Deca durabolin 100mg

Deca durabolin

Product Description
Deca durabolin (Organon):
Generic Name:
nandrolone decanoate

Deca durabolin is the Organon brand name for nandrolone decanoate. World wide Deca is one of the most popular injectable steroids. It's popularity is likely due to the fact that Deca exhibits significant anabolic effects with minimal androgenic side effects.

Considered by many the best overall steroid for a man to use (side effects vs. results) Deca durabolin is most commonly injected once per week at a dosage of 200-400mg. With this amount, estrogen conversion is slight so gyno is no problem. Also uncommon are problems with liver enzymes, blood pressure or cholesterol levels. At higher dosages, side effects may become increasingly more frequent, but this is still a very well tolerated drug. It should also be noted that in HIV studies, Deca has been shown not only to be effective at safely bringing up the lean bodyweight of patient but also to be beneficial to the immune system.

For bodybuilding, Deca durabolin can effectively be incorporated in both mass and cutting cycles it stacks good with sustanon, dianabol, anadrol... One major drawback to Deca is that it can be detected in a drug screen for as long as a year after use. Unfortunately for many competitive athletes, this makes Deca and other nandrolone products off limits. Deca is also a comparatively expensive anabolic. Black market, 200mg of Deca will cost upwards of $20 in most instances. Deca produces very few side effects.

It is easy on the liver and promotes good size and strength gains while reducing body fat. Deca can be used by almost all athletes, with positive results and very few side effects, deca has gained a reputation as being somewhat of an alleviator of sore joints and tendons. Athletes report that sore shoulders, knees and/or elbows are somehow without pain on the Deca cycle.
This drug dramatically improves nitrogen retention and recuperation time between workouts.

Effective Dose: 250 - 1500 mg/week

Considered by many the best overall steroid for a man to use (side effects vs. results) Deca durabolin is most commonly injected once per week at a dosage of 200-400mg. With this amount, estrogen conversion is slight so gyno is no problem. Also uncommon are problems with liver enzymes, blood pressure or cholesterol levels. At higher dosages, side effects may become increasingly more frequent, but this is still a very well tolerated drug. It should also be noted that in HIV studies, Deca has been shown not only to be effective at safely bringing up the lean bodyweight of patient but also to be beneficial to the immune system.

For bodybuilding, Deca durabolin can effectively be incorporated in both mass and cutting cycles it stacks good with sustanon, dianabol, anadrol... One major drawback to Deca is that it can be detected in a drug screen for as long as a year after use. Unfortunately for many competitive athletes, this makes Deca and other nandrolone products off limits. Deca is also a comparatively expensive anabolic. Black market, 200mg of Deca will cost upwards of $20 in most instances. Deca produces very few side effects.

It is easy on the liver and promotes good size and strength gains while reducing body fat. Deca can be used by almost all athletes, with positive results and very few side effects, deca has gained a reputation as being somewhat of an alleviator of sore joints and tendons. Athletes report that sore shoulders, knees and/or elbows are somehow without pain on the Deca cycle. This drug dramatically improves nitrogen retention and recuperation time between workouts.

Effective Dose: 250 - 1500 mg/week

Deca Durabolin®
Description:

by Bill Roberts - This drug is unique (so far as I know) in that 5 a -reductase, the enzyme which converts testosterone to the more-potent DHT, actually converts nandrolone to a less-potent compound. Therefore this AAS is somewhat deactivated in the skin, scalp, and prostate, and these tissues experience an effectively-lower androgen level than the rest of the body. Therefore, for the same amount of activity as another drug at the androgen receptors (ARs) in muscle tissue, Deca gives less activity in the scalp, skin, and prostate. Thus, it is the best choice for those particularly concerned with these things.

Its effectiveness at the androgen receptor of muscle tissue is superior to that of testosterone: it binds better. Yet, it gives only about half the muscle-building results per milligram. This I think is a result of its being less effective or entirely ineffective in non-AR-mediated mechanisms for muscle growth.

It also appears less effective or entirely ineffective in activity on nerve cells, certainly on the nerve cells responsible for erectile function. Use of Deca as the sole AAS often results in complete inability to perform sexually.

These problems can be solved by combining with a drug that does supply the missing activity: e.g. testosterone .

Nandrolone is proven to be a progestin. This fact is of clear importance in bodybuilding, because while moderate Deca-only use actually lowers estrogen levels as a consequence of reducing natural testosterone levels and thus allowing the aromatase enzyme less substrate to work with, Deca nonetheless can cause gyno in some individuals. Furthermore, just as progesterone will to a point increase sex drive in women, and then often decrease it as levels get too high, high levels of progestogenic steroids can kill sex drive in male bodybuilders, though there is a great deal of individual variability as to what is too much.

Incidentally, this progestogenic activity also inhibits LH production, and contrary to common belief, even small amounts of Deca are quite inhibitory, approximately as much so as the same amount of testosterone.

To some extent, nandrolone aromatizes to estrogen, and it does not appear that this can be entirely blocked by use of aromatase inhibitors – indeed, aromatase may not be involved at all in this process (there is no evidence in humans that such occurs) with the enzyme CYP 2C11 being in my opinion the more likely candidate for this activity. In any case, Cytadren , an aromatase inhibitor, has not been found effective in avoiding aromatization of nandrolone.

The drug is moderately effective at doses of 400 mg/week. The long half-life of nandrolone decanoate makes it unsuited to short alternating cycles, but suitable for more traditional cycles, with a built-in self-tapering effect in the weeks following the last injection.

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Apidra Solostar 100units/ml

Apidra Solostar

Product Description
What is Apidra?
Apidra (insulin glulisine) is a hormone that is produced in the body. It works by lowering levels of glucose (sugar) in the blood. It is a faster-acting form of insulin than regular human insulin.

Apidra is used to treat type 1 (insulin-dependent) diabetes in adults and children who are at least 4 years old. It is usually given together with another long-acting insulin.

Insulin glulisine is a rapid-acting insulin analogue that differs from human insulin in that the amino acid asparagine at position B3 is replaced by lysine and the lysine in position B29 is replaced by glutamic acid. It was developed by Sanofi-Aventis and sold under the trade name Apidra. When injected subcutaneously, it appears in the blood earlier than human insulin.When used as a meal time insulin, the dose is given within 15 minutes before a meal or within 20 minutes after starting a meal. Intravenous injections may also be used for extreme hyperglycemia, but must be performed under the supervision of a medical professional.

Important Safety Information for Apidra® (insulin glulisine [rDNA origin] injection):
Do not use Apidra® during a low blood sugar reaction (hypoglycemia) or if you are allergic to any of the ingredients in Apidra®.

You must test your blood sugar levels while using insulin, such as Apidra®. Do not make any changes to your dose or type of insulin without talking to your healthcare provider. Any change of insulin should be made cautiously and only under medical supervision. Apidra® must only be used if the solution is clear and colorless with no particles visible. Do not share needles, insulin pens or syringes with others.

Apidra®, when given by injection under the skin, should not be mixed with insulins other than NPH. Do not mix Apidra® with any insulin when used in the pump or for intravenous administration.

