postmenopausal women after tamoxifen therapy for 2–3 years.

Contraindications

☞renal failure severe (creatinine clearance less than 20 ml / min);

☞moderate and severe liver failure (safety and efficacy not established);

☞concomitant therapy with tamoxifen;

☞children’s age (safety and efficacy not established);

☞pregnancy;

☞lactation (breastfeeding);

☞Hypersensitivity to anastrozole and other components of the drug.

The drug is not prescribed to women in premenopausal women.

Dosage
Adults, including elderly patients, the drug is prescribed 1 mg orally 1 time / day, long-term. If there is evidence of disease progression, the drug should be discontinued. As adjuvant therapy, the recommended duration of treatment is 5 years.

Patients with mild and moderately severe renal impairment do not require dose adjustment.

Patients with mild hepatic impairment do not require dose adjustment.

The tablet should be swallowed whole and washed down with water. It is recommended to take the drug at the same time of day.

Side effects
👣 Determination of the frequency of adverse reactions: very often (> 10%); often (1-10%); rarely (0.1-1%); very rarely (<0.1%).

👣 Since the cardiovascular system: very often – tides.

👣 From the musculoskeletal system: often – arthralgia.

👣 Reproductive system: often – vaginal dryness; rarely, vaginal bleeding (mainly during the first weeks after the cancellation or change of previous hormonal therapy with Arimidex).

👣 On the part of the digestive system: often – nausea, diarrhea; rarely – anorexia, vomiting, increased activity of GGT and alkaline phosphatase.

👣 On the part of the nervous system: often – headache, carpal tunnel syndrome (mainly observed in patients with risk factors for this disease); rarely – drowsiness.

👣 Metabolism: rarely – hypercholesterolemia. The drug may cause a decrease in bone mineral density due to a decrease in circulating estradiol, thereby increasing the risk of osteoporosis and bone fractures.

👣 Dermatological reactions: often – thinning hair, skin rash; very rarely – erythema multiforme (Stevens-Johnson syndrome).

👣 Allergic reactions: very rarely – angioedema, urticaria, anaphylactic shock.

👣 Other: often – asthenia.

Overdose
Single clinical cases of drug overdose are described. A single dose of Arimidex, at which life-threatening symptoms develop, has not been established.

Treatment: there is no specific antidote. If necessary, carry out symptomatic therapy: induction of vomiting (if the patient is conscious), general supportive therapy, monitoring the patient and monitoring the function of vital organs and systems. Dialysis is possible.

Drug interaction
Clinical studies on drug interactions with antipyrine and cimetidine indicate that co-administration of Arimidex with other drugs is unlikely to lead to a clinically significant interaction due to cytochrome P450.

There is no clinically significant drug interaction when taking Arimidex at the same time as other frequently prescribed drugs.

At the moment there is no information on the use of Arimidex in combination with other anticancer drugs.

Estrogen containing preparations should not be administered concurrently with Arimidex, since they reduce the pharmacological effect of the latter.

Tamoxifen should not be given at the same time as Arimidex, since it may weaken the pharmacological action of the latter.

Special instructions
In women with a receptor-negative estrogen tumor, the efficacy of Arimidex has not been demonstrated, unless there was a prior positive clinical response to tamoxifen.

In case of doubts about the hormonal status of the patient, the menopause must be confirmed by determining the sex hormones in the blood serum.

There are no data on the safety of Arimidex in patients with severe liver dysfunction or in patients with severe renal insufficiency (CC less than 20 ml / min).

In case of persistent uterine bleeding while receiving Arimidex, consultation and supervision of a gynecologist is necessary.

Drugs containing estrogen should not be administered simultaneously with Arimidex.

By lowering the level of circulating estradiol, Arimidex can cause a decrease in bone mineral density.

In patients with osteoporosis or with the risk of osteoporosis, bone mineral density should be assessed by means of densimetry (for example, DEXA scan) at the beginning of treatment and over time. If necessary, treatment or prevention of osteoporosis should be initiated under the close supervision of a physician.

There is no data on the simultaneous use of anastrozole and preparations of GnRH analogues.

It is not known whether anastrozole improves the results of treatment when used in combination with chemotherapy.

Safety data for long-term treatment with anastrozole has not yet been obtained.

