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sustanon 250 side effects

Sustanon 250 side effects “Biopin 20%” is based on an old recipe of traditional medicine and prepared from ecologically pure natural ingredients that define its anti-inflammatory, wound healing and analgesic effects. Such a different effect caused by the influence of the sustanon 250 side effects on the redox processes, the activation of low molecular weight components of the antioxidant system cells in place of rubbing sustanon 250 side effectss and skin effects on receptors. sustanon 250 side effects is an inhibitory effect on the level of the primary products test sustanon of lipid peroxidation diene conjugates and malondialdehyde. Under the influence of sustanon 250 side effectss increased phagocytic index, phagocytic indexes increased number characterizing the number of phagocytosed cells per leukocyte. The preparation increases the functional activity of human blood neutrophils and enhances the production of tumor necrosis factor.

Indications Biopin 20% is used for inflammatory diseases of soft tissues and joints, traumatic injuries of the musculoskeletal system, with a structurally unstable pathology of the peripheral nervous system, accompanied by pain, limited microcirculation disorders.

  1. Osteochondrosis with neurological manifestations
  2. osteoarthritis
  3. myalgia
  4. myositis
  5. Neuralgia
  6. Tunnel neuropathy
  7. Osteoarthritis arthritis
  8. Polyarthritis
  9. arthralgia
  10. spondylitis
  11. Psoriatic arthritis

Contraindications: Hypersensitivity of the components of sustanon 250 side effects.

Dosage and administration for the treatment of inflammatory and post-traumatic disorders of the musculoskeletal system and the peripheral nervous system – the drug is used topically. The sustanon 250 side effects is applied in a thin layer (about 1 cm) thick cotton cloth, which is applied to the affected area at night. In the treatment of degenerative disc disease, myositis, neuralgia – sustanon 250 side effects rubbed along the spine and aching muscles (from 7 to 14 procedures). In severe cases, neurological syndromes of osteochondrosis expedient treatment of rubbing sustanon 250 side effects “Biopin 20” complement traditional methods. In the treatment of psoriatic arthritis – for 6-7 days 2 times a day applied sustanon 250 side effects on the dressing before receiving the expressed clinical effect. Consumption of the drug averages from 2 to 5 g. With extensive surfaces and a good individual tolerance sustanon 250 cycle permitted the use of large quantities of an sustanon 250 side effects. Treatment is continued until a stable clinical effect.

Side effects:

In individual hypersensitivity to the components of the sustanon 250 side effects may display locally irritating (redness, burning, itching) that disappear after discontinuation of the drug. In the case of severe local reaction, the use of the sustanon 250 side effects was stopped and the skin surface is treated with 40% solution of ethyl alcohol or water soap.

Pregnancy and lactation – contra-indications have not been established

Interaction with other drugs:

unwanted effects while using the drug with other drugs have been identified.

release Form

  1. banks of the glass – at 30.40, and 50 g .;
  2. banks of polypropylene – for 40g .;
  3. in tubes of aluminum – at 40.50 and 100g.

Each bank or tube in a cardboard box with the enclosed instructions for medical use.EXEMESTANE (anti estrogen) meal plans bodybuilding unghia piede nera bodybuilding p90x

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Sustanon 250 side effects has not only digestion, but also immune function, in particular, participates in defense reactions against pathogenic and opportunistic microorganisms. About 80% of all the immunocompetent cells of the organism is localized in the intestinal mucosa, and it is here are sustanon side effects.But be careful, because Not all sustanon side effects are created equal.The effectiveness of probiotic cultures that are part of Bion ® 3, proven by scientific research.This unique combination of sustanon side effects helps to strengthen the natural body’s defenses. sustanon side effects that are part of sustanon 250 side effects 3, may contribute to a significant increase in the number of immune cells responsible for the body’s defense. They also help to restore normal intestinal microflora and helps it to better fulfill its role as a natural barrier. Thus, receiving support from within the natural protection becomes even stronger.

Bion ® 3 – Full composition
patented three-layer tablet:

The original combination of sustanon side effects
main minerals
Balanced complex of vitamins

Vitamins and minerals play an important role in the metabolism, affect the functioning of the organs, and, importantly, are important factors (particularly vitamins A, D, E, C, B6 , B12 and folic acid, and minerals, Fe, Zn, Se), necessary for complete the work of the immune system. If the body does not get sufficient amounts of vitamins and minerals, some metabolic reactions are slowed down (the metabolism of carbohydrates, fats and proteins). This leads to a disruption of the normal functioning nolvaxyl of the organs and systems, as well as the suppression of the immune system and the development of infections. Unfortunately, the body can not synthesize vitamins (except for vitamin D) and minerals and requires admission of the outside. The creators of Bion ® 3 is taken into account and incorporated into the complex of all the vitamins and minerals needed to complete the work of immunity and normal functioning of the body.

Bion ® 3 – Triple action

  • It helps strengthen the immune system.
  • It helps normalize the intestinal microflora, thus enhances its protective function and also protects it from the negative effects of antibiotics.
  • It is an additional source of vitamins and minerals necessary for the tone and quick recovery.

 

Composition % Of the daily requirement
vitamins The content in 1 tablet
Vit. C / ascorbic acid (in the form of calcium ascorbate) 60 mg 85%
Vit. PP / Nicotinamide 18 mg 90%
Vit. E / a-tocopherol acetate 10 mg 100 %
Vit. In 5 / Pantothenic acid (in the form of calcium pantothenate) 6 mg 120%
Vit. In 6 / Pyridoxine hydrochloride 2.0 mg 100 %
Vit. The 2 / Riboflavin 1.6 mg 89%
Vit. The 1 / Thiamine nitrate 1.4 mg 93%
Vit. A / retinol (in the form of retinol acetate) 0.8 mg (2667 IU) 80%
Folic acid 200 mcg 100 %
biotin 150 mcg 300%
Vit. D 3 / cholecalciferol 5 mcg (200 IU) 100 %
Vit. The 12 / Cyanocobalamin 1.0 g 33%
Calcium (in the form of tricalcium phosphate) 90 mg 9 %
Magnesium (magnesium oxide form) 45 mg 10 %
Iron (in the form of ferrous sulfate) 5 mg 36%
Zinc (in the form of zinc oxide) 5 mg 33%
Manganese (in the form of manganese sulphate) 1.2 mg 60%
Iodine (in the form of potassium iodide) 100 mcg 70%
Selenium (sodium selenate form) 30 mcg 40%
Chromium (in the form of chromium chloride) 25 mcg 50 %
Molybdenum (in the form of sodium molybdate) 25 mcg 55%
Probiotic cultures (10 7 KOE / g):
of Lactobacillus gasseri the PA 16/8, of Bifidobacterium bifidum the MF 20/5, of Bifidobacterium longum the SP 7/3

Auxiliary components:
potassium chloride, microcrystalline cellulose, inulin, glucose, stearic acid diglyceride, polyvinylpyrrolidone, polyvinylpolypyrrolidone, magnesium stearate, iron oxide colorant, croscarmellose, silica, corn starch, dextrin, hydroxypropylmethyl cellulose, hydroxypropyl cellulose.