The most common side effect of insulin, including Apidra®, is low blood sugar (hypoglycemia), which may be serious. Some people may experience symptoms such as shaking, sweating, fast heartbeat, and blurred vision. Severe hypoglycemia may be serious and life threatening. It may cause harm to your heart or brain. Other possible side effects may include low blood potassium, injection site reactions, such as changes in fat tissue at the injection site, and allergic reactions, such as itching and rash. Less common, but potentially more serious or life-threatening, is generalized allergy to insulin, including anaphylactic reactions.

Tell your doctor about other medicines and supplements you are taking because they can change the way insulin works. Before starting Apidra®, tell your doctor about all your medical conditions including if you have liver or kidney problems, are pregnant or planning to become pregnant, or are breast-feeding or planning to breast-feed.

If the pump or infusion set does not work right, you may not receive the right amount of insulin. Hypoglycemia, hyperglycemia, or ketosis can happen. Problems should be identified and corrected as quickly as possible. Change the Apidra® in the pump reservoir every 48 hours.

Apidra® has not been studied in children with type 2 diabetes or in children younger than 4 years of age with type 1 diabetes. In a clinical study of children with type 1 diabetes, there was a higher rate of severe symptomatic hypoglycemia in the two treatment groups (Apidra® or insulin lispro) compared to adult trials with type 1 diabetes.

Apidra® SoloSTAR® is a disposable prefilled insulin pen. Please talk to your healthcare provider about proper injection technique and follow instructions in the Instruction Leaflet that accompanies the pen.

Indications and Usage for Apidra® (insulin glulisine [rDNA origin] injection):
Prescription Apidra® is a rapid-acting insulin for adults with type 2 diabetes or adults and children (4 years and older) with type 1 diabetes to improve blood sugar control. Apidra® given by subcutaneous injection is usually used with a longer-acting insulin. When used as a mealtime insulin, Apidra® should be given within 15 minutes before or within 20 minutes after starting a meal.

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Accent 15mg

Accent 15mg

Product Description
Product Details:
Accent (Sibutramine) 10mg by Macter Pharma x 1 Pack (14 Capsules)
Composition:
Each Capsule contains Sibutramine hydrochloride monohydrate 10 & 15mg
Sibutramine (usually in the form of the hydrochloride monohydrate salt) is an oral anorexiant. Until 2010 it was marketed and prescribed as an adjunct in the treatment of exogenous obesity along with diet and exercise.
Sibutramine was originally developed and marketed by Knoll Pharmaceuticals and was most recently manufactured and marketed by Abbott Laboratories before its withdrawal from the market. It was sold under a variety of brand names including Reductil, Meridia and Sibutrex.
Prescribing Information: Accent belongs to Sibutramine class which is a weight reducer. Sibutramine is a neurotransmitter reuptake inhibitor that inhibits the reuptake serotonin (by 73%), norepinephrine (by 54%). It helps enhance Satiety. Sibutramine is well absorbed from the GI-Tract (77%), Undergoes a first-pass metabolism reducing its bioavailability. It reaches its peak plasma level after 1 hour. Is metabolized by cytochrome-P450-isoenzyme resulting in 2 active primary and secondary amines (called active metabolites 1 and 2). Peak plasma concentrations of active metabolites 1 and 2 are reached after 3 to 4 hours. Accent is excreted 85% in urine and 15%faeces. Although predominantly inactive metabolites are excreted by the renal route, caution is recommended when treating patients with reduced renal function. Initial dosage is 10mg once daily. In patients with inadequate response to Accent (Sibutramine) at 10mg the dose may be increased to 15mg once daily.
Side effects:
A higher number of cardiovascular events has been observed in people taking sibutramine versus control (11.4% vs. 10.0%). In 2010 the FDA noted the concerns that sibutramine increases the risk of heart attacks and strokes in patients with a history of cardiovascular disease.
Frequently encountered side effects are: dry mouth, paradoxically increased appetite, nausea, strange taste in the mouth, upset stomach, constipation, trouble sleeping, dizziness, drowsiness, menstrual cramps/pain, headache, flushing, or joint/muscle pain.
Sibutramine can substantially increase blood pressure and pulse in some patients. Therefore regular monitoring needs to be performed.
The following side effects are infrequent but serious and require immediate medical attention: cardiac arrhythmias, paresthesia, mental/mood changes (e.g., excitement, restlessness, confusion, depression, rare thoughts of suicide).
Symptoms that require urgent medical attention are seizures, problems urinating, abnormal bruising or bleeding, melena, hematemesis, jaundice, fever and rigors, chest pain, hemiplegia, abnormal vision, dyspnea and edema.
Currently, no case of pulmonary hypertension has been noted, although related compounds (such as Fen-Phen) have shown this rare but clinically significant problem.

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Mogadon 5mg

Mogadon 5mg

Product Description
Nitrazepam:
Nitrazepam is a type of benzodiazepine drug and is marketed in English-speaking countries under the following brand names: Alodorm, Arem, Insoma, Mogadon, Nitrados, Nitrazadon, Ormodon, Paxadorm, Remnos, and Somnite.It is a hypnotic drug used in the treatment of moderate to severe insomnia which has sedative and motor impairing properties,as well as anxiolytic, amnestic, anticonvulsant, and skeletal muscle relaxant properties. Nitrazepam is available in 5 mg and 10 mg tablets. In the Netherlands, Australia, Israel, and the United Kingdom it is only available in 5 mg tablets. In Denmark it is available as 2.5 mg and 5 mg tablets under the name Pacisyn.

Tolerance to the sleep inducing effects of nitrazepam occurs after about seven days;tolerance also frequently occurs to the anticonvulsant effects of nitrazepam.A benzodiazepine dependence can develop with a benzodiazepine withdrawal syndrome occurring when the drug is stopped or the dose lowered.Common withdrawal symptoms include; anxiety, insomnia, concentration problems and fatigue.Long-term effects of benzodiazepines such as nitrazepam include worsening mental and physical health as well as cognitive deficits;immunological disturbancesand an increased risk of developing cancer has also been associated with long-term use.

Nitrazepam at doses of 5 mg or higher impairs driving skillsand nitrazepam, like other hypnotic drugs is associated with an increased risk of road traffic accidents.In the elderly nitrazepam is associated with an increased risk of falls and hip fractures due to impairments on body balance.The elimination half-life of nitrazepam is 40 hours in the elderly and 29 hours in younger adults.Nitrazepam is commonly taken in overdose by drug abusers or suicidal individuals, sometimes leading to death.Nitrazepam is teratogenic if taken in overdose during pregnancy with 30 percent of births showing congenital abnormalities.Nitrazepam is a popular drug of abuse in countries where it is available.

Nitrazepam is not recommended during pregnancy as it is associated with causing a neonatal withdrawal syndromeand is not generally recommended in alcohol- or drug-dependent individuals as well as people with comorbid psychiatric disorders.The Dutch, British and French system called the System of Objectified Judgement Analysis for assessing whether drugs should be included in drug formularies based on clinical efficacy, adverse effects, pharmacokinetic properties, toxicity and drug interactions was used to assess nitrazepam. A Dutch analysis using the system found that nitrazepam is unsuitable to be included in drug prescribing formularies.

Therapeutic uses:
Nitrazepam is used to treat short-term sleeping problems (insomnia),namely difficulty falling asleep, frequent awakening, early awakenings, or a combination of each.

Nitrazepam is sometimes used for refractory epilepsies. However, long term prophylactic treatment of epilepsy has considerable drawbacks. Most importantly the loss of antiepileptic effects due to tolerance which renders prolonged nitrazepam therapy ineffective. Nitrazepam also has the drawback of significant side effects such as sedation, which is why nitrazepam and benzodiazepines in general are only prescribed in the acute management of epilepsies.Nitrazepam has been found to be more effective than clonazepam in the treatment of West syndrome which is an age dependent epilepsy, affecting the very young. However, as with other epilepsies treated with benzodiazepines, long term therapy becomes ineffective with prolonged therapy and the side effects of hypotonia and drowsiness are troublesome with nitrazepam therapy, other antiepileptic agents are therefore recommended for long term therapy, possibly Corticotropin (ACTH) or vigabatrin.In uncontrolled studies nitrazepam has shown effectiveness in infantile spasms; nitrazepam is sometimes considered as a treatment option for this indication when other drugs fail to control infantile spasms.

Popularity:
Nitrazepam along with diazepam, oxazepam, and temazepam in 1993 represented 82% of the benzodiazepine market in Australia.The rate of benzodiazepine prescribing in Tasmania is higher than in other Australian states; Nitrazepam and flunitrazepam prescribing levels in Tasmania are disturbingly high.Prescribing of hypnotics in Norway is quite restrictive with only 4 hypnotics which are prescribable; nitrazepam, flunitrazepam, zolpidem and zopiclone.The usage of benzodiazepine hypnotics in local authority homes for the elderly 1982 in Edinburgh, established via a clinical survey, was that 34% of residents were taking sleeping medication. However, the number varied between the homes, with some homes reporting only 2.3% of residents to be on hypnotic medication and others up to 56.5% on hypnotic drugs. Nitrazepam was the most frequently prescribed hypnotic medication accounting for a third of hypnotic use in Edinburgh residential homes in 1982.

Side effects:
Common side effects:
Central nervous system depression including, somnolence, dizziness, depressed mood, rage, violence, fatigue, ataxia, headache, vertigo, impairment of memory, impairment of motor functions, hangover feeling in the morning, slurred speech, decreased physical performance, numbed emotions, reduced alertness, muscle weakness, double vision and inattention have been reported. Unpleasant dreams and rebound insomnia have also been reported. High levels of confusion, clumsiness also occurs after administration of nitrazepam.Increased reaction time, co-ordination problems and impaired learning and memory.

Impaired learning and memory occurs due to the action of the drug on benzodiazepine receptors which causes a dysfunction in the cholinergic neuronal system.Nitrazepam causes a reduced output of serotonin which is closely involved in regulating mood and may be the cause of feelings of depression in users of nitrazepam or other benzodiazepines.

Nitrazepam is a long acting benzodiazepine with an elimination half-life of 15-38 (mean elimination half-life 26 hours).Residual "hangover" effects after nighttime administration of nitrazepam such as sleepiness, impaired psychomotor and cognitive functions may persist into the next day which may impair the ability of users to drive safely and increases the risk of falls and hip fractures.Significant impairment of visual perception and sedative effects persisting into the next day typically occurs with nitrazepam administration as was demonstrated in a human clinical trial assessing the effect of nitrazepam on peak saccade velocity.

Impairment of psychomotor function may especially occur after repeated administration, with the elderly being more vulnerable to this adverse effect. Overall accuracy of completing tasks is impaired after repeated administration of nitrazepam and is due to drug accumulation of nitrazepam. The elderly are more vulnerable to these side effects.

Less common side effects:
Hypotension,faintness, palpitation, rash or pruritus, gastrointestinal disturbances, changes in libido. Very infrequently, paradoxical reactions may occur,for example, excitement, stimulation, hallucinations, hyperactivity and insomnia. Also depressed or increased dreaming, disorientation, severe sedation, retrograde amnesia, headache, hypothermia, delirium tremens.Acroparaesthesia has been reported as a side effect from nitrazepam with symptoms including, pins and needles in hands and loss of power of fingers and clumsiness of the fingers.Severe liver toxicity has also been reported.

Tolerance dependence and withdrawal Tolerance:
Tolerance to a drug's effects occurs after regular exposure to a drug. The mechanism of nitrazepam tolerance may be due to down-regulation of benzodiazepine receptors (observed in rats).When tolerance and habituation occurs to nitrazepam its pharmacokinetic profile changes with absorption of the drug slowing down, elimination increasing and brain concentration of nitrazepam increasing significantly.Increased levels of GABA in cerebral tissue and alterations in the activity state of the serotoninergic system occurs as a result of nitrazepam tolerance.

After six days of use, tolerance to nitrazepam's but not temazepam's sleep-inducing effects and performance-impairing effects occurred in a study. One study demonstrated tolerance to the sleep promoting effects of nitrazepam and temazepam after seven days nightly administration in 19 elderly inpatients. Self reported quality of sleep was found to be increased after the first nights administration of either nitrazepam or temazepam but by day seven self reported quality of sleep was found to have returned to baseline in these patients, suggesting the development of tolerance after seven days use. The effect was more pronounced in patients of lower intelligence.In mice tolerance to the anticonvulsant properties of nitrazepam developed profoundly and rapidly over six days, and then did not proceed. Some anticonvulsant effects were still apparent after six days administration.In humans tolerance to the anticonvulsant effects of nitrazepam is a frequent occurrence.

Dependence and withdrawal:
See also: benzodiazepine withdrawal syndrome
Benzodiazepine drugs such as nitrazepam can cause dependence and addiction and is what is known as the benzodiazepine withdrawal syndrome. Withdrawal from nitrazepam or other benzodiazepines often leads to withdrawal symptoms which are similar to those seen with alcohol and barbiturates, including delirium tremens.The higher the dose and the longer the drug is taken the greater the risk of experiencing unpleasant withdrawal symptoms. Withdrawal symptoms can however occur at standard dosages and also after short term treatment. Benzodiazepine treatment should be discontinued as soon as possible via a slow and gradual dose reduction regime.Common withdrawal symptoms include, anxiety, insomnia, concentration problems and fatigue.

Frequent use of nitrazepam may cause dependence and when the drug is reduced or stopped, withdrawal symptoms occur. Withdrawal symptoms including a worsening of insomnia compared to baseline typically occurs after discontinuation of nitrazepam even after short term single nightly dose therapy.Dependence on benzodiazepines such as nitrazepam or temazepam often occurs due to discharging patients from hospital on benzodiazepines who were started on benzodiazepine hypnotics in hospital. It is recommended that hypnotic use in hospital be limited to five days to avoid the development of drug dependence and withdrawal insomnia.

After discontinuation of nitrazepam a rebound effect may occur about four days after stopping medication.Nitrazepam has more side effects than other hypnotic drugs and tolerance to sedative properties and rebound insomnia after discontinuation occurs after only seven days administration. Tolerance to the anticonvulsant and anxiolytic effects also develops rapidly during daily administration.