With the use of Arimidex, ischemic diseases were observed more frequently than with tamoxifen therapy, but no statistical significance was noted.

The efficacy and safety of Arimidex and tamoxifen, when applied simultaneously, regardless of the status of hormone receptors, are comparable to those of tamoxifen alone. The exact mechanism of this phenomenon is not yet known.

Use in Pediatrics

Safety and efficacy of the drug in children have not been established.

Influence on ability to drive motor transport and control mechanisms

Some side effects of Arimidex, such as asthenia and drowsiness, may adversely affect the ability to perform work that requires increased concentration of attention and quickness of psychomotor reactions. In this regard, it is recommended that when these symptoms appear, caution should be exercised when driving a car or moving machinery.

Pregnancy and lactation
The drug is contraindicated for use during pregnancy and lactation (breastfeeding).

Use in childhood
The drug is contraindicated for use in children (safety and efficacy not established).

In case of impaired renal function
Patients with mild and moderately severe renal impairment do not require dose adjustment.

Contraindicated in severe renal failure (creatinine clearance less than 20 ml / min).

With abnormal liver function
Patients with mild hepatic impairment do not require dose adjustment.

Contraindicated in moderate or severe liver failure (safety and efficacy not established).

Pharmacy sales terms
The drug is available without a prescription.

Terms and conditions of storage
The drug should be stored out of reach of children at a temperature not exceeding 30 ° C. Shelf life – 5 years.

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Analogs of Fluoxetine.

Other names for this medication:
Actan, Adofen, Alental, Apo-fluoxetin,  Astrin,  Auscap,  Bioxetin,  Depreks,  Deproxin, Diesan, Equilibrane, Erocap, Eufor, Flotina, Floxet, Flucti-nerton, Fluctin, Fluctine, Fludac, Flufran, Fluneurin, Flunil, Fluox, Fluox-puren, Fluoxac, Fluoxeren, Fluoxeron, Fluoxetina, Fluoxetinum, Fluoxil, Fluoxin, Fluseren, Flutine, Fluxet, Fluxil, Fluxonil, Fondur, Fontex, Fysionorm, Ladose, Lovan, Margrilan, Motivone, Oxetine, Pragmaten, Prodep, Pronil, Prozac, Reneuron, Rowexetina, Seronil, Zactin.

Composition
Fluoxetine tablets contain 20 mg fluoxetine, as well as lactose monohydrate, gelatin, corn starch, calcium stearate, povidone, silicon (Si) colloidal dioxide, talc, magnesium (Mg) light carbonate, tropeoline 0, additive E171 (titanium (Ti ) dioxide), mineral oil, sugar, yellow wax.

Form of issue
Tablets covered with a film coating of yellow color in blisters for 10 pcs, 1 or 2 blisters in a package.

Pharmachologic effect
The drug has an anorexigenic effect, eliminates depression and relieves feelings of depression.

Pharmacodynamics and pharmacokinetics Fluoxetine – what is it?
The active substance of the preparation fluoxetine hydrochloride is a water-soluble crystalline powder of white (or almost white) color.

What is Fluoxetine?
Fluoxetine is a selectively inhibitory reverse neuronal seizure of serotonin (ONS) agent. The drug belongs to the pharmacotherapeutic group “Antidepressants”.

Pharmacodynamics
The medicine is intended for oral administration. The mechanism of its action is related to the ability to selectively (selectively) and reverse the ONZS.
Antidepressant Fluoxetine slightly affects the capture of dopamine and norepinephrine and weakly affects acetylcholine receptors and H1-type histamine receptors.
Along with antidepressant also has a stimulating effect. After taking the tablets / capsules, the patient’s fear, anxiety and mental tension decrease, the mood improves, the symptoms of dysphoria are eliminated.
Wikipedia notes that the remedy does not cause orthostatic hypotension, does not have a sedative effect, is not cardiotoxic.
To achieve a stable clinical effect with regular use of the drug takes from 3 to 4 weeks.

Pharmacokinetic parameters:
➡absorption in the alimentary canal – good;
➡bioavailability – 60% (with oral administration);
➡ТСмах – from 6 to 8 hours;
➡binding to plasma proteins (including alpha (α) -1-glycoprotein and albumin) – 94.5%;
➡T½ – 48-72 hours.
The liver is involved in the metabolism of the substance. As a result of its biotransformation, a number of unidentified metabolites are formed, as well as norfluoxetine, the selectivity and activity of which is equivalent to that of fluoxetine.

Pharmacologically inactive metabolic products are eliminated by the kidneys.
Due to the fact that the substance is removed from the body slowly enough, the plasma concentration necessary for maintaining the therapeutic effect persists for several weeks.

Indications for use: what are the prescribed tablets and fluoxetine?
Indications for use of fluoxetine:
➡depression (in particular, accompanied by fears), including with the inefficiency of other antidepressants;
➡obsessive-compulsive disorder (OCD);
➡kinoreksiya (to reduce uncontrolled craving for food, the remedy is used as part of complex psychotherapy).

Contraindications
The drug is not prescribed when:
➢known hypersensitivity to its active substance or any of the auxiliary ➢components;
➢epilepsy;
➢convulsive conditions in the anamnesis;
➢severe liver and / or kidney failure;
➢suicidal tendencies;
➢vatony of the bladder;
➢glaucoma;
➢prostate adenoma;
➢simultaneous application with MAO inhibitors .
After using MAO inhibitors, Fluoxetine can be used no earlier than 14 days; MAO inhibitors after the end of treatment with fluoxetine are prescribed no earlier than 5 weeks.

Side effects of fluoxetine
General disorders that occur during the use of the drug may manifest in the form of hyperhidrosis, chills, fever or cold sensation, photosensitivity, neuroleptic syndrome, alopecia, lymphadenopathy, anorexia, erythema multiforme, which can progress to malignant exudative or develop into Lyell’s syndrome.

Some patients have symptoms of serotonin intoxication, including:  ➳changes in mental status (delirium, euphoria, anxiety, agitation, hallucinations, mutism, confusion, manic syndrome, coma);
➳neuromuscular pathologies (akathisia, coordination disorders, bilateral Babinsky symptom, hyperreflexia, myoclonus, epileptiform seizures, nystagmus (horizontal and vertical), oculogic crises, paresthesia, opisthotonus, tremor, muscular rigidity);
➳vegetative dysfunction (hyperthermia, abdominal and headaches, diarrhea, dilated pupils, lacrimation, tachypnea, tachycardia, nausea, fluctuations in blood pressure, hyperhidrosis, chills).

From the digestive system of organs are possible: diarrhea, nausea, decreased appetite, vomiting, dysphagia, dyspepsia, taste change, pain in the esophagus, dry mouth, dyskinesia, liver dysfunction. In isolated cases, idiosyncratic hepatitis can develop.
CNS reactions to the taking of tablets are manifested in the form of: ➣bruxism, headache, weakness, sleep disorders (nighttime delirium, pathological dreams, insomnia), dizziness, fatigue (hypersomnia, drowsiness);                                                                                                                ➣violations of attention, processes and concentration of thinking, memory; anxiety and associated psychovegetative syndrome, dysphemia, panic attacks, suicidal thoughts and / or attempts to deprive oneself of life.
Reactions from the urogenital tract:                                                                  ➣dysuria, urine retention, polakii-and nocturia, protein and albuminuria, polyuria, oliguria, UTI, renal failure, cystitis, decreased libido (before its complete loss), erectile dysfunction, breast enlargement and soreness , disorders of ejaculation, anorgasmia, priapism, impotence, metro- and menorrhagia, painful menstruation.
The probability of development is not excluded:
➣immunopathological and allergic reactions;
➣myalgia, arthralgia, chondrodystrophy, bone pain, osteomyelitis, arthritis and a number of other side effects from the musculoskeletal system;
➣vasodilation;
➣postural hypotension;
➣tides;
➣palpitation;
➣metabolic disorders (including hyponatremia, hypocalcemia, hyper- or hypokalemia, vasopressin secretion disorder, diabetes mellitus, hypercholesterolemia, hyperuricemia, edema, diabetic acidosis, dehydration, hypothyroidism);
➣skin reactions (including polymorphic rash, acne, ulcerative lesions of the skin, gyrustism, psoriasis, furunculosis, exfoliative dermatitis, etc.).
Discontinuation of treatment with the drug can trigger a withdrawal syndrome, the main signs of which are: sensitivity disorders, dizziness, sleep disorders, asthenia, nausea and / or vomiting, agitation, headache, tremor.
Reviews of side effects suggest that the drug with uncontrolled admission is addictive. In some cases, the dependence is so strong that a person needs the help of a specialist to treat it.
Other adverse reactions that patients mention in the reviews are severe drowsiness, tremors, convulsions, decreased appetite, nausea. Nevertheless, there are people who had no adverse effects on the background of treatment at all.