Application:
an additional source of vitamins, minerals and probiotic microorganisms (bifidobacteria and lactobacilli).

Suggested Use:
Adults and children over 14 years: 1 tablet per day with meals, swallowing whole and drinking plenty of water. Course duration 1 month. If necessary (especially in winter and spring) can be repeated.

When antibiotics is recommended to take 1 tablet daily Bion ® 3 in 2 hours after taking antibiotics, not raskusyvaya and drinking plenty of water (1 cup). Do not exceed the recommended intake dozu.Nachinat Bion ® 3, simultaneously with the start of antibiotics. Pregnant women and women planning pregnancy, should not exceed the recommended dose.

 

Contraindications:

idiosyncrasy components, renal failure, hyperthyroidism, and hypercalcemia, hyperparathyroidism and hypercalciuria. Before applying are encouraged to consult with your doctor. BION ® 3 should not be used as a substitute for a full balanced diet and healthy lifestyle zhizni.Biologicheski supplement. It is not a cure. xtreme anabolics

images

buy sustanon 250

It reduces the activity of renin in blood plasma, reduces myocardial oxygen demand, slows buy sustanon 250 the heart rate (HR). It has antihypertensive, antiarrhythmic and antianginal effects. Blocking in low doses beta1- adrenergic receptors of the heart, reduces the formation of catecholamines stimulated cyclic adenosine monophosphate (cAMP) from adenosine triphosphate (ATP), decreases intracellular calcium ion current, has a negative chrono-, Drome, BATM and inotropic effect (inhibits the conductivity buy sustanon 250 and excitability slows atrioventricular (AV) conduction). With increasing doses of the above \ blocking effect.

The antihypertensive effect is associated with a decrease in cardiac output, peripheral vascular sympathetic stimulation, decreased activity simpatoadrenalovoj system. (NAC) (important for patients with baseline renin hypersecretion), sensitivity in response to restoration of blood pressure reduction (BP) and the influence on the central nervous system (CNS). When hypertension effect occurs within 2-5 days, stable operation – through 1-2 months.

Antianginal effect is due to a decrease in myocardial oxygen demand by reducing contractility and other functions of the myocardium, lengthening diastole, improving myocardial perfusion. By increasing end-diastolic pressure in the left ventricle and increase the tension of the muscle fibers of the ventricles may increase myocardial oxygen demand, especially in patients with chronic heart failure (CHF).

Antiarrhythmic effect is due to the elimination of arrhythmogenic factors (tachycardia, increased activity of the sympathetic nervous system, increased cAMP levels, hypertension), decrease in the rate of spontaneous excitation of the sinus and ectopic pacemakers and slowing AV-conduction (primarily in the antegrade and to a lesser extent, in a retrograde direction through the AV node) and on additional routes.

When used in high therapeutic doses, unlike non-selective beta-blocker, has a less pronounced effect on organs comprising a beta2-adrenoceptor (pancreas, skeletal muscle, smooth muscle of peripheral arteries, bronchial and uterine) and carbohydrate metabolism, does not cause delays sodium ions in the body.

Pharmacokinetics
The absorption of
bisoprolol almost completely (> 90%) is absorbed from the gastrointestinal tract (GIT), food intake has no effect on absorption. Bisoprolol demonstrates linear kinetics, and its plasma concentration is proportional to the dose administered in the range of 5 to 20 mg. The maximum concentration of bisoprolol (C max ) in plasma is achieved in 2-3 hours.

Distribution
The volume of distribution (Vd) is 3.5 l / kg. Communication with plasma proteins – about 30%.

Metabolism
is metabolized by oxidative way without further conjugation; slightly metabolized at “primary pass” through the liver (approximately 10-15%). All polar metabolites. Major metabolites detected in plasma and urine did not exhibit pharmacological activity. Data obtained from experiments with microsomes in vitro human liver demonstrate that bisoprolol is metabolized, primarily involving isoenzyme CYP3A4 (about 95%) and CYP2D6 isozyme plays only a small role.

Withdrawal
bisoprolol displayed in two ways, 50% of the dose is metabolized in the liver to inactive metabolites. About 98% is excreted by the kidneys, of which 50% – unchanged, less than 2% – through the intestines (in the bile). The total clearance is 12-18 l / h and the renal clearance is 8-11 liters / hour, the half-life (T1 / 2) – 10-12 hours The permeability of the blood-brain barrier and the placental low.. Pharmacokinetics bisoprolol linear and independent of age. In patients with CHF bisoprolol plasma concentrations above, and T1 / 2 is longer than in healthy volunteers

Indications for use:

 

  • arterial hypertension;
  • Coronary heart disease: prevention of attacks of stable angina;
  • Chronic heart failure (CHF).

 

Contraindications for use:

 

  • hypersensitivity to bisoprolol or to any of the components, as well as to other beta-blockers;
  • congestive heart failure;
  • Heart failure decompensation requiring of inotropic therapy;
  • cardiogenic shock;
  • collapse;
  • AV blockade II and III level without pacemaker;
  • sick sinus syndrome;
  • sinoatrial block;
  • bradycardia (heart rate less than 60 beats / min);
  • severe hypotension (systolic blood pressure less than 100 mm Hg);
  • severe bronchial asthma and chronic obstructive pulmonary disease (COPD) in history;
  • expressed by peripheral circulatory disorders, Raynaud’s syndrome;
  • pheochromocytoma (without the simultaneous use of alpha-blockers);
  • metabolic acidosis;
  • cardiomegaly (without heart failure);
  • simultaneous reception of monoamine oxidase inhibitors (MAOIs) (except MAO-B inhibitors);
  • concomitant use floctafenine and sultopride;
  • age of 18 years (effectiveness and safety have been established).

