Everolimus is metabolized primarily in the liver and to some extent in the intestinal wall, with the participation of isoenzyme  Everolimus is also a substrate for the protein P-glycoprotein transporter.Consequently, the absorption and the subsequent elimination of systemically absorb everolimus may affect drugs interact with trenboloneand / or P-glycoprotein. Combined use Sertikana with strong inhibitors or inducers recommended.  Inhibitors can reduce the release of everolimus from intestinal cells and increase in the serum concentration of everolimus. In vitro everolimus was a competitive inhibitor , potentially increasing the plasma concentrations of drugs that are excreted with the participation of these enzymes. Therefore, caution should be exercised with concomitant  substrates , which have a narrow therapeutic index. All in vivo interaction studies were conducted without the simultaneous application of cyclosporine.

The bioavailability of everolimus was significantly increased, while the use of cyclosporine. In a study of a single dose to healthy volunteers cyclosporine in microemulsion (Sandimmun Neoral) increased the AUC everolimus by 168% (from 46% to 365%) and C max – 82% (from 25% to 158%) compared to the use of only one everolimus . If you change the dose of cyclosporine may require correction dosing regime everolimus.

Clinically significant effect on the pharmacokinetics of cyclosporine Sertikana minimal in patients with kidney and heart transplant receiving cyclosporine microemulsion form.

in healthy volunteers previously treated with multiple doses of rifampicin, in the subsequent application Sertikana in a single dose was observed almost 3-fold increase in clearance of everolimus and decrease in Cmax by 58% and AUC – 63%. Combined use Sertikana with rifampicin is not recommended.
With atorvastatin or pravastatin in healthy volunteers clinically trenbolone not significantly affect the pharmacokinetics of atorvastatin, pravastatin and everolimus, as well as for the total bioreaktivnost reductase inhibitors in plasma.

However, these results can not be extrapolated to other reductase. Patients receiving reductase, should be monitored for the development of rhabdomyolysis and other unwanted phenomena in accordance with the instructions for use of said resources.

Other possible interactions
Moderate inhibitors  may increase everolimus concentration in the blood (eg, antifungal agents: fluconazole; antibiotics macrolides: erythromycin, calcium channel blockers verapamil, nicardipine, diltiazem, protease inhibitors: nelfinavir, indinavir, amprenavir.

Inducers may increase the metabolism of everolimus and decrease everolimus blood levels (eg St. John’s wort), anticonvulsants: carbamazepine, phenobarbital, phenytoin;  treatment: efavirenz, nevirapine).

Grapefruit and grapefruit juice affect cytochrome , so avoid their use against application Sertikana.

Immunosuppressants may affect response to vaccination; during treatment Sertikanom vaccination may be less effective. Avoid use of live vaccines.

Treatment Sertikanom should start and carry only doctors with experience of immunosuppressive therapy following organ transplantation and who has the ability to monitor everolimus concentration in whole blood. In clinical studies Sertikan used simultaneously with cyclosporine in the form of a microemulsion, basiliximab and corticosteroids. Application Sertikana in combination with other immunosuppressive agents are poorly understood. Application Sertikana in patients at high immunological risk are poorly understood.

Not recommended combined use Sertikana with strong inhibitors trenbolone (eg, ketoconazole, itraconazole, voriconazole, clarithromycin, telithromycin, ritonavir) and inducers (eg, rifampicin, rifabutin), except in cases where the expected benefits of such therapy outweighs the potential risk. It is recommended to monitor the everolimus concentration in whole blood while the use of inducers or inhibitors and after their withdrawal. In patients receiving immunosuppressive therapy means, including Sertikan, increased risk of lymphomas and other malignant diseases, especially skin. Absolute risk is more likely with the duration and intensity of immunosuppression than with the use of a particular drug. You should regularly monitor the condition of patients to identify skin lesions, to recommend to minimize the effects of ultraviolet radiation, sunlight and use appropriate sunscreen.

Over-immunosuppression predisposes patients to infections, especially caused by opportunistic pathogens. There have been reports of fatal infections and sepsis.

In clinical studies conducted Sertikana prevention of pneumonia caused by Pneumocystis jiroveci (carini), for 12 months after transplantation.

In patients with an ever continuing clinical pneumonia after failure of antibiotic therapy and exclusion of infectious, neoplastic and other non-use of drugs processes should be suspected interstitial lung disease.

The prevention of trenbolone cytomegalovirus infection recommended for 3 months after transplantation, particularly for patients at increased risk for this infection. Combined use Sertikana cyclosporin in microemulsion form transplant patients was associated with an increase in the content of serum cholesterol and triglyceride levels, which may require the appropriate treatment. Patients receiving Sertikan, should be monitored in order to detect and treat hyperlipidemia lipid-lowering agents, if necessary, to assign the appropriate corrective diet. It is necessary to evaluate the risk / benefit ratio for patients identified hyperlipidemia before initiating therapy with immunosuppressive agents, including Sertikan. You should also weigh the risk / benefit of continued therapy Ssrtikanom in patients with severe refractory giperlipidsmiey. Running low dose t3 clen cycle trying to lose bodyfat isn’t a real hot idea imo.