Instructions for use of fluoxetine
Tablets are taken orally. The intake of food for assimilation of the drug is not affected.
For relief of depressive symptoms, the drug should be drunk 1 time per day, in the morning, at a dose of 20 mg. With clinical need, 3-4 weeks after the start of therapy, the frequency of receptions is increased to 2 r. / Day. (tablets are taken in the morning and in the evening).

Patients with an insufficient response to treatment at a dosage of 20 mg / day, in some cases, the daily dose is gradually increased to 60-80 mg. In this case, divide it into 3-4 receptions. The highest dose for people of elderly and senile age is 60 mg / day.
Dosage for bulimic neurosis – 60 mg / day. (tablets take 3 r./day on one), in ROC – depending on the severity of clinical symptoms – from 20 to 60 mg / day.
It should be taken into account that increasing the dose may increase the severity of side effects.
The maintenance dose is 20 mg / day.

When does the drug start to act?
Significant improvement in the condition is usually observed after about 2 weeks of systematic drug intake.

How long should I take fluoxetine?
The elimination of depressive symptoms goes away from six months.
In obsessive manic disorders (HMP), the drug is given to the patient for 10 weeks. Further recommendations depend on the results of treatment. If there is no clinical effect, the fluoxetine treatment regimen is revised.
If there is a positive dynamics, therapy is continued with the use of an individually selected minimum maintenance dose. Periodically, the patient’s need for further treatment should be reviewed.
Long-term – more than 24 weeks in patients with HMR and more than 3 months in patients with bulimia nervosa – has not been studied.

General recommendations
After the treatment with Fluoxetine is completed, the active substance circulates in the body for another 2 weeks, which should be taken into account when discontinuing treatment or prescribing other medicines.
Patients with liver / kidney failure, elderly people with concomitant diseases, as well as patients taking other medicines, are prescribed a half dose of the drug. In some cases, it is advisable to transfer the patient to an intermittent reception.
It is not recommended to abruptly stop therapy with fluoxetine. The drug is canceled, gradually reducing the dose for 1-2 weeks. This avoids the development of withdrawal syndrome.
If after the dose reduction / withdrawal the patient’s condition worsens, it is necessary to return to treatment with the previous effective therapeutic dose. Gradual reduction of the dose is resumed after the appearance of positive dynamics.
If we compare Fluoxetine and Fluoxetine Lannacher or Fluoxetine and Fluoxetine OZONE, we can conclude that the instructions for the use of Fluoxetine Lannacher and Fluoxetine OZON provide recommendations similar to those listed above.

Overdose
Overdosage Fluoxetine is accompanied by: nausea / vomiting, convulsions, hypomania, anxiety, agitation, large epileptic seizures.
A high dose of the drug in combination with codeine, maprotiline, temazepam can lead to death.
The person suffering from an overdose should be washed with a stomach, give sorbitol, enterosorbent and – with convulsions – diazepam. Also, monitoring of respiratory activity and parameters characterizing the functional state of the heart is important. In the future, symptomatic and supportive therapy is performed.
Peritoneal dialysis, blood transfusion, hemodialysis, forced diuresis are ineffective.

Interaction
Strengthens the effects of hypoglycemic drugs, ethanol, diazepam, alprazolam.
Twice increases the plasma concentration of tricyclic antidepressants, phenytoin, trazodone, maprotiline. When appointing fluoxetine in combination with tricyclic antidepressants, the dose of the latter should be reduced by 50%.
It can provoke an increase in the plasma concentration of Li +, which in turn increases the likelihood of developing its toxic effects. In case of simultaneous application, it is recommended to keep the concentration of Li + in the blood under control.
The use as an adjunct to electroconvulsive therapy can lead to the development of prolonged epileptic seizures.
Serotonergic effects of the drug are enhanced in combination with tryptophan. The likelihood of the development of serotonin intoxication is increased in the case of simultaneous administration with agents suppressing the enzyme MAO.
The likelihood of adverse reactions and increased oppressive effects on the central nervous system increases in combination with drugs that depress the central nervous system.
Admission with drugs that have a high degree of binding to proteins can trigger an increase in the plasma concentration of unbound (free) drugs, as well as an increase in the likelihood of unwanted effects.

