Nandroline

# Nandroline ## Overview Nandoone is an anabolic-androgenic steroid (AAS) with a high anabolic-to-androgenic ratio. It is available as nandrolone decanoate or phenylpropionate for intramuscular injection. ## Primary Indications - Anemia of renal insufficiency (FDA-approved) - HIV/AIDS-associated muscle wasting - Osteoporosis (off-label) - Hereditary angioedema (off-label) - Adjunctive therapy for severe burn or trauma (off-label) ## Adult Dosing Dosing is highly dependent on indication, local protocol, and product formulation. - **Anemia of renal insufficiency (nandrolone decanoate):** Men 100–200 mg IM weekly; Women 50–100 mg IM weekly. Maximum 200 mg/week for men, 100 mg/week for women. Adjust based on hemoglobin response. - **HIV wasting (off-label):** 100–200 mg IM every 1–2 weeks. Maximum 400 mg per week not typically recommended; most guidelines suggest 200 mg every 2 weeks. - **Osteoporosis (off-label):** 50–100 mg IM every 3–4 weeks (consults specialist). Duration is typically 2–3 months then a drug-free interval. **Exact doses and frequency vary; refer to institutional protocols.** ## Pediatric Dosing Limited data; use only under specialist guidance. - **Anemia of renal insufficiency:** 1–3 mg/kg IM weekly (nandrolone decanