Nandrolone Decanoate

What is Nandrolone Decanoate

Nandrolone Structure

Nandrolone Structure

Nandrolone Decanoate is an anabolic steroid that is pharmacologically classified under androgen hormones. Nandrolone is primarily indicated for the treatment of conditions that are associated with anemia but it can also be used to treat osteoporosis, chronic renal failure and mass wasting syndrome that is associated with HIV/AIDS. This agent has the ability to increase the mass and size of red blood cells and also to increase the concentration of hemoglobin in them. But, due to the recent development of the recombinant human erythro-proteins, the use of Nandrolone Decanoate for the treatment of anemic conditions as a result of renal failure has greatly diminished. In many cases, this drug has been a subject of serious drug abuse and misuse. In most of these circumstances, it leads to negative effects like hepatotoxicity, antisocial behavioral changes, changes in libido and higher chances of acquiring cardiovascular diseases. Nandrolone has masculinization effects on women but they are totally reversible. This drug was approved for clinical use in 1983 and it was listed under controlled substances in 1991.

What is Nandrolone’s mode of action?

Nandrolone Decanoate has the same mechanisms of action as any other androgen hormones such as testosterone. Nandrolone Decanoate is an exogenous androgen that facilitates the anabolism of proteins and it stimulates an appetite for food, this leads to a reversed action of catabolic processes in the body and a negative nitrogen balance. Nandrolone Decanoate can be used to increase bone density in osteoporosis patients and to increase the lean body mass in patients with cachexia e.g. patients who are malnourished from dialysis. Androgens also have a great effect on; the production of erythrocytes, calcium balance and adjusting blood sugar levels. An increased production of erythrocytes is due to an increased production of the ESF- Erythropoietic Stimulating Factor. After a treatment using this medication, patients with anemia that is associated with renal diseases will note an increased volume of hemoglobin and red blood cells in their systems.

Because of the androgynous effects that Nandrolone Decanoate exhibits, it should never be administered to young children since it can facilitate the abnormal development of sexual characteristics. It can also lead to some serious disturbances to normal growth. This medication can lead to undesired effects on women since endogenous hormones inhibit the synthesis and production of the gonadotropin releasing hormone which initiates a negative feedback mechanism on the pituitary that facilitates a reduced gonadotropic function. All these processes result in a substantial reduction of the endogenously produced luteinizing hormone, testosterone, and follicle stimulating hormone. Endogenous hormones can also affect the testes directly. Other effects of these hormones can include a decrease in high-density lipoprotein concentration and an increase in low-density lipoproteins.

The Pharmacokinetics of Nandrolone Decanoate

Nandrolone Decanoate is usually administered intramuscularly and once it gets to the circulatory system, it goes through rapid hydrolysis that is effected by plasma esterases, after that, it dissociates into free Nandrolone particles which are highly soluble in lipids, so they are quickly dissolved into the body cells where they affect their actions. After its action in the cells, it undergoes metabolism in the liver through oxidation and reduction processes that are similar to those of other androgens such as testosterone. Information on exactly how the metabolites of this agent are excreted is still inconclusive but when in the plasma, it clears off at a rate of 1.6L/h/Kg and it has an elimination half-life of 3 to 6 days.

Route specific Pharmacokinetics

After an intramuscular administration, Nandrolone Decanoate is released periodically and slowly from the intramuscular depots into the body at constant rates for about 4 days. A dose of 100mg can produce peak serum concentrations in 3 to 6 days.

Indications of Nandrolone Decanoate

Nandrolone Decanoate has been clinically indicated for the treatment of anemia which is as a result of renal dysfunction but off the label, it can be used as a solution for osteoporosis, cachexia and mass wasting syndrome.

Contraindications and Precautions when using Nandrolone Decanoate

Before you start taking this medication, you should inform your health service provider in case you are suffering from any of the following conditions; Diabetes, breast cancer, kidney diseases, heart diseases, prostate dysfunctions, and liver diseases. You should also inform your doctor if you react hypersensitively to Nandrolone decanoate, other medicines, types of foods, dyes, and preservatives. Your healthcare provider should also be informed if you are pregnant, trying to get pregnant or if you are breastfeeding.
Nandrolone Decanoate medications should never be administered intravenously. The correct mode of administration is through the muscles. This formulation should never be used in patients who react hypersensitively to alcohol, more specifically benzyl alcohol because it has been reconstituted using benzyl alcohol.

Therapy using androgens like Nandrolone Decanoate can lead to the loss of diabetic control. This medication should be used with caution in patients with diabetes mellitus. Their blood sugar levels should also be monitored closely so that safety levels are ensured all the time.

Nandrolone Decanoate is on the FDA pregnancy category X and it is exclusively contraindicated during pregnancy because of the presumed negative effects that it may have on a fetus. Anabolic steroids are commonly known to cause fetotoxicity, embryotoxicity, and it can also have serious effects like masculinization of a female fetus. In a case where a patient becomes pregnant while on this medication, its administration should be discontinued immediately. Otherwise, all the possible methods of contraception should be adopted to ensure that the patient is pregnancy free.

It is still not clear whether anabolic steroids are excreted in a mother’s milk, nevertheless, it is still contraindicated for breastfeeding mothers. This is because it has the potential to produce very negative effects on an infant. If the administration of this medication is unavoidable, alternative solutions to direct breastfeeding should be considered.
The administration of androgens, including Nandrolone Decanoate to children, should be carried out extremely cautiously. Androgens can accelerate the maturation of the bones in the body without stimulating a consequent linear growth to make up for this maturation. This will eventually result in an abnormal adult stature. When children are put on this medication, it is important to assess their levels of bone maturation and the effects of this drug on their epiphyseal centers, radiographic examinations can be performed on their wrists or hands to ascertain this. It should be noted that once the epiphyses are closed, growth is terminated and this closure can be enhanced for a prolonged period of time after the administration of this medication has been stopped.

Nandrolone Decanoate can facilitate the growth and development of cancerous tissues. It should never be used in male patients with prostate or breast cancer. Patients with prostatic hypertrophy should be treated cautiously using this medication because of the possible development of a malignant growth.

All androgens, including Nandrolone decanoate, should be used cautiously in patients with hypercalcemia because this medication can induce osteolysis. Androgen-induced hypercalcemia is very often in patients who are immobile and patients with metastatic breast cancer.

Anabolic steroids like Nandrolone can affect the solid lipid make up of the serum by facilitating an increase in LDL and a decrease in HDL. For this reason, this drug should be used with caution in any patient with a condition of hypercholesterolemia and cardiac diseases. It is advisable to closely monitor their serum lipoprotein concentrations. The retention of sodium is also another factor that facilitates the retention of fluids which can lead to edema during a treatment with androgens. Thus, Nandrolone should be used with a lot of care in patients with severe cardiac diseases, peripheral edema, and patients with heart failure. Patients with severe hepatic diseases should avoid this medication completely because of the developmental effects that it may have on these conditions.

This list does not include all the possible contraindications, so you must be sure that you check in with your doctor for more information.

Interactions of Nandrolone Decanoate

Some possible interactions of Nandrolone include; medications that are used to treat diabetes, e.g. leuprolide and goserelin, medicines that are used to treat prostate diseases e.g. saw palmetto, warfarin, finasteride, and dutasteride. This list does not contain all the possible interactions, so, you should always ensure that you provide your physician with a conclusive list of all the medications that you are currently on. This should include all the prescription drugs, non-prescription drugs, alcohols, herbs, dietary supplements and illegal drugs.
Androgens are known to enhance the effects of anticoagulants. Before during and after a treatment using anabolic steroids or androgen in combination with anticoagulants, it is very important to monitor a patient very closely. Nandrolone Decanoate can induce a pharmacodynamic reaction if it interacts with these agents which may affect the action of coagulants that are circulating the blood system. In case this combination is inevitable, the dosage levels of the anticoagulant may need to be adjusted so that the action time of prothrombin is maintained at therapeutic levels.
Androgens should not be used concurrently with 5-alpha reductase inhibitors, e.g. finasteride and dutasteride because these agents are known to antagonize the action of androgens.
Saw palmetto extracts exhibit antiandrogenic effects which are presumed to act by antagonizing the actions of anabolic steroids, so it would not be logical to administer a combination of these two medications.
Exogenously administered androgens like anabolic steroids and derivatives of testosterone have effects that vary from patient to patient in relation to blood sugar control in patients with diabetes type II. Generally, a low testosterone concentration in the serum is associated with more resistance to insulin. Tests carried out on hypogonadal men using exogenous androgens showed an improvement in their glycemic controls which is indicated by a substantial reduction in their serum glucose levels.

Androgens can increase the concentration of cyclosporine in the plasma which may lead to greater risks of developing nephrotoxicity.

Edema/ increased fluid retention may occur if Nandrolone Decanoate is used concurrently with corticosteroids. This may be more pronounced with corticosteroids like fludrocortisone which have greater mineral Corti steroid activity.
In a majority of cases, androgens are usually necessary to induce a growth response in a human growth hormone therapy in children, but its levels should be checked and maintained because an overdose can accelerate the maturation of the epiphyses and termination of growth.
This list does not include all the possible drug interactions, so you should make sure that you communicate to your physician before you begin or stop administering this medicine.