Storage conditions
Tablets should be stored at a temperature below 25 ° C.

Shelf life
5 years.

Special instructions
In the treatment of patients with low body weight, anorexic effects should be considered when prescribing the drug.
In diabetics during treatment Fluoxetine may develop hypo-, and after discontinuation of the drug – hyperglycemia. In view of this, it is recommended to make changes in the dosage regimen of insulin and / or hypoglycemic agents for oral administration. Before the improvement of the clinical picture, patients with diabetes should be under constant medical supervision.
During treatment it is necessary to refrain from engaging in activities that require high speed of psychomotor reactions and increased attention.
The composition of the tablets includes lactose, so they should not be taken with galactosemia, lactase deficiency, the syndrome of impaired glucose / galactose absorption.
Like other antidepressants, fluoxetine can cause affective disorders (mania or hypomania).

The central organ of the metabolism of the drug is the liver, the excretion of metabolites is responsible for the kidneys. Patients with liver pathologies should be prescribed low or alternative daily doses.
With renal failure (with Clcr less than 10 ml / min.) After 2 months of treatment with a dose of 20 mg / day. the plasma concentration of fluoxetine / norflouxetine is the same as in patients with healthy kidneys.
Depression is associated with an increased risk of suicidal thoughts and attempts to kill oneself. The risk persists until complete remission.     Clinical experience of the drug shows that the risk of suicide increases, usually in the early stages of recovery.
Patients with mental illness and depressive syndrome should be under constant supervision. In placebo-controlled studies, the group receiving antidepressant patients found that the risk of suicidal behavior is highest in people under 25 years of age.
Special attention is also required by patients who have been transferred to a lower / higher dose.

The use of fluoxetine is associated with the development of akathisia, the subjective features of which are the constant need to be in motion, as well as the inability to sit or stand. These phenomena are especially pronounced in the first weeks of treatment. Patients who developed similar symptoms, the drug is prescribed in the minimum effective dose.
With a sudden discontinuation, approximately 60% of patients develop withdrawal symptoms. The likelihood of their appearance depends on the dose used, the duration of the course, and the level of dose reduction. The dose is recommended to be reduced by titration within 7-14 days.
There have been reports of subcutaneous hemorrhages, such as purpura or ecchymosis, occurring during the treatment period. Therefore, patients taking oral anticoagulants, affecting the function of platelets and increasing the likelihood of hemorrhages, as well as patients with bleeding history, Fluoxetine is prescribed taking into account possible risks.

Which is better: Prozac or Fluoxetine?
The active substance of the drug Prozac is fluoxetine. Therefore, when choosing in favor of this or that tool, the decisive factors are price and subjective sensations. The cost of fluoxetine is much lower than the cost of its analogue.

For children
Not applicable for treatment of patients younger than 18 years.
A nineteen-week clinical trial showed that in children suffering from depression, 8-18 years of age, Fluoxetine causes a decrease in body height and weight. The effect of the drug on achieving normal growth in adulthood has not been studied.
At the same time, the probability of growth retardation in the pubertal period can not be ruled out.

Fluoxetine and alcohol
Drinking alcohol during treatment with fluoxetine is contraindicated.

Fluoxetine for weight loss
Fluoxetine is often prescribed for a bulimic syndrome – a mental syndrome, which is accompanied by a lack of satiety and uncontrolled overeating.
The use of the drug can reduce appetite and relieve a constant feeling of hunger.
Thus, it can be concluded that fluoxetine can get rid of excess weight only if the reason for its collection is the appetite.
However, the drug is not intended for weight loss, its main purpose is the treatment of depression. Reducing appetite and losing weight are side effects.
The drug is quite powerful, and the body often responds to its reception with anaphylactic reactions and systemic disorders involving the pathological process of the lungs, skin, kidneys and liver.

How to take fluoxetine for weight loss?
At the initial stage, diet pills are taken in the minimum dosage – one once a day. With good tolerability, you can go to the reception of two tablets – one drink in the morning, the second – in the evening.
The maximum allowable dose is 4 tab. / Day.
The drug begins to act after 4-8 hours, removing fluoxetine from the body takes about a week.
Reviews on the forums confirm the effectiveness of the means – for 1-3 months people without much effort got rid of 5-13 kg. In this case, all patients taking Fluoxetine note that it is not worth while to drink it just for the sake of losing weight, like Fenibut or Fentropil, in the absence of evidence.

In pregnancy
The safety of the drug in pregnant women is poorly understood, the results of individual published epidemiological studies are contradictory. In some random and cohort studies, there was no increase in the likelihood of congenital developmental abnormalities.
ENTIS prospective study suggests an increase in the likelihood of developing congenital anomalies in the structure of large vessels or heart in children whose mothers took fluoxetine in the 1st trimester of pregnancy, compared with children whose mothers did not receive this medication.
It was not possible to establish a reliable relationship between the use of the drug in the early stages of pregnancy and the formation of malformations in the fetus. The specific group of CCC abnormalities was also not determined.
The use of SSRIs in the last weeks of pregnancy contributes to the development of complications in newborns, in particular, the prolongation of the duration of ventilation and probe nutrition and the duration of hospitalization.
There are mentions of the development of apnea, respiratory distress syndrome, seizures, hypoglycemia, lability of body temperature and blood pressure, tremor, hyperreflexia, vomiting, cyanosis, difficulties with adequate nutrition, constant crying, excitability, nervous irritability.
The listed pathological conditions can be a consequence of the syndrome of withdrawal of SSRIs or the manifestation of their toxic effects.

Reviews of fluoxetine
Feedback from the host fluoxetine (APO, Lannacher, Kanon) patients leave the impression of the efficacy of this remedy for depression, bulimic neuroses and OCD.
At forums also the possibility of application of a preparation for the control of appetite and correction of weight is quite often discussed.
Reviews of doctors about fluoxetine for weight loss are unequivocal: you can use a medicine to fight excess pounds only if the cause of weight gain is a mental disorder.
When excess weight is the result of depression caused by stress or overeating, the drug for 2-3 weeks can completely get rid of binge eating attacks and for the first month to remove up to 5 kg.
Reviews losing weight about Fluoxetine (Lannacher, OZONE, etc.) allow you to conclude that to reduce weight on this drug is not possible to all: someone has completely lost appetite (right up to aversion in food), someone has left it the former.
However, in most cases, the remedy has serious side effects: many people who took it noted a decrease in sexual desire and a deterioration in sexual life, a sense of inhibition, severe pain, drowsiness, increased aggression, the appearance of suicidal thoughts.
In addition, for many of the debilitated drugs, the need to stop driving and drinking alcohol, and the fact that fluoxetine is highly addictive.
Summarizing reviews, the following conclusions can be drawn: Fluoxetine is primarily a cure for depression and can only be taken if there is evidence and only under the supervision of a doctor.

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▶ Analogs of Clomid: Fertomid.

The Latin name of the substance: Clomiphenum(Clomipheni)

▶ Chemical name: 2- [4- (2-Chloro-1,2-diphenyl) phenoxy] -N, N-diethylethanamine (as citrate)

▶ Gross-formula: C26H28ClNO

▶ Therapeutic substance Clomiphene
Estrogens, progestins; antagonists, and their homologs

▶ The nosological classification (ICD-10)

  • E28.2 Syndrome of polycystic ovaries
  • N46 Male infertility
  • N91 lack of menstruation, scanty and rare menstruation
  • N93 Other abnormal bleeding from the uterus and vagina
  • N97 Female infertility
  • O92.6 galactorrhea

▶ Code CAS
911-45-5

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▶ Pharmacology
Mode of action – anti-estrogen.
It binds estrogen receptors in the hypothalamus and ovaries. If ingestion is well absorbed from the gastrointestinal tract. It is metabolized in the liver. Excreted in the bile, subjected to enterohepatic recirculation. Because the body is excreted in the faeces. T1 / 2 of 5-7 days. In small doses, it increases the secretion of gonadotropins (prolactin, FSH and LH) stimulates ovulation. At low levels of endogenous estrogens in the body has a mild estrogenic effect, at a high level – antiestrogen. By reducing the level of circulating estrogen, promotes the secretion of gonadotropins. In large doses slows secretion of gonadotropins. Progestogens, and androgen activity is not.

▶ Application of the substance Clomiphene
Anovulatory infertility (ovulation induction), dysfunctional uterine bleeding, amenorrhea (disgonadotropnaya form secondary, postkontratseptivnaya), galactorrhea (on the background of the pituitary tumor), polycystic ovaries (Stein syndrome – Leventhal), Chiari-Frommelya syndrome, androgen deficiency, oligospermia, for diagnosis violations of gonadotropic pituitary function.

▶ Contraindications
Hypersensitivity, severe liver and / or kidney failure, metrorrhagia of unknown etiology, ovarian cysts, pituitary tumor or failure, pregnancy (including suspected it).

Pregnancy and breast-feeding
Contraindicated during pregnancy.
Category effects on the fetus by FDA – X.

▶ Side effects of substance Clomiphene
From the nervous system and sensory organs: headache, dizziness, depression, fatigue, anxiety, insomnia, slowing of mental and motor responses, impaired vision.

From the digestive tract: nausea, vomiting, gastralgia, flatulence, diarrhea.

With the genitourinary system: cystic enlargement of the ovaries, dysmenorrhea, pollakiuria, polyuria, multiple pregnancy.

▶ Other: hot flashes, weight gain, pain in the abdomen, the chest, the testes (in men), hyperthermia, reversible hair loss, allergic skin reactions.

▶ Interaction
Compatible with drugs gonadotropins.

▶ Overdose
Symptoms: Nausea, vomiting, flushing, visual disturbances, pain in the abdomen.
▶ Treatment: symptomatic therapy.

▶ Dosing and Administration
Inside. To stimulate ovulation appoint 50 mg 1 time a day at bedtime, starting from 5th day of the menstrual cycle during 5 days (in the absence of the cycle – at any time); if there is no effect (ovulation does not occur within 30 days) increase the dose to 150 mg / day or lengthen the course to 10 days. Heading dose should not exceed 1 g of ovulation is determined by the presence of a biphasic basal body temperature, the average cyclical increase in production of LH, increase in serum progesterone during the luteal phase of the likely medium or menstruation women with amenorrhea. If ovulation has occurred and pregnancy has not occurred, it is necessary to repeat the course. If held after ovulation was no menstrual bleeding, you should take into account the possible pregnancy.

Men are not to treat oligospermia appoint 50 mg 1-2 times a day for 3-4 months (requires systematic monitoring spermiogram).

▶ Precautions substance Clomiphene
Before and during treatment must be continued monitoring gynecologist should check ovarian function, vaginal exercise study to observe the phenomenon of “pupil” and others. With an increase in ovarian cystic transformation or clomiphene treatment suspended until the normalization of the size of the ovaries. The therapy continues with minimal doses or shorten the period of treatment. The treatment is recommended to monitor liver function. You can not assign an exemption from work to persons whose professional activity requires quick physical and mental reactions.

▶ Doping Information
This drug is added to the list of banned doping agents. Detection time is 3-6 months, depending on the method of detection.

▶ Clomid (clomiphene) or Nolvadex (tamoxifen), which is better?
In this article we will try to resolve doubts about the choice between the two drugs, as well as find the differences: Clomid and Nolvadex.
Clomiphene citrate (available in pharmacies under the brand names Clomid, Clomid) and tamoxifen (brand name Nolvadex) is an antiestrogen trifeniletilenov belonging to the same group. They are structurally similar and are classified as selective estrogen receptor modulators with mixed agonistic and antagonistic properties. This means that in certain tissue, they block the action of estrogen receptors by binding, while in other tissues could act as a real estrogen receptors activating. In men, both drugs act as anti-estrogens in their ability to interfere with estrogen negative feedback on the hypothalamus and stimulate the increased production of GnRH (gonadotropin-releasing hormone). This will result in increased production of luteinizing hormone by the pituitary gland, which in turn can increase the production of testosterone by the testes. This makes both drugs, but for some reason bodybuilders continue to think that only good for Clomid testosterone stimulation.
Studies conducted in the late ’70s in the University of Ghent in Belgium make clear the advantages of Nolvadex over Clomid to increase testosterone levels. Researchers have looked at the effect of Nolvadex and Clomid endocrine system healthy men, as well as those who have suffered a small amount of spermatozoids (oligospermia). also found that Nolvadex when used for 10 days at a dosage of 20mg per day increased testosterone in the serum 142% of the initial level that was comparable with the effect of Clomid 150mg per day over the same period of time (an increase in testosterone levels were slightly but not significantly greater with Clomid). We must remember that this is the effect of three 50mg tablets of Clomid. At about the same price 50mg Clomid and 20mg Nolvadex we can already see a difference in relation to the price / benefit result in Nolvadex.

▶ Clomid (clomiphene) or Nolvadex (tamoxifen): differences
Clomid (Clomid) acts on the estrogen receptors in the pituitary and ovaries. By linking estrogen receptors in the pituitary gland, Clomid breaks a negative feedback mechanism, ie, if usually estrogen, acting on the pituitary gland, reduce the production of FSH and LH, when taking Clomid does not happen. Directly on blood levels of estrogen Clomid does not work.
Nolvadex (tamoxifen) also has no effect on estrogen levels, as its mechanism of action is also reduced to the estrogen receptor blockade, including the pituitary gland. However, Clomid is a more selective (selective) blocker and Nolvadex – less selective. If Clomid binds to estrogen receptors in the pituitary and preferably testes Nolvadex then contacting them almost in the entire organism. The exception is the bone where clomid and tamoxifen contrary to activate estrogen receptors.
Thus, Clomid acts as an estrogen antagonist and eliminates their inhibitory effect on the hypothalamus and pituitary gland, contributing to a more rapid recovery of their functions. Nolvadex blocks the receptors in almost all tissues and helps to ensure that the body began to rebuild its own testosterone. Importantly, Nolvadex capable of blocking estrogen receptors in the pituitary less than Clomid.
Clomiphene and tamoxifen did not affect the metabolism of estrogenic hormones, so the intake of estrogens these means continue to erode the liver enzymes, and do not accumulate in the body.

▶ Nolvadex has drawbacks: quite toxic (sometimes it manifests itself loss of appetite and nausea, increased risk of thrombosis). Tamoxifen increases the amount of progesterone receptors, so it can not be used, if the rate is based on progestin drugs (nandrolone, trenbolone). In this case, you should use clomiphene.

Dosages clomiphene citrate determined depending on the degree of severity of the course. The more drugs were involved than in high dosages, and how these drugs were stronger, the longer you will need time to recover, and the greater the amount of Clomid need.

▶ Overall, the scheme can be described as follows:
Very tough course – 3 * 150/12 * 100/15 * 50/15 * 25
Hard course – 15 * 100/15 * 50/15 * 25
The average rate – 30 * 50/15 * 25
Easy Course -15 * 50/15 * 25/15 * 25 (every 2 days)
Very easy course – 15 * 50/15 * 25
* Note – the first digit, the number of days, the second digit after the asterisk – dosage of clomiphene. For example, 15 * 50/15 * 25 means that the first 15 days is necessary to take 50 mg of Clomid, and then for the next 15 days – 25 mg.

▶ Reviews of Clomid in bodybuilding
Any negative reviews on the use of Clomid in bodybuilding absent. Not surprisingly, since the side effects of the drug are absent (at least, not observed). Clomiphene citrate helps athletes recover quickly and incurring minimal losses after a course of steroids.

▶ Question: What is Clomid?
Answer: This is a synthetic estrogen that is mostly prescribed by doctors to girls, to stimulate ovulation in women.
Question: Why do bodybuilders use it while Clomid?
Answer: As you know, all anabolic steroids lead to a reduction in endogenous secretion of testosterone by the body (yes, everything, even oxandrolone 20 mg for 4 weeks and your test with LH and FSH greatly reduced). After discontinuation of AAS endogenous testosterone at zero, and hormonal therapy is finished. It enters the body in the catabolic process. In turn, Clomid is used during this period to quickly lower stimulate FSH and LH and testosterone levels to raise usual. This will reduce the catabolism of the period for your body.

▶ As a therapeutic drug Clomid for infertility have started to apply to the United States in the early 70s. Today it is already known around the world and is produced by pharmaceutical companies under the names Clomid, serofen, sepafar, omifin, pergotaym, gonafen, duinum, klostil, AYou and klostilbegit.

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