Abrupt withdrawal after long term use from therapeutic doses of nitrazepam may result in a severe benzodiazepine withdrawal syndrome. Reports in the medical literature report of two psychotic states developing after abrupt withdrawal from nitrazepam including delirium after abrupt withdrawal of 10 mg of nitrazepam and in another case auditory hallucinations and visual cognitive disorder developed after abrupt withdrawal from 5 mg of nitrazepam and 0.5 mg of triazolam. Gradual and careful reduction of the dosage was recommended to prevent severe withdrawal syndromes from developing. Antipsychotics increase the severity of benzodiazepine withdrawal effects with an increase in the intensity and severity of convulsions. Depersonalisation has also been reported as a benzodiazepine withdrawal effect from nitrazepam.

Special precautions:
Benzodiazepines require special precaution if used in the alcohol or drug dependent individuals and individuals with comorbid psychiatric disorders.It has been recommended that caution should be exercised in prescribing nitrazepam to anyone who is of working age due to the significant impairment of psychomotor skills; This impairment is greater the higher the dosage that is prescribed.Nitrazepam in doses of 5 mg or more causes significant deterioration in vigilance performance combined with increased feelings of sleepiness.Doses as low as 5 mg of nitrazepam can impair driving skills. Therefore people driving or conducting activities which require vigilance should exercise caution in using nitrazepam or possibly avoid it all together.

Elderly:
Nitrazepam, similar to other benzodiazepines and nonbenzodiazepines causes impairments in body balance and standing steadiness in individuals who wake up at night or the next morning. Falls and hip fractures are frequently reported. The combination with alcohol increases these impairments. Partial, but incomplete tolerance develops to these impairments.Nitrazepam has been found to be dangerous in elderly patients due to a significant increased risk of falls.This increased risk is probably due to the persisting drug effects of nitrazepam well into the next day.Nitrazepam is a particularly unsuitable hypnotic for the elderly as it induces a disability characterised by general mental deterioration, inability to walk, incontinence, dysarthric, confusion, prone to stumbling, falls, and disoriention which can occur from doses as low as 5 mg. The nitrazepam induced symptomatology can lead to a misdiagnosis of brain disease in the elderly, for example dementia and can also lead to the symptoms of postural hypotension which may also get misdiagnosed. It was reported that a geriatric unit was seeing as many as 7 patients a month with nitrazepam induced disabilities and health problems. It was recommended that nitrazepam should join the barbiturates in not being prescribed to the elderly.Only nitrazepam and lorazepam were found to increase the risk of falls and fractures in the elderly.CNS depression occurs much more frequently in the elderly and is especially common in doses above 5 mg of nitrazepam.Both young and old patients report sleeping better after three nights use of nitrazepam however they also report feeling less awake and are slower on psychomotor testing up to 36 hours after intake of nitrazepam. The elderly showed cognitive deficits, making significantly more mistakes in psychomotor testing than younger patients despite similar plasma levels of the drug, suggesting that the elderly are more sensitive to nitrazepam due to increased sensitivity of the aging brain to nitrazepam. Confusion and disorientation can result from chronic nitrazepam administration to elderly subjects. Also the effects of a single dose of nitrazepam may last up to 60 hours after administration.

Children:
Nitrazepam is not recommended for use in those under eighteen years of age. Use in very young children may be especially dangerous. Children treated with nitrazepam for epilepsies may develop tolerance within months of continued use, with dose escalation often occurring with prolonged use. Sleepiness, deterioration in motor skills and ataxia were common side effects in children with tuberous sclerosis treated with nitrazepam. The side effects of nitrazepam may impair the development of motor and cognitive skills in children treated with nitrazepam. Withdrawal of nitrazepam only occasionally resulted in a return of seizures and some children withdrawn from nitrazepam appeared to improve. Development, for example, able to walk at five years was impaired in many children taking nitrazepam but was not impaired with several other non benzodiazepine antiepileptic agents. It has been recommended that children being treated with nitrazepam should be reviewed and have their nitrazepam gradually discontinued whenever appropriate. Excess sedation, hypersalivation, swallowing difficulty, high incidence of aspiration pneumonia as well as several deaths has been associated with nitrazepam therapy in children.

Pregnancy:
The use of nitrazepam during pregnancy can lead to intoxication of the new born. A neonatal withdrawal syndrome can also occur if nitrazepam or other benzodiazepines are used during pregnancy with symptoms such as hyper-excitability, tremor and gastro-intestinal upset (diarrhea or vomiting) occurring. Breast feeding by mothers using nitrazepam is not recommended.Nitrazepam is a long acting benzodiazepine and there is a risk of drug accumulation, even though no active metabolites are formed during metabolism. Accumulation can occur in various body organs including the heart, accumulation is even greater in babies. Nitrazepam rapidly crosses the placenta and also is present in breast milk in high quantities. Therefore benzodiazepines including nitrazepam should be avoided during pregnancy.In early pregnancy nitrazepam levels are lower in the baby than in the mother and in the later stages of pregnancy nitrazepam is found in equal levels in both the mother and the unborn child.Internationally benzodiazepines are known to cause harm when used during pregnancy and nitrazepam is a category D drug during pregnancy.

Benzodiazepines are lipophilic and rapidly penetrate membranes and therefore rapidly penetrate the placenta with significant uptake of the drug. Use of benzodiazepines such as nitrazepam in late pregnancy especially high doses may result in floppy infant syndrome.Use in the third trimester stage of pregnancy may result in the development of a severe benzodiazepine withdrawal syndrome in the neonate. Withdrawal symptoms from benzodiazepines in the neonate may include hypotonia, and reluctance to suck, to apnoeic spells, cyanosis, and impaired metabolic responses to cold stress. These symptoms may persist for hours or months after birth.

Other precautions:
Caution in hypotension.

Caution in those suffering from hypotension, nitrazepam may worsen hypotension.

Caution in hypothyroidism.

Caution should be exercised by people who have hypothyroidism as this condition may cause a long delay in the metabolism of nitrazepam leading to significant drug accumulation.

Contraindications:
Nitrazepam should be avoided in patients with chronic obstructive pulmonary disease (COPD), especially during acute exacerbations of COPD, because serious respiratory depression may occur in patients who are receiving hypnotics.

As with other hypnotic drugs nitrazepam is associated with an increased risk of road traffic accidents.Nitrazepam is recommended to be avoided in patients who drive or operate machinery. A study assessing driving skills of sedative hypnotic users found that users of nitrazepam were found to be significantly impaired up to 17 hours after dosing, whereas users of temazepam did not show significant impairments of driving ability. These results reflect the long acting nature of nitrazepam.

Toxicity Humans:
The Journal of Clinical Sleep Medicine published a paper which had carried out a systematic review of the medical literature concerning insomnia medications and raised concerns about benzodiazepine receptor agonist drugs, the benzodiazepines and the Z-drugs that are used as hypnotics in humans. The review found that almost all trials of sleep disorders and drugs are sponsored by the pharmaceutical industry. It was found that the odds ratio for finding results favorable to industry in industry-sponsored trials was 3.6 times higher than non-industry-sponsored studies and that 24% of authors did not disclose being funded by the drug companies in their published paper when they were funded by the drug companies. The paper found that there is little research into hypnotics that is independent from the drug manufacturers. Also of concern was the lack of focus in industry sponsored trials on their own results showing that use of hypnotics is correlated with depression. The author was concerned that there is no discussion of adverse effects of benzodiazepine agonist hypnotics discussed in the medical literature such as significant increased levels of infection, cancers and increased mortality in trials of hypnotic drugs and an overemphasis on the positive effects. No hypnotic manufacturer has yet tried to refute the epidemiology data that shows that use of their product is correlated with excess mortality. The author stated that "major hypnotic trials is needed to more carefully study potential adverse effects of hypnotics such as daytime impairment, infection, cancer, and death and the resultant balance of benefits and risks." The author concluded that more independent research into daytime impairment, infection, cancer, and shortening of lives of sedative hypnotic users is needed to find the true balance of benefits and risks of benzodiazepine agonist hypnotic drugs in the treatment of insomnia.Chronic use of benzodiazepines seemed to cause significant immunological disorders in a study of selected outpatients attending a psychopharmacology department.

Cancer:
Benzodiazepine usage for more than one to six months at prescribed doses is associated with an increased risk of the development of ovarian cancer.There have been fifteen epidemiologic studies which have shown that hypnotic drug use is associated with increased mortality, mainly due to increased cancer deaths in humans. The cancers included cancer of the brain, lung, bowel, breast, and bladder, and other neoplasms. Not only are benzodiazepines associated with an increased risk of cancer, the benzodiazepine receptor agonist Z-drugs also are associated with cancer in humans in these studies. Initially U.S. Food and Drug Administration (FDA) reviewers did not want to approve the Z-drugs due to concerns of cancer but ultimately changed their mind and approved the drugs despite the concerns. The data shows that trial subjects receiving hypnotic drugs had an increased the risk of developing cancer. The review author concluded saying; "the likelihood of cancer causation is sufficiently strong now that physicians and patients should be warned that hypnotics possibly place patients at higher risk for cancer".

Mortality:
Nitrazepam therapy compared with other drug therapies increases risk of death when used for intractable epilepsy in an analysis of 302 patients. The risk of death from nitrazepam therapy may be greater in younger patients (children below 3.4 years in the study) with intractable epilepsy. In older children (above 3.4 years) the tendency appears to be reversed in this study.Nitrazepam may cause sudden death in children. Nitrazepam therapy can cause swallowing incoordination, high-peaked esophageal peristalsis, bronchospasm, delayed cricopharyngeal relaxation and severe respiratory distress necessitating ventilatory support in children. Nitrazepam may promote the development of parasympathetic overactivity or vagotonia leading to potentially fatal respiratory distress in children.

Liver:
Nitrazepam has been associated with severe hepatic disorders, similar to other nitrobenzodiazepines. Nitrobenzodiazepines such as nitrazepam, nimetazepam, flunitrazepam, and clonazepam are more toxic to the liver than other benzodiazepines as they are metabolically activated by CYP3A4 which can result in cytotoxicity. This activation can lead to the generation of free radicals, oxidation of thiol as well as covalent binding with endogenous macromolecules; this results then in oxidation of cellular components or inhibition of normal cellular function. Metabolism of a non-toxic drug to reactive metabolites is has been connected with causing a variety of adverse reactions.

Long-term effects:
Long-term effects of benzodiazepine drugs such as nitrazepam include worsening mental and physical health as well as cognitive deficits. These adverse effects show improvement after a period of abstinence.

Interactions:
Nitrazepam interacts with the antibiotic erythromycin which is a strong inhibitor of CYP3A4, which affects concentration peak time. This interaction is not to believed to be clinically important.However, anxiety, tremor and depression have been documented in a case report following administration of nitrazepam and triazolam. Following administration of erythromycin to the patient, repetitive hallucinations and abnormal bodily sensations developed. The patient had however acute pneumonia and renal failure. Co-administration of benzodiazepine drugs at therapeutic doses with erythromycin may cause serious psychotic symptoms especially in those with other significant physical complications.Oral contraceptive pills, reduce the clearance of nitrazepam which may lead to increased plasma levels of nitrazepam and accumulation.Rifampin increases the clearance of nitrazepam significantly and probenecid decreases the clearance of nitrazepam significantly.Cimetidine slows down the elimination rate of nitrazepam leading to more prolonged effects of nitrazepam and increased risk of accumulation.Alcohol (ethanol) in combination with nitrazepam may cause a synergistic enhancement of the hypotensive properties of both benzodiazepines and alcohol.Benzodiazepines including nitrazepam may inhibit the glucuronidation of morphine leading to increased levels of and prolongation of the effects of morphine in rat experiments.

Pharmacology:
Nitrazepam is a nitrobenzodiazepine.It is a 1,4 benzodiazepine, with the chemical name 1,3-Dihydro-7-nitro-5-phenyl-2H-1,4- benzodiazepin-2-one.

It is long acting, is lipophilic and is metabolised hepatically via oxidative pathways. It acts on benzodiazepine receptors in the brain which are associated with the GABA receptors, causing an enhanced binding of GABA (gamma-aminobutyric acid) to GABAA receptors.GABA is a major inhibitory neurotransmitter in the brain, involved in inducing sleepiness, muscular relaxation and control of anxiety and seizures, and slows down the central nervous system. The mechanism of action of nitrazepam is the same as other benzodiazepine drugs and zopiclone.[93] The anticonvulsant properties of nitrazepam and other benzodiazepines may be in part or entirely due to binding to voltage-dependent sodium channels rather than benzodiazepine receptors. Sustained repetitive firing seems to be limited by benzodiazepines effect of slowing recovery of sodium channels from inactivation in mouse spinal cord cell cultures.The muscle relaxant properties of nitrazepam are produced via inhibition of polysynaptic pathways in the spinal cord of decerebrate cats.It is a full agonist of the benzodiazepine receptor.The endogenous opioid system may play a role in some of the pharmacological properties of nitrazepam in rats.Nitrazepam causes a decrease in the cerebral contents of the amino acids glycine and alanine in the mouse brain. The decrease may be due to activation of benzodiazepine receptors.At high doses decreases in histamine turnover occur as a result of nitrazepam's action at the benzodiazepine-GABA receptor complex in mouse brain.Nitrazepam has demonstrated cortisol suppressing properties in man.Nitrazepam is an agonist for both central benzodiazepine receptors, and to the peripheral type benzodiazepine receptors found in rat neuroblastoma cells.

EEG and sleep:
In sleep laboratory studies, nitrazepam decreased sleep onset latency. In psychogeriatric in-patients nitrazepam was found to be no more effective than placebo tablets in increasing total time spent asleep, was found to significantly impair trial subjects abilities to move and carry out everyday activities the next day and it was concluded that nitrazepam should not be used as a sleep aid in psychogeriatric in-patients.

Stage 2 NREM sleep is significantly increased by nitrazepam but SWS stage sleep is significantly decreased by nitrazepam.There is delay in the onset, and decrease in the duration of REM sleep. Following discontinuation of the drug, REM sleep rebound has been reported in some studies. Nitrazepam is reported to significantly affect stages of sleep; a decrease stage 1, 3, and 4 sleep and to increase stage 2.In young volunteers the pharmacological properties of nitrazepam was found to produce sedation, impaired psychomotor performance and standing steadiness. EEG tests showed a decrease of alpha activity and increased the beta activity. These effects increased according to blood plasma levels of nitrazepam.Performance was significantly impaired 13 hours after dosing with nitrazepam as was decision-making skills. EEG tests show more drowsiness and light sleep 18 hours after nitrazepam intake more so than amylobarbitone. Fast activity was recorded via EEG 18 hours after nitrazepam dosing.An animal study demonstrated that nitrazepam induces a drowsy pattern of spontaneous EEG including high-voltage slow waves and spindle bursts increase in the cortex and amygdala, while the hippocampal theta rhythm is desynchronized. Also low-voltage fast waves occur particularly in the cortical EEG. The EEG arousal response to auditory stimulation and to electric stimulation of the mesencephalic reticular formation, posterior hypothalamus and centromedian thalamus is significantly suppressed. The photic driving response elicited by a flash light in the visual cortex is also suppressed by nitrazepam. Estazolam was found to be more potent however.Nitrazepam increases the slow wave light sleep (SWLS) in a dose-dependent manner whilst suppressing deep sleep stages. Less time is spent in stages 3 and 4 which are the deep sleep stages, when benzodiazepines such as nitrazepam are used. Benzodiazepines are therefore not good hypnotics in the treatment of insomnia. The suppression of deep sleep stages by benzodiazepines may be especially problematic to the elderly as they naturally spend less time in the deep sleep stage.

Pharmacokinetics:
Nitrazepam is largely bound to plasma proteins.Benzodiazepines such as nitrazepam are lipid soluble and have a high cerebral uptake.The time for nitrazepam to reach peak plasma concentrations following oral administration is about 2 hours (0.5 to 5 hours). The half-life of nitrazepam is 16.5 to 48.3 (mean 28.8) hours. Both low dose (5 mg) and high dose (10 mg) of nitrazepam significantly increases growth hormone levels in humans. Nitrazepam's half-life in the cerebrospinal fluid, 68 hours, indicates that nitrazepam is eliminated extremely slowly from the cerebrospinal fluid. Nitrazepam has a half-life of about 29 hours in young people and a much longer half-life in the elderly. In the elderly the half-life is about 40 hours.Concomitant food intake has no influence on the rate of absorption of nitrazepam nor on its bioavailability. Therefore nitrazepam can be taken with or without food.

Abuse potential:
Nitrazepam is a drug which is very frequently involved in drug intoxication.Nitrazepam was the most commonly detected benzodiazepine in urine samples in the UK in 1997 suggesting a high liking and preference amongst drug abusers. However, it has been superseded by temazepam, despite the fact that temazepam is much more highly regulated in the UK.Apart from nicotine and alcohol in Nepal in 1996 nitrazepam was a major drug of abuse among young adults as was codeine cough syrup, heroin, buprenorphine and cannabis.

Nitrazepam in animal studies has been shown to increase reward seeking which may suggest increased risk of addictive behavioural patterns in rats. A study found that nitrazepam caused significant euphoria as against placebos and was identified as an active drug by freshly detoxified experienced drug abusers of heroin and other drugs. Nitrazepam resembled diazepam (Valium), however, on certain parameters the effects produced by nitrazepam were more pronounced in these drug abusers. Nitrazepam was found to be an abusable drug and has similar abuse liability like diazepam, if not slightly higher in these drug abusers. Nitrazepam in drug abusers produces effects including feeling energetic, relaxed, drunken, talkative, pleasure and euphoria. In India up to 50-60% of heroin addicts abuse benzodiazepines and 20% of injecting substance misusers also inject benzodiazepines.

Treatment with nitrazepam should usually not exceed seven to ten consecutive days. Use for more than two to three consecutive weeks requires complete re-evaluation of the patient. Prescriptions for nitrazepam should be written for short-term use (seven to ten days) and it should not be prescribed in quantities exceeding a one month supply. Dependence can occur in as little as four weeks.

Benzodiazepines, including diazepam, nitrazepam, and flunitrazepam account for the largest volume of forged drug prescriptions in Sweden, a total of 52% of drug forgeries being for benzodiazepines, suggesting benzodiazepines are a major prescription drug class of abuse.In Bangladesh, benzodiazepines, including nitrazepam, are used in organised crime to commit drug facilitated crime such as robbery.

Nitrazepam and other benzodiazepines are detected frequently in cases of people suspected of driving under the influence of drugs in Sweden. Other benzodiazepines and zolpidem and zopiclone are also found in high numbers in suspected impaired drivers. Many drivers have blood levels far exceeding the therapeutic dose range suggesting a high degree of abuse potential for benzodiazepines and zolpidem and zopiclone.In Northern Ireland in cases where drugs were found in tests on impaired drivers, benzodiazepines were found to be present in 87% of cases.In Norway benzodiazepines are the most commonly detected illicit drug in suspected drugged drivers being detected in 38-57 percent of drivers.

Overdose:
Nitrazepam overdose may result in stereotypical symptoms of benzodiazepine overdose including intoxication, impaired balance and slurred speech. In cases of severe overdose this may progress to a comatose state with the possibility of death. The risk of nitrazepam overdose is increased significantly if nitrazepam is abused in conjunction with opioids, as was highlighted in a review of deaths of users of the opioid buprenorphine. Nitrobenzodiazepines such as nitrazepam can result in a severe neurological effects.Nitrazepam taken in overdose is associated with a high level of congenital abnormalities (30 percent of births). Most of the congentital abnormalities were mild deformities.

Severe nitrazepam overdose resulting in coma causes the central somatosensory conduction time (CCT) after median nerve stimulation to be prolonged and the N20 to be dispersed. Brain-stem auditory evoked potentials demonstrate delayed interpeak latencies (IPLs) I-III, III-V and I-V. Toxic overdoses therefore of nitrazepam cause prolonged CCT and IPLs. An alpha pattern coma can be a feature of nitrazepam overdose with alpha patterns being most prominent in the frontal and central regions of the brain.

Benzodiazepines were implicated in 39% of suicides by drug poisoning in Sweden, with nitrazepam and flunitrazepam accounting for 90% of benzodiazepine implicated suicides, in the elderly over a period of 2 decades. In three quarters of cases death was due to drowning, typically in the bath. Benzodiazepines were the predominant drug class in suicides in this review of Swedish death certificates. In 72% of the cases benzodiazepines were the only drug consumed. Benzodiazepines and in particular nitrazepam and flunitrazepam should therefore be prescribed with caution in the elderly.In a brain sample of a fatal nitrazepam poisoning high concentrations of nitrazepam and its metabolite were found in the brain of the deceased person.

In a retrospective study of deaths, when benzodiazepines were implicated in the deaths, the benzodiazepines nitrazepam and flunitrazepam were the most common benzodiazepines involved. Benzodiazepines were a factor in all deaths related to drug addiction in this study of causes of deaths. Nitrazepam and flunitrazepam were significantly more commonly implicated in suicide related deaths than natural deaths. In four of the cases benzodiazepines alone were the only cause of death.In Australia, nitrazepam and temazepam were the benzodiazepines most commonly detected in overdose drug related deaths. In a third of cases benzodiazepines were the sole cause of death.