Adverse reactions and side effects associated with Nandrolone Decanoate

Some of the common side effects that are associated with Nandrolone Decanoate include; hair loss, diarrhea, sleeping problems and changes in sex drive and performance. This list does not contain all the possible side effects so you should contact your health care service provider or emergency care services immediately, in case you experience any signs of allergies. These can include but are not limited to; skin rashes and hives, itching, swelling of the face, lips and tongue, breathing problems, breast lumps, mood instability that is characterized by anger, depression and rage, increased facial hair, darker urine, acne, irregular periods, stomach pains, vomiting, swelling of the ankles, yellow skin or eyes and problems with passing urine.
The disruption of the normal menstrual cycle that is as a result of treatment using Nandrolone Decanoate in women is generated as a result of a decreased production of the gonadotropic hormones. This decrease can also lead to oligomenorrhea or amenorrhea.
When androgens, including Nandrolone, are administered to women, virilization can occur and it is usually characterized by reduced breast size, male pattern baldness, clitoromegaly, hirsutism, acne and voice hoarseness/deepening of the voice. If this treatment is discontinued immediately on the onset of these effects, they will eventually subside but if the administration is prolonged for extended periods, these characteristics may be irreversible. If the administration of this medication is unavoidable, its benefits should be conclusively outweighed by the risks.
Androgens can facilitate teratogenesis and they are under the pregnancy category X. They can result in extremely negative effects on a fetus especially a female fetus so it is strictly contraindicated during pregnancy.
In male patients, feminization can occur due to a prolonged use of this androgen. This feminization is presumed to be as a result of the inhibition of gonadotropin production which leads to the conversion of androgens to estrogens. These effects are more apparent in patients with hepatic diseases like gynecomastia and mastalgia but they are reversible. Other effects that men can experience include a decreased testicular function, impotence, testicular atrophy bladder irritation, and epididymitis.

Boys who are still at puberty are immature and when they are treated using androgens like Nandrolone decanoate, they can experience virilism which is a big disadvantage because it is usually accompanied by a premature epiphyseal closure. Once the epiphyses are closed, physical growth is terminated. In a case of this therapy on children, skeletal maturation should be monitored exclusively after a period of about 6-month intervals. An enlargement of the penis and increased erection frequencies are also some of the effects that can be experienced by boys at puberty.
Male and female patients can experience peripheral edema which may be as a result of sodium-generated fluid retention because of prolonged use of Nandrolone. This condition is usually manifested by an abnormal weight gain. Fluid retention has greater significance in patients with congestive heart failure and renal dysfunctions. Other electrolytes that are also retained in the fluids can include; potassium, chlorides, calcium, and phosphates.
Treatment using androgens is associated with the secretion of subcutaneous glands and growth which can facilitate the development of acneiform rashes that is indistinguishable from acne vulgaris.
Anabolic androgenic steroids can cause hepatic dysfunctions which may be more severe with concurrent administration of oral 17 alpha alkyl androgens e.g. methyltestosterone. Cholestatic jaundice, hepatic necrosis, and even death have been reported from these effects.
Androgen therapy can induce osteolysis which can worsen a condition of hypercalcemia. Hypercalcemia that is caused by androgen therapy if very frequent in immobile patients and patients with breast cancer.
Androgens decrease the concentration levels of HDL in the serum and increase the concentration levels of LDL. Synthetic androgens can produce a greater lowering ratio of HDL: LDL than testosterone and oral anabolic steroids can produce greater effects compared to parenterally administered formulations. Patients who are at a greater risk of developing these effects, i.e. those with atherosclerosis and dyslipidemias, should be treated using Nandrolone Decanoate with a lot of caution and they should be closely monitored.
Androgen therapy can lead to a libido increase or decrease but geriatric men are more likely to experience enhanced and excessive sexual stimulation.
Other side effects that have been reported from Nandrolone include a decreased tolerance to glucose, edema, diarrhea, excitability, mental depression, vomiting, nausea, and insomnia. Intramuscular administration can cause urticaria, inflammation, furunculosis, and post injection induration. Prolonged bleeding can also occur due to the suppression of clotting factors II, V, VI, and X.

You should contact your health care service provider in a case of any negative experiences which may include chest pains/ tightness, difficulty in breathing, dizziness, wheezing and red swollen, painful areas on your legs.

How is this medication best administered?

Nandrolone Decanoate should be administered through an injection into the muscles. You can schedule injection appointments with your doctor in a clinic or if you like, you can be taught how to prepare this medication and administer it. You should talk to a pediatrician concerning the use of this medication to treat children, since exclusive and special care and monitoring may be required. In the case of an overdose, you should contact a poison control center or emergency services immediately.

What should you do if you miss a dose?

If you miss your dose, you should take it as soon as you remember about it. But it is better to skip a dose if you are too close to your next shot.

This drug should be stored at temperatures of about 68F to 77F; it should be stored away from heat and away from the reach of children. Remember to throw away any unused medicine after it has passed its expiry date and never flush medicine through the sink or toilets.

Conclusion

Nandrolone Decanoate is commonly prescribed for the treatment of anemia, osteoporosis, cachexia, and AIDS-associated mass wasting. The dosage strength of this injection that is available at our pharmacy is a 5ml vial in 200mg/ml. The dosage form available is an injection solution and at Absolute Pharmacy, we compound all our injection solutions following the strict rules of the USP 797. We also have a quality assurance process that ensures uniformity, potency, and top quality of all the products that we dispense. For more information on this medication and its administration, feel free to contact us.

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