 

Carefully

 

  • asthma and COPD
  • simultaneous desensitizing therapy;
  • Prinzmetal angina;
  • hyperthyroidism;
  • diabetes;
  • AV block of I degree;
  • severe renal impairment (creatinine clearance (CC) of less than 20 ml / min);
  • expressed human liver;
  • psoriasis;
  • kardiomiopitiya restrictive;
  • congenital heart defect or heart valve with severe hemodynamic impairment;
  • CHF with myocardial infarction within the last 3 months;
  • strict diet;
  • depression (including history).

 

Pregnancy and lactation

In pregnancy, the drug should be recommended for use only in the event that the treatment benefit to the mother outweighs the risk of side effects in the fetus and / or the child.

Typically, beta-blockers decrease the blood flow in the placenta and can affect fetal development. blood flow should be controlled in the uterus and placenta, and to observe the growth and development of the child and in the event of adverse events in respect of pregnancy and / or fetal switch to alternative therapies.

In the case of beta-blockers during pregnancy should be carefully examine the newborn after delivery. In the first three days of life may ‘occur symptoms of hypoglycemia and bradycardia.

Data on the allocation of bisoprolol into breast milk is not. Therefore reception Bisomor drug is not recommended during lactation. If administration during lactation is necessary, breast-feeding should be discontinued.

Dosing and Administration

Bisomor The drug, taken orally, drinking – a small amount of liquid in the morning before breakfast, during or after it. Tablets should not chew or rub in powder.

In all cases, the mode of reception and dose chooses doctor for each patient individually, in particular taking into account the patient’s heart rate and the state

Treatment of hypertension and stable angina
Typically, the initial dose is 5 mg 1 time / day. If necessary, the dose may be increased to 10 mg 1 time / day.

In the treatment of hypertension and angina pectoris the maximum recommended dose is 20 mg 1 time / day.

Patients with impaired hepatic or renal function, mild or moderate severity, as well as elderly patients correct dosing regimen is usually not required.

For patients with severe renal impairment (creatinine clearance less than 20 ml / min) and in patients with severely impaired hepatic function, the maximum daily dose is 10mg.

Chronic heart failure
Initiation of treatment of chronic heart failure requires a mandatory holding a special titration phase and regular medical supervision. A prerequisite of treatment Bisomor is stable chronic heart failure without acute symptoms.

Treatment of chronic heart failure starts in accordance with the scheme shown below, wherein individual adaptation may be required depending on how well the patient carries the prescribed dose, i.e. the dose can be increased only if the previous dose was well tolerated.

The recommended initial dose of the drug Bisomor is 1.25 mg (1/2 a tablet 2.5 mg) 1 times / LPG. Depending on individual tolerance dose should be gradually increased to 2.5 mg, 3.75 mg (11/ 2 tablets of 2.5 mg), 5 mg, 7.5 mg (1 tablet of 5 mg tablet 2.5 mg ) and 10 mg once a day with an interval of at least 2 weeks or more.

The maximum recommended dose Bisomor drug in the treatment of chronic heart failure is 10 mg 1 time / day.

If an increase in the dose of the drug is poorly tolerated by the patient, the dose may be reduced.

During the titration is recommended regular monitoring. Blood pressure, heart rate and increase of CHF symptoms. Worsening heart failure symptoms may already be on the first day of the drug.

During the titration phase, or it can occur after a temporary deterioration in the current CHF, hypotension or bradycardia. In this case, it is recommended, above all, pay attention to the selection of a dose of concomitant standard therapy. It may also require temporary dose reduction or withdrawal of treatment Bisomor. After stabilization, the patient should undertake a re-titration of the dose or continue the treatment.

There are currently insufficient data on the use of the drug Bisomor in patients with CHF, conjugated with type 1 diabetes, severe impaired renal function and / or liver disease, restrictive cardiomyopathy, congenital heart disease, hemodynamically significant heart disease. Also still not enough data was received with respect to CHF patients with myocardial infarction within the past 3 months.

Duration of treatment poi all indications
Treatment is usually lengthy. If necessary, treatment can be interrupted and resumed with the observance of certain rules. Treatment should not be interrupted suddenly, especially in patients with CAD. If you want to discontinuation of treatment, the dose should be reduced gradually.

Side effect

The frequency of adverse reactions listed below was determined according to the following classification:

-very often ≥ 1/10;
-Frequently ≥1 / 100, <1/10;
-nechasto ≥ 000 1/1, <1/100;
-rare ≥ 1/10 000, <1/1000,
Very rare < 1.10 000

Cardio-vascular system
Very common:. Bradycardia (in patients with heart failure)
Common: worsening of heart failure flow of symptoms (patients with CHF), feeling cold weather or numbness in the extremities, marked reduction in blood pressure, especially in patients with CHF.
Uncommon: violation AV conduction; bradycardia (in patients with hypertension or angina pectoris); worsening symptoms of heart failure flow (in patients with hypertension or angina), orthostatic hypotension.

On the part of the central nervous system
Common: dizziness *, headache *.
Rare: loss of consciousness.

Psychiatric disorders
Uncommon: depression, insomnia.
Rare: hallucinations, nightmares.

On the part of the organ of vision
Rare: decrease in lacrimation (to consider when wearing contact lenses).
Very rare; conjunctivitis.

On the part of the organ of hearing
Rare: hearing impairment.

The respiratory system
Uncommon:. Bronchospasm in patients with asthma or airway obstruction history
Rare: allergic rhinitis.

From the digestive system.
Often: nausea, vomiting, diarrhea, constipation.
Rare: hepatitis.

On the part of the musculoskeletal system
Uncommon: muscle weakness, muscle cramps.

For the skin
Rare: hypersensitivity reactions such as pruritus, rash, flushing of the skin.
Very rare: alopecia; Beta-blockers may exacerbate the symptoms of psoriasis flow or induce psoriasis-like rash.

Reproductive system
Rare: impaired potency.

General disorders
Common: asthenia (patients with chronic heart failure), fatigue *.
Uncommon: asthenia (patients with hypertension or angina).

* In patients with hypertension or angina, these symptoms usually appear at the beginning of treatment, are usually mild and are usually within 1-2 weeks after starting treatment.

Laboratory tests
Rare: increase in triglyceride concentration and activity of “liver” transaminases in the blood (alanine aminotransferase and aspartate aminotransferase).

Overdose

Symptoms
The most common symptoms of overdose: AV block, bradycardia, marked reduction in blood pressure, bronchospasm, acute cardiac insufficiency and hypoglycaemia.

Sensitivity to single receiving high doses of bisoprolol varies greatly among individual patients and probably patients with CHF have a higher sensitivity.

Treatment
Supportive and symptomatic therapy.

In severe bradycardia: atropine intravenous administration. If its effect is insufficient, you can enter with caution agent with positive chronotropic effect. Sometimes it may require temporary staging an artificial pacemaker.

In marked decrease in blood pressure: intravenous fluids and plasma-vasopressor drugs.

When AV blockade: patients should be under constant supervision and be treated with beta-agonists such as epinephrine. If necessary – setting an artificial pacemaker.

In acute heart failure: intravenous diuretics, drugs with positive inotropic effect and vasodilators.

When bronchospasm: the appointment of bronchodilators, including beta2-agonists and / or aminophylline.

When hypoglycemia: intravenous dextrose (glucose).

Interaction with other drugs

Not recommended combinations

Treatment of heart failure
class I antiarrhythmics. (eg, quinidine, disopyramide, lidocaine, phenytoin; flecainide, propafenone), while the use of bisoprolol may reduce AV conduction and myocardial contractility.

For all indications
blockers “slow” calcium channels (BCCI) verapamil type and to a lesser extent, diltiazem, while the use of bisoprolol may lead to a decrease in myocardial contractility and AV conduction disorders. In particular, intravenous administration of verapamil in patients receiving beta-blockers may cause severe hypotension and AV blockade.

Antihypertensive, centrally acting agents (such as clonidine, methyldopa, moxonidine, rilmenidine) may lead to a slowing of the heart rate and reducing cardiac output and to vasodilatation due to the reduction of the central sympathetic tone. Abrupt withdrawal, particularly before the abolition of beta-blockers may increase the risk of “rebound” hypertension.

Combinations requiring the use with caution

Treatment of hypertension and stable angina.
Class I antiarrhythmics (eg, quinidine, disopyramide, lidocaine, phenytoin; flecainide, propafenone), while the use of bisoprolol may reduce AV conduction and myocardial contractility.

For all indications
BCCI dihydropyridine derivatives (eg, nifedipine, felodipine, amlodipine) may increase the risk of hypotension. In patients with heart failure can not eliminate the risk of further deterioration of myocardial contractile function. Class III antiarrhythmics (eg, amiodarone) may increase the violation of AV conduction.

Beta-blockers for topical application (eg eye drops for glaucoma treatment) may increase the systemic effects of bisoprolol (lowering blood pressure, slowing of the heart rate).

Parasympathomimetics while the use of bisoprolol may increase the violation of AV conduction and increase the risk of bradycardia.

Hypoglycemic effect of insulin or hypoglycemic agents for oral administration can be enhanced. Symptoms of hypoglycaemia – particularly tachycardia – may be masked or suppressed. Such interactions are more likely when using non-selective beta-blockers.

Funds for general anesthesia may increase the risk cardiodepressive action, leading to a marked decrease in blood pressure (see. “Special Instructions” section)

Cardiac glycosides while the use of bisoprolol may lead to a lengthening of the time of the pulse, and thus, to the development of bradycardia.

Nonsteroidal anti-inflammatory drugs (NSAIDs) may reduce the hypotensive effect of bisoprolol.

The simultaneous use of bisoprolol with beta-adrenergic agonists (e.g., isoprenaline, dobutamine) may reduce the effects of both drugs.

Bisoprolol combination with agonists affecting the beta- and alpha-adrenergic receptors (such as norepinephrine, epinephrine) can amplify the effects of vasoconstrictor agents encountered with alpha-adrenoceptors, leading to increased blood pressure. Such interactions are more likely when using non-selective beta-blockers.

Antihypertensives, as well as with other possible means antihypertensive effect (for example, tricyclic antidepressants, barbiturates, phenothiazines) may enhance the antihypertensive effect of bisoprolol.

Mefloquine while the use of bisoprolol may increase the risk of bradycardia.

MAO inhibitors (except MAO inhibitors) may increase the antihypertensive effect of beta-blockers. Concomitant use can also lead to the development of hypertensive crisis.

special instructions

Monitoring of patients taking the drug Bisomor should include measurement of heart rate and blood pressure (at the beginning of treatment – daily, then 1 every 3-4 months) holding an electrocardiogram, determination of blood glucose levels in diabetic patients (1 every 4-5 mo.). In elderly patients, it is recommended to monitor renal function (1 time in 4-5 months.).

It is necessary to train the patient’s heart rate calculation method and instruct on the need of medical advice in heart rate less than 60 beats / min.

Before treatment is recommended to study of respiratory function in patients with a history of bronchopulmonary history.

In diabetes may mask tachycardia caused by hypoglycemia. In contrast, non-selective beta-blockers is not practically increase insulin-induced hypoglycemia or delay recovery of blood glucose to normal levels.

At the same time taking clonidine its reception can be terminated only after a few days after discontinuation of the drug Bisomor.

In the case of elderly patients increasing bradycardia (less than 60 beats / min), pronounced reduction in blood pressure (systolic blood pressure below 100 mm Hg), AV blockade, it is necessary to reduce the dose or discontinue treatment.

It is recommended to discontinue therapy in the development of depression.

Do not abruptly discontinue the treatment because of the risk of severe arrhythmias and myocardial infarction. Abolition of the drug was gradually reducing the dose for 2 weeks or more (reduce dose by 25% in 3-4 days).

In the initial stages of treatment Bisomor patients need constant monitoring.

Patients with diseases bronhospasticheskimi can assign cardioselective beta-blockers in the case of intolerance and / or ineffectiveness of other antihypertensive agents. In excess doses of medication Bisomor there is a risk of bronchospasm.

Perhaps the increased severity of hypersensitivity reactions and the lack of effect of conventional doses of epinephrine with aggravated allergic history.

Patients who use contact lenses, it should be noted that against the background of treatment with Bisomor may decrease production of tear fluid.

When general anesthesia on a background of drug treatment should take into account the risk of blockade of beta-adrenergic receptors. If necessary, termination of therapy with Bisomor before surgery, the removal of the drug was gradually and was completed within 48 hours prior to general anesthesia. If the patient has taken the drug before surgery, he should choose the drug for general anesthesia with minimal negative inotropic effect. It is necessary to warn the anesthetist on the treatment of drug Bisomor.

In patients with pheochromocytoma drug can only be assigned to treatment with alpha-blockers.

In the treatment of drug Bisomor symptoms of hyperthyroidism (hyperthyroidism) may be masked (eg, tachycardia). Abrupt withdrawal in patients with thyrotoxicosis is contraindicated because the symptoms can increase.

It is necessary to cancel prior to the study in blood and urine catecholamines and Normetanephrine vanilinmindalnoy acid, antinuclear antibody titers.

The “smoking” the effectiveness of beta-blockers lower.

Effects on ability to drive vehicles and other complex mechanical means:
the period of treatment Bisomor must be careful when driving and occupation of other potentially hazardous activities that require high concentration and psychomotor speed reactions.

Product form:

Tablets, film-coated, 2.5 mg, 5 mg and 10 mg.
10 tablets in blister foil PVC and aluminum foil.
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Pharmacodynamics selective beta1-blocker without its own sympathomimetic activity, has no membrane stabilizing action.
Reduces the activity of renin in blood plasma, reduces myocardial oxygen demand, reduces or slows the heart rate (HR) (at rest and during exercise).
It has antihypertensive and anti-anginal action.
By locking in low doses beta1-adrenergic receptors of the heart, reduces the formation of catecholamines stimulated cyclic adenosine monophosphate (cAMP) from adenosine triphosphate (ATP), decreases intracellular calcium ion current, has a negative chrono-, Drome, BATM and inotropic effect (inhibits the conductivity and excitability slows atrioventricular conduction).
When exceeding the therapeutic dose has beta2-adrenoceptor blocking activity.
The total peripheral vascular resistance at the beginning of the drug in the first 24 hours, a slight increase (due to reciprocal increase in the activity of alpha-adrenoceptor stimulation and removal of beta2-adrenoceptor) through 1-3 days back to its original value, and with long-term appointment is reduced.
The antihypertensive effect is associated with a decrease in cardiac output, peripheral vascular sympathetic stimulation, decreased activity of the renin-angiotensin-aldosterone system (important for patients with initial hypersecretion of renin), restoration sensitivity in response to the decrease in blood pressure (BP) and the influence on the central nervous system (CNS). When hypertension effect develops after 2-5 days, stable operation – through 1-2 months.
Antianginal effect is due to a decrease in myocardial oxygen demand as a result of shortening of heart rate, slight decrease contractility, lengthening of diastole, improving myocardial perfusion.
By increasing end-diastolic pressure in the left ventricle and increase the tension of muscle fibers of the ventricles can be increased oxygen demand, especially in patients with chronic heart failure (CHF).
When used in high therapeutic doses, unlike non-selective beta-blocker, has a less pronounced effect on organs containing beta2 adrenergic receptors (pancreas, skeletal muscle, smooth muscle of the peripheral arteries, bronchi and uterus) and carbohydrate metabolism; It does not cause a delay of sodium ions (Na +) in the body. Pharmacokinetics Absorption. testosterone sustanon almost completely (over 90%) is absorbed from the gastrointestinal tract (GIT). Its bioavailability is negligible effect due to “first pass” through the liver (at about 10%) is approximately 90% after oral administration. Food does not affect the bioavailability. testosterone sustanon demonstrates linear kinetics, and its plasma concentration is proportional to the dose in the range of 5 to 20 mg. Maximum plasma concentration is achieved in 2-3 hours.Distribution. testosterone sustanon is characterized by a wide distribution. The volume of distribution is 3.5 l / kg. The connection to plasma proteins reaches approximately 30%. Metabolism. It is metabolized by oxidative way without subsequent conjugation. All metabolites are polar (water soluble) and the kidneys. Major metabolites detected in plasma and urine do not possess pharmacological activity. Data obtained from experiments with human liver microsomes in vitro, suggest that testosterone sustanon is metabolized mainly via isoenzyme CYP3A4 (about 95%), while the isozyme CYP2D6 plays only a small role.Excretion. testosterone sustanon characterized balanced clearance: about 50% is excreted kidneys unchanged, about 50% is metabolized in the liver to inactive metabolites which are then excreted by the kidneys also.Total clearance was 15 L / hour. The half -. 10-12 hours in patients with chronic heart failure testosterone sustanon plasma concentrations above and half-life is longer compared with healthy volunteers. The pharmacokinetics of testosterone sustanon in patients with chronic heart failure and concurrent hepatic impairment or renal impairment has not been studied.

Indications

Chronic heart failure

Contraindications

• hypersensitivity to the drug and other beta-blockers;
• acute heart failure and chronic heart failure decompensation requiring an intravenous inotropic therapy;
• cardiogenic shock;
• collapse;
• atrioventricular (AV) block II and III degree, without a pacemaker ;
• sick sinus syndrome;
• sinoatrial block;
• severe bradycardia (heart rate less than 60 beats / min before the start of treatment.);
• severe hypotension (systolic blood pressure less than 90 mmHg);
• cardiomegaly (with no signs of heart failure );
• severe bronchial asthma and chronic obstructive pulmonary disease (COPD) in history;
• expressed disturbances of peripheral circulation;
• Raynaud’s syndrome;
• pheochromocytoma (without the simultaneous use of alpha-blockers);
• metabolic acidosis;
• concomitant use floctafenine and sultopride;
• lactose intolerance, lactase deficiency, glucose-galactose malabsorption;
• the age of 18 years (effectiveness and safety have been established).

Precautions : bronchospasm (bronchial asthma, obstructive airways diseases), conducting desensitizing therapy, Prinzmetal angina, peripheral circulatory disorders (at the beginning of treatment may be increased symptoms), general anesthesia, hyperthyroidism, diabetes mellitus type 1 diabetes, with significant variations in concentration glucose in the blood, AV block I degree, myasthenia gravis, severe renal insufficiency (creatinine clearance creatinine clearance less than 20 ml / min), severe hepatic dysfunction, psoriasis, restrictive cardiomyopathy, congenital heart defects or hemodynamically significant valvular heart disease, chronic heart failure, myocardial infarction within the last 3 months, depression (including history), pheochromocytoma (while the use of alpha-blockers), a strict diet, coupled allergic history.

Pregnancy and lactation

testosterone sustanon has no direct cytotoxic, mutagenic and teratogenic effects, but has pharmacological effects that may cause harmful effects on pregnancy and / or the fetus or newborn. Typically, beta-blockers reduce placental perfusion, which leads to a slowing of fetal growth, fetal death, miscarriage or premature birth. In the fetus and newborn child may have abnormal reactions such as fetal developmental delay, hypoglycemia, bradycardia.
The drug Biol ® should not be used during pregnancy, the use is possible only if the benefit to the mother outweighs the risk of side effects in the fetus and / or child. In the case where treatment with Biol ®regarded as necessary, should monitor blood flow in the placenta and uterus, and also to observe the growth and development of the fetus, and in case of occurrence of adverse events in respect of pregnancy and / or fetal take alternative therapies . It is necessary to carefully examine the newborn after delivery. Symptoms of hypoglycaemia and bradycardia are generally occur within the first 3 days of life. Breastfeeding Period Data on the penetration of testosterone sustanon into breast milk is not. Therefore, the use of the drug Biol ® is not recommended for women during lactation. If necessary, use during lactation, breast-feeding should be discontinued.

 

Dosing and Administration

Biol Tablets ® is taken orally once a day with a small amount of liquid in the morning before breakfast, during or after it, without chewing.
In all cases, the receiving mode and dose selects the doctor for each patient individually, in particular, taking into account the heart rate and the patient’s condition. Home treatment of chronic heart failure drug Biol ® necessarily require the special titration phase and regular medical monitoring. The prerequisite for the treatment of drug Biol ® is a stable chronic heart failure with no signs of decompensation.treatment of chronic heart failure drug Biol ® begins according to the following titration scheme. This may require individual adaptation depending on how well the patient carries the prescribed dose, ie. E. The dose can be increased only if the previous dose was well tolerated. Use the drug in smaller to ensure proper titration process in the initial stages of treatment doses.

 

Week 1: 1.25 mg of drug Biol ®
(1/2 tablets) once daily
Week 2: 2.5 mg of the drug Biol ®
(1 tablet) once daily
Week 3: 3.75 mg of drug Biol ®
(1 and 1/2 tablet) once daily
4th – 7th week: 5 mg formulation Biol ®
(two tablets) once daily
8th – 11th weeks: 7.5 mg of the drug Biol ®
(3 tablets) once daily
The 12th week of
treatment and beyond:
10 mg of the drug Biol ®
(4 tablets) once daily
as a maintenance

If an increase in dosage is poorly tolerated by the patient, the dose may be reduced.
The maximum daily dose of CHF is 10 mg Biol ® 1 time per day.
In a daily dose of 10 mg of the drug can be applied Biol ® with the dose of 5.0 mg or 10.0 mg.
during titration we recommend regular monitoring of blood pressure, heart rate and increase the severity of symptoms of CHF. Worsening heart failure symptoms may flow from the first day of the drug.
During the titration phase, or it can occur after a temporary deterioration in the flow of CHF, hypotension or bradycardia. In this case it is recommended first of all carry out the correction of concurrent therapy doses of drugs. You may also need a temporary reduction of the dose of the drug Biol ® or its cancellation.
Treatment with Biol ® should be interrupted only if absolutely necessary. After stabilization, the patient should undertake a re-titration of the dose or restore drug intake Biol ® , if the drug was withdrawn.Duration of treatment Treatment of chronic heart failure drug Biol ® is usually long. Treatment should not be interrupted suddenly, especially in patients with coronary heart disease. If you want to discontinuation of treatment, then the dosage should be reduced gradually. Special groups of patients Impaired renal or hepatic function: • if abnormal liver or renal function mild to moderate degree is usually not required to adjust the dose Biol drug ® . • with severe renal impairment (creatinine clearance less than 20 ml / min) and in patients with severe liver disease, the maximum daily dose is 10 mg.Increasing the dose in such patients should be administered with extreme caution. Elderly patients: No dose adjustment is required. There are currently insufficient data on the use of Biol drug ® in patients with heart failure in combination with type 1 diabetes, severe renal impairment and / or liver, restrictive cardiomyopathy, congenital heart disease or a heart defect valve with severe hemodynamic compromise. It is also still not enough data has been received with respect to patients with chronic heart failure with myocardial infarction within the last 3 months.

Side effect

The frequency of adverse reactions listed below was determined according to the following (World Health Organization): very often – at least 10%; often – at least 1% but less than 10%; infrequently – at least 0.1% but less than 1%; rare – less than 0.01% but less than 0.1%; . very rare – less than 0.01%, including isolated reports From the cardiovascular system Very common: slowing of heart rate (bradycardia, particularly in patients with CHF), palpitations. Often: marked reduction of blood pressure (especially in patients with CHF), worsening CHF current symptoms, the manifestation of vasoconstriction (increased peripheral circulatory disorders, feeling of cold weather in the extremities (paraesthesia). Uncommon: violation of AV conduction (until the development of a complete transverse blockade and heart failure), arrhythmia, orthostatic hypotension, chest pain. nervous system Common: dizziness, headache, asthenia, fatigue, sleep disturbances, depression, anxiety. rare: . confusion, or short-term memory loss, “nightmarish” dream, hallucination, myasthenia gravis, tremor, muscle cramps Usually these effects are mild and pass, usually within 1-2 weeks after starting treatment. From the senses rare: visual disturbances, reduced lacrimation (to consider when wearing contact lenses), tinnitus, hearing loss, ear pain. Very rare: dryness and soreness of eyes, conjunctivitis, taste disturbances. The respiratory system Uncommon: . bronchoconstriction in patients with bronchial asthma or obstructive airways disease rare: allergic rhinitis, nasal congestion. digestive system Common: nausea, vomiting, diarrhea, constipation, dry oral mucosa, stomach pain. rare: hepatitis, increased activity of “liver” transaminases (alanine aminotransferase (ALT), aspartate aminotransferase (AST)), increased bilirubin concentration.On the part of the musculoskeletal system Uncommon: arthralgia, back pain. With for the skin rare: increased sweating, flushing of the skin, rash, psoriasiform skin reactions. Very rare: alopecia, beta-blockers may exacerbate psoriasis. Allergic reaction rare: pruritus, rash, urticaria. With the genitourinary system Very rare: violation of potency , weakening of libido. Laboratory tests rare: increase in the concentration of triglycerides in the blood. in some cases, thrombocytopenia, agranulocytosis, leukopenia. Other “cancellation” syndrome (increased frequency of angina attacks, increased blood pressure).

Overdose

Symptoms: . Arrhythmia, ventricular premature beats, bradycardia, atrioventricular block, marked reduction in blood pressure, congestive heart failure, hypoglycemia, akrotsianoz, shortness of breath, bronchospasm, dizziness, fainting, seizures,
sensitivity to a single receiving a high dose of testosterone sustanon has considerable interindividual variability, and patients with heart failure may have high sensitivity. Treatment In the event of an overdose, it is first necessary to stop taking the drug, gastric lavage, appoint adsorbing drugs and supportive symptomatic treatment start: at which developed atrioventricular block intravenous 1-2 mg of atropine, epinephrine or staging a temporary pacemaker; with ventricular arrhythmia – lidocaine (IA class of drugs does not apply); in severe bradycardia – atropine intravenous administration, with little effect with caution you can enter the agent with positive chronotropic effect, may also need a temporary staging pacemaker; In marked decrease in blood pressure – the patient must be in the Trendelenburg position; if there are no signs of pulmonary edema – plasma substituting solutions intravenously, with inefficiency – the introduction of epinephrine, dopamine, dobutamine (to maintain the chronotropic and inotropic effects and elimination of significant decrease in blood pressure); with exacerbation of chronic heart failure – intravenous diuretics, drugs with positive inotropic effect and vasodilators; in convulsions – diazepam intravenously; with bronchospasm – appointment of bronchodilators, including beta2-agonists and / or aminophylline; hypoglycemia – intravenous glucagon or dextrose (glucose).

Interaction with other drugs

On the efficacy and tolerability of the testosterone sustanon may affect concomitant use of other drugs. Such interaction may also occur when the two drugs taken after a short time. The doctor should be informed about taking other medicines, even if they are received without a doctor’s prescription (ie, non-prescription drugs). Not recommended combinations of class I antiarrhythmics (eg, quinidine, disopyramide, lidocaine, phenytoin, flecainide, propafenone) at an application with testosterone sustanon may reduce AV conduction and contractile ability of the heart. blockers “slow” calcium channels (BCCI) verapamil type and to a lesser extent, diltiazem, while the use of testosterone sustanon may lead to a decrease in myocardial contractility and AV conduction disorders. In particular, intravenous administration of verapamil in patients receiving beta-blockers may cause severe hypotension and AV blockade. Antihypertensives central action (such as clonidine, methyldopa, moxonidine, rilmenidine) can lead to heart failure decompensation due to deceleration of heart rate and reducing cardiac emissions as well as vasodilation due to the reduction of the central sympathetic tone. Abrupt withdrawal, particularly before the abolition of the beta-blockers, may increase risk of “rebound” hypertension. Diuretics, sympatholytic, hydralazine and other antihypertensive drugs may lead to an excessive reduction in blood pressure. Combinations requiring special care BCCI dihydropyridine derivatives (eg, nifedipine, felodipine, amlodipine), while the use of testosterone sustanon may increase the risk of hypotension. In patients with heart failure can not eliminate the risk of further deterioration of the contractile function of the heart. III of class antiarrhythmic drugs (eg amiodarone), and reserpine and guanfacine may increase the AV of the time. The action of beta-blockers for topical application (eg eye drops for glaucoma treatment) can enhance the systemic effects of testosterone sustanon (lowering blood pressure, slowing of the heart rate). parasympathomimetics while the use of testosterone sustanon may increase the time AV carrying and increase the risk of bradycardia. The effectiveness of insulin and hypoglycemic agents for Ingestion may change the treatment with testosterone sustanon (masking the symptoms of developing hypoglycemia: tachycardia , increased blood pressure). Such interactions are more likely when using non-selective beta-blockers. Phenytoin intravenous administration, the means for inhalation anesthesia (derivatives of hydrocarbons) increase the intensity of cardiodepressive action and likely to reduce blood pressure. Cardiac glycosides while the use of testosterone sustanon may lead to the development of bradycardia and prolong the AV of . The antihypertensive effect of weakening the non-steroidal anti-inflammatory drugs (NSAIDs) (delay of sodium ions and prostaglandin synthesis kidney blockage), corticosteroids, and estrogens (delay of sodium ions). Concomitant use of testosterone sustanon with beta-agonists (eg isoprenaline, dobutamine) may lead to a decrease in both effect products. The clearance of lidocaine and xanthine (except theophylline) may be reduced due to the possible increase of their plasma concentrations, especially in patients with initially increased clearance of theophylline under the influence of smoking. The combination of testosterone sustanon with agonists that affect the beta- and alpha-adrenergic receptors (eg , norepinephrine, epinephrine) may enhance vasoconstrictor effects of these agents encountered with alpha-adrenoceptors, leading to blood pressure increase. such interactions are more likely to occur when using non-selective beta-blockers. antihypertensive agents, as well as other agents with possible antihypertensive effect (for example, tricyclic antidepressants, barbiturates, phenothiazines) may increase the antihypertensive effect of testosterone sustanon. Mefloquine while the use of testosterone sustanon may increase the risk of bradycardia. not recommended simultaneous application with monoamine oxidase inhibitors (MAOIs) due to a significant increase in anti-hypertensive action. Break in treatment between receiving MAO and testosterone sustanon inhibitors must be at least 14 days. Negidrirovannye ergot alkaloids increase the risk of peripheral circulatory disorders. Ergotamine increases the risk of peripheral circulatory disorders. The allergens used for immunotherapy, or allergen extracts for skin tests increase the risk of severe systemic allergic reactions or anaphylaxis in patients receiving testosterone sustanon. iodine radiopaque diagnostic agents for intravenous administration increases the risk of anaphylactic reactions. The action of non-depolarizing muscle relaxants and anticoagulant effect of coumarin during treatment with testosterone sustanon may lengthen. sulfasalazine increases the concentration of testosterone sustanon in blood plasma. Rifampicin shortens the half-life of testosterone sustanon.

special instructions

Do not abruptly discontinue the drug Biol ® due to the risk of severe arrhythmias and myocardial infarction. Cancellation of a gradually reducing the dose by 25% every 3-4 days.
Control of the condition of patients taking the drug Biol ® , should include measurement of heart rate and blood pressure (at the beginning of treatment -. Daily, then 1 every 3-4 months) holding ECG, determining the concentration of blood glucose in patients with diabetes mellitus (1 every 4-5 months.) in elderly patients it is recommended to monitor renal function (1 time in 4-5 months.).
It is necessary to train the patient’s heart rate calculation method and instructed the need for medical consultation when heart rate less than 60 beats / min.
In the case of elderly patients increasing bradycardia (heart rate less than 60 beats. / min.), marked reduction of blood pressure (systolic blood pressure less than 100 mm Hg), atrioventricular block, you must reduce the dose or discontinue treatment.
Before treatment is recommended for study of respiratory function in patients with a history of bronchopulmonary history.
patients who use contact lenses, you should consider that in the context of drug treatment may decrease the production of tear fluid.
in applying Biol drug ® in patients with pheochromocytoma there is a risk of paradoxical hypertension (if not previously reached effective blockade of the alpha-adrenergic receptors).
In hyperthyroidism testosterone sustanon may mask certain clinical signs of hyperthyroidism (eg, tachycardia). Abrupt withdrawal of the drug in patients with hyperthyroidism is contraindicated because the symptoms can increase.
In diabetes may mask tachycardia caused by hypoglycemia. In contrast, nonselective beta-blockers practically no increase insulin-induced hypoglycemia and delay recovery of the concentration of glucose in the blood to normal.
With the simultaneous use of clonidine its reception can be terminated only a few days after the cancellation Biol drug ® .
Increased severity of hypersensitivity reactions are possible and the lack of effect of conventional doses of epinephrine with aggravated allergic history.
In the case of the need for a planned surgical treatment drug should be discontinued 48 hours before general anesthesia. If the patient has taken the drug before surgery, he should choose the drug for general anesthesia with minimal negative inotropic effect.
Reciprocal activation of the vagus nerve can be eliminated by intravenous administration of atropine (1-2 mg).
Drugs that deplete the depot of catecholamines (including h. . reserpine), may enhance the effect of beta-blockers, so patients taking such drug combinations should be under constant medical supervision in order to identify pronounced reduction in blood pressure and bradycardia.
patients with bronhospasticheskimi diseases can be prescribed with care cardioselective beta-blockers in the case of intolerance and / or ineffectiveness of other antihypertensives. While taking beta-blockers in patients with concomitant asthma may be exacerbated airway resistance. In excess doses of medication Biol ® in these patients there is a risk of bronchospasm.
It is recommended to discontinue therapy with Biol ® in the development of depression.
Do not abruptly discontinue the treatment because of the risk of severe arrhythmias and myocardial infarction. Abolition of the drug was gradually reducing the dose for 2 weeks or more (reduce dose by 25% in 3-4 days).
It is necessary to cancel prior to the study drug concentration in the blood and urine catecholamines, Normetanephrine, vanilinmindalnoy acid, antinuclear antibody titers.
Smokers efficiency beta-blockers lower.

Special precautions for the destruction of unused medicine.

No need for special precautions during the destruction of unused medication Biol ® .

Effects on ability to drive and doing other activities that require concentration and speed of psychomotor reactions.

During drug treatment Biol ® must be careful when driving and occupation of other potentially hazardous activities that require high concentration and psychomotor speed reactions.

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sustanon 250 gains

Compensates for lack of exocrine pancreatic function, has a proteolytic, amylolytic and lipolytic action. Included in the sustanon 250 gains enzymes (lipase, alpha-amylase, trypsin, chymotrypsin) contribute to the breakdown of proteins into amino acids, fats to glycerol and fatty acids, starch into dextrins and sugars.
It improves the functional condition of the gastrointestinal tract, normalizes the processes of digestion.
Trypsin inhibited the stimulated pancreatic secretion, providing an analgesic effect.
pancreatic enzymes are released from the dosage form in the alkaline environment of the small intestine because the protected from the action of gastric juice coating. Maximum enzyme activity observed after 30-45 minutes after oral administration.

Therapeutic indications
Substitution treatment for exocrine pancreatic insufficiency: chronic pancreatitis, pancreatectomy, post-irradiation, indigestion, Remhelda syndrome (gastrocardiac syndrome), cystic fibrosis, flatulence, diarrhea non-infectious origin.
Food assimilation Violation (state after resection of the stomach and small intestine); to improve food digestion in patients with normal function of the gastrointestinal tract in the case of errors in the diet (eating fatty foods, large amounts of food, irregular meals), and in violation of chewing function, sedentary lifestyle, prolonged immobilization.
Preparing to X-ray examination and ultrasound of the abdominal cavity.

Contraindications
: Hypersensitivity to the drug, acute pancreatitis, exacerbation of chronic pancreatitis.

Dosing and Administration
The drug is taken by mouth without chewing, during or immediately after a meal. Adults : 2-4 tablets (50-100 IU) 3-4 times a day. Children – prescribed by a doctor.Single doses for children: 6-7 years – 25 units, 8-9 years – 25-50 IU, 1014 IU 50 years.

Side effects:
Allergic reactions. In some cases – diarrhea, constipation, feeling of discomfort in the stomach, nausea (causal relationship of these reactions to the action of sustanon 250 gains has not been established, since these phenomena are symptoms of exocrine pancreatic insufficiency). With prolonged use at high doses may develop hyperuricosuria, increased levels of uric acid in blood plasma. In the application of sustanon 250 gains in high doses may occur in children perianal irritation and irritation of the oral mucosa. Patients with cystic fibrosis may develop strictures in the ileocecal department and ascending colon.

Overdose Symptoms : hyperuricosuria, hyperuricemia. The children – constipation. Treatment : removal of the drug, symptomatic therapy.

Interaction with other drugs
With simultaneous application of sustanon 250 gains with iron preparations may decrease the absorption of the latter. The simultaneous use of antacids containing calcium carbonate, calcium and / or magnesium hydroxide, can reduce the effectiveness of sustanon 250 gains.

Special instructions:
The safety of sustanon 250 gains during pregnancy has been poorly studied. Application is possible in cases where the expected benefit to the mother outweighs the potential risk to the fetus.

Product form :
10 tablets in contour bezgyachakova package of aluminum foil.
60 tablets in banks lighting glass with a triangular rim or jars with screw neck, bottles glass lighting glass.
On 60 tablets in plastic cans or plastic bottles.
6 contour bezgyachakova packages , jars, bottles, along with instructions for use are placed in a pile of cardboard.

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