Individuals with chronic illnesses are much more vulnerable to lethal overdose with nitrazepam, as fatal overdoses can occur at relatively low doses in these individuals.

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Arimidex 1mg

Arimidex 1mg

Product Description
Anastrozole (INN) (marketed under the trade name Arimidex by AstraZeneca) is an aromatase-inhibiting drug approved for treatment of breast cancer after surgery, as well as for metastasis in both pre and post-menopausal women. The severity of breast cancer is increased by estrogen, as sex hormones cause hyperplasia, and differentiation at estrogen receptor sites. Anastrozole works by inhibiting the synthesis of estrogen
Medical uses:
The ATAC (Arimidex, Tamoxifen, Alone or in Combination) trial was an international randomised controlled trial of 9366 women with localized breast cancer who received either anastrozole, tamoxifen, or both for five years, followed by five years of follow-up. After more than 5 years the group that received anastrozole had significantly better clinical results than the tamoxifen group. The trial suggested that anastrozole is the preferred medical therapy for postmenopausal women with localized breast cancer that is estrogen receptor (ER) positive. Another study found that the risk of recurrence was reduced 40%, which also included an increased risk of bone fractures, and that ER negative patients benefited from switching to anastrozole.

Mechanism of action:
Anastrozole binds reversibly to the aromatase enzyme through competitive inhibition, inhibits the conversion of androgens to estrogens in peripheral tissues (outside the CNS), and a few CNS sites in various regions within the brain.

Side effects:
Bone weakness has been associated with anastrozole. Women who switched to anastrozole after two years on tamoxifen reported twice as many fractures as those who continued to take tamoxifen (2.1% compared to 1%). Bisphosphonates are sometimes prescribed to prevent the osteoporosis induced by aromatase inhibitors. The level of circulating oestradiol is likely causal here and not the anastrozole itself, and so the dose will determine likelihood of osteoporosis (oestradiol inhibits osteoclasts, which resorb bone).

Usage in men:
Anastrozole has been tested for reducing estrogens, including estradiol, in men. Excess estradiol in men can cause benign prostatic hyperplasia, gynecomastia, and symptoms of hypogonadism. It can also contribute to increased risk of stroke, heart attack, chronic inflammation, prostate enlargement and prostate cancer. Some athletes and body builders use anastrozole as part of their steroid cycle to reduce and prevent symptoms of excess estrogen--gynecomastia, emotional lability and water retention. Study data suggests dosages of 0.5 mg to 1 mg a day reduce serum estradiol approx. 50% in men, which differs in postmenopausal women.

Usage in children;
Anastrozole may be used off-label in children with precocious puberty, or children with pubertal gynecomastia. Following the onset of puberty, the epiphyseal plate begins to close due to an increased amount of estrogen production escaping local metabolism and spreading to the circulatory system. It is shown to help slow this process, and increase adult height prediction in adolescent males treated with protein-based peptide hormones for the treatment of growth hormone deficiency

Chemical synthesis:
The synthesis begins with nucleophilic substitution of two benzylic bromides in α,α'-dibromomesitylene (prepared by radical bromination of mesitylene, not shown on the scheme) with cyanide by treatment with potassium cyanide under phase transfer conditions, affording the dinitrile. Exhaustive methylation with methyl iodide and sodium hydride leads to the replacement of the more acidic side chain hydrogen atoms by methyl groups. The treatment with bromine in the presence of benzoyl peroxide leads to the formation of the corresponding benzyl bromide. Reaction of that product with 1,2,4-triazole in the presence of a base completes the synthesis of the aromatase inhibitor.

Important information about Arimidex;
Do not use Arimidex if you are pregnant. It could harm the unborn baby.

You may need to take a pregnancy test before using Arimidex, to make sure you are not pregnant.

You should not use Arimidex if you are allergic to anastrozole, if you are breast-feeding a baby, or if you have not yet completed menopause. Arimidex is not for use in men or children.

Before using Arimidex, tell your doctor if you have heart disease, circulation problems, a history of stroke or blood clot, severe liver disease, high cholesterol, osteoporosis, or low bone mineral density.

Arimidex may not work as well if you take it together with tamoxifen or an estrogen medication (such as hormone replacement therapy, estrogen creams, or birth control pills, injections, implants, skin patches, and vaginal rings). Before you start taking this medicine, tell your doctor if you also take tamoxifen or estrogen.

You may need to keep taking Arimidex for up to 5 years. Follow your doctor's instructions.

Before taking Arimidex:
You should not use Arimidex if you are allergic to anastrozole, if you are breast-feeding a baby, or if you have not yet completed menopause. Arimidex is not for use in men or children.

To make sure you can safely take Arimidex, tell your doctor if you have any of these other conditions:

heart disease;

circulation problems;

a history of stroke or blood clot;

severe liver disease;

high cholesterol; or

osteoporosis or low bone mineral density.

Arimidex can decrease bone mineral density, which may increase your risk of developing osteoporosis. Your bone mineral density may need to be tested before and during treatment with this medicine.

FDA pregnancy category D. Do not use Arimidex if you are pregnant. It could harm the unborn baby. Use effective birth control, and tell your doctor if you become pregnant during treatment. It is not known whether anastrozole passes into breast milk or if it could harm a nursing baby. You should not breast-feed while you are using Arimidex.

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Stanozolol 5mg

Stanozolol 5mg

Product Description
What is stanozolol?
Stanozolol is a man-made steroid, similar to the a naturally occurring steroid testosterone.

Stanozolol is used in the treatment of hereditary angioedema, which causes episodes of swelling of the face, extremities, genitals, bowel wall, and throat. Stanozolol may decrease the frequency and severity of these attacks.

Stanozolol, commonly sold under the name Winstrol (oral) and Winstrol Depot (intramuscular), is a synthetic anabolic steroid derived from dihydrotestosterone.

Stanozolol has been used in both animal and human patients for a number of conditions. In humans, it has been demonstrated to be successful in treating anaemia and hereditary angioedema. Veterinarians may prescribe the drug to improve muscle growth, red blood cell production, increase bone density and stimulate the appetite of debilitated or weakened animals.

Stanozolol is one of the anabolic steroids commonly used as a performance enhancing drug and is banned from use in sports competition under the auspices of the International Association of Athletics Federations (IAAF) and many other sporting bodies. Additionally, stanozolol has been used in US horse racing.

Stanozolol is commonly used by athletes and bodybuilders alike to lose fat while retaining lean body mass. It is usually used in a "cutting cycle", to help preserve lean body mass while metabolizing adipose, although it has not been proven conclusively that it has any special fat-burning properties.[citation needed]

It is presented most commonly as a 50 mg/mL injection or a 5 mg tablet. However, recently 100 mg/mL versions have become available. A common dosage can be 10–25 mg/day orally and 25–50 mg daily injected, with optimal results usually seen at 50 mg/day. It is reduced to micrometer particles in aqueous suspension and does not have a typical elimination half-life. Authentic stanozolol can easily be seen, because it will separate in its container if left undisturbed for a number of hours (the micronized crystal will fall to the bottom, and the water suspension will rise to the top).

What is the most important information I should know about stanozolol?
In rare cases, serious and even fatal cases of liver problems have developed during treatment with stanozolol. Contact your doctor immediately if you experience abdominal pain, light colored stools, dark colored urine, unusual fatigue, nausea or vomiting, or yellowing of the skin or eyes. These may be early signs of liver problems.

Do not take stanozolol without first talking to your doctor if you have:
prostate cancer;

breast cancer; or

a high level of calcium in the blood (hypercalcemia).

Before taking stanozolol, talk to your doctor if you:
have heart or blood vessel disease;

have had a heart attack;

have a high level of cholesterol in the blood;

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Hynidate 10mg

Hynidate 10mg

Product Description
What is Hynidate:
Hynidate/Ritalin (methylphenidate) is a central nervous system stimulant. It affects chemicals in the brain and nerves that contribute to hyperactivity and impulse control.

Ritalin is used to treat attention deficit disorder (ADD) and attention deficit hyperactivity disorder (ADHD). Ritalin is also used in the treatment of a sleep disorder called narcolepsy (an uncontrollable desire to sleep). When given for attention deficit disorders, Ritalin should be an integral part of a total treatment program that may include counseling or other therapies.

Ritalin may also be used for purposes not listed in this medication guide.

Important information about Hynidate:
Do not use Ritalin if you have used an MAO inhibitor such as furazolidone (Furoxone), isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate) within the past 14 days. Serious, life-threatening side effects can occur if you use Ritalin before the MAO inhibitor has cleared from your body. Do not use this medication if you are allergic to Ritalin or if you have glaucoma, overactive thyroid, severe high blood pressure, tics or Tourette's syndrome, angina, heart failure, heart rhythm disorder, recent heart attack, a hereditary condition such as fructose intolerance, glucose-galactose malabsorption, or sucrase-isomaltase deficiency, or severe anxiety, tension, or agitation.

Ritalin may be habit-forming and should be used only by the person it was prescribed for. Never share Ritalin with another person, especially someone with a history of drug abuse or addiction. Keep the medication in a place where others cannot get to

Before taking Hynidate:
Do not take Ritalin if you have used an MAO inhibitor such as furazolidone (Furoxone), isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate) within the past 14 days. Serious, life-threatening side effects can occur if you use Ritalin before the MAO inhibitor has cleared from your body.

Do not use Ritalin if you are allergic to methylphenidate or if you have:

glaucoma;

overactive thyroid;

severe high blood pressure;

angina (chest pain), heart failure, heart rhythm disorder, or recent heart attack;

a personal or family history of tics (muscle twitches) or Tourette's syndrome;

severe anxiety, tension, or agitation (methylphenidate can make these symptoms worse); or

a hereditary condition such as fructose intolerance, glucose-galactose malabsorption, or sucrase-isomaltase insufficiency.

Some stimulants have caused sudden death in children and adolescents with serious heart problems or congenital heart defects. Tell your doctor if you have a congenital heart defect.

If you have any of these other conditions, your doctor may need to adjust the dose of Ritalin or order special tests:

a congenital heart defect;

a personal or family history of mental illness, psychotic disorder, bipolar illness, depression, or suicide attempt;

epilepsy or other seizure disorder; or

a history of drug or alcohol addiction.

FDA pregnancy category C. It is not known whether Ritalin will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medication. It is not known whether methylphenidate passes into breast milk or if it could harm a nursing baby. Do not use Ritalin without telling your doctor if you are breast-feeding a baby.

Long-term use of Ritalin can slow a child's growth. Tell your doctor if the child using this medication is not growing or gaining weight properly.

Do not give Ritalin to a child younger than 6 years old without the advice of a doctor.

How should I take Hynidate:
Take Ritalin exactly as prescribed by your doctor. Do not take in larger or smaller amounts or for longer than recommended. Follow the directions on your prescription label.

Take Ritalin tablets at least 30 to 45 minutes before a meal. The extended-release forms of Ritalin can be taken with or without food.

Do not crush, chew, or break an extended-release Ritalin tablet. Swallow it whole. Breaking the pill may cause too much of the drug to be released at one time.

You may open the Ritalin extended-release capsule and sprinkle the medicine into a spoonful of pudding or applesauce to make swallowing easier. Swallow right away without chewing. Do not save the mixture for later use. Discard the empty capsule.

To prevent sleep problems, take this medication early in the day, no later than 6:00 pm.

If you need to have any type of surgery, tell the surgeon ahead of time that you are using Ritalin. You may need to stop using the medicine the day of your surgery.

Store Ritalin at room temperature away from moisture and heat. Keep track of the amount of medicine used from each new bottle. Ritalin is a drug of abuse and you should be aware if anyone is using your medicine improperly or without a prescription.

What happens if I miss a dose?
Take the missed dose as soon as you remember. Skip the missed dose if it is later than 6:00 p.m. Do not take extra medicine to make up the missed dose.

What happens if I overdose?
Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An overdose of Ritalin can be fatal.

Overdose can cause vomiting, agitation, tremors, muscle twitching, seizure (convulsions), confusion, hallucinations, sweating, fast or pounding heartbeat, blurred vision, dry mouth and nose, and fainting.

Ritalin side effects:
Get emergency medical help if you have any of these signs of an allergic reaction to Ritalin: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop taking Ritalin and call your doctor at once if you have a serious side effect such as:

fast, pounding, or uneven heartbeats;

feeling like you might pass out;

fever, sore throat, and headache with a severe blistering, peeling, and red skin rash;

aggression, restlessness, hallucinations, unusual behavior, or motor tics (muscle twitches);

easy bruising, purple spots on your skin; or

dangerously high blood pressure (severe headache, blurred vision, buzzing in your ears, anxiety, confusion, chest pain, shortness of breath, uneven heartbeats, seizure).

Less serious Ritalin side effects may include:

stomach pain, nausea, vomiting, loss of appetite;

vision problems, dizziness, mild headache;

sweating, mild skin rash;

numbness, tingling, or cold feeling in your hands or feet;

nervous feeling, sleep problems (insomnia); or

weight loss.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect Hynidate:
Tell your doctor about all other medicines you use, especially:

a blood thinner such as warfarin (Coumadin);

clonidine (Catapres);

dobutamine (Dobutrex), epinephrine (EpiPen), or isoproterenol (Isuprel);

cold/allergy medicine that contains phenylephrine (a decongestant);

potassium citrate (Urocit-K, Twin-K), sodium acetate, sodium bicarbonate (Alka-Seltzer), citric acid and potassium citrate (Cytra-K, Poly-Citra), or sodium citrate and citric acid (Bicitra, Oracit);

medications to treat high or low blood pressure;

stimulant medications or diet pills;

seizure medicine such as phenytoin (Dilantin), phenobarbital (Luminal), primidone (Mysoline); or

an antidepressant such as amitriptyline (Elavil, Vanatrip), citalopram (Celexa), doxepin (Sinequan), fluoxetine (Prozac, Sarafem), nortriptyline (Pamelor) paroxetine (Paxil), sertraline (Zoloft), and others.

This list is not complete and other drugs may interact with Ritalin. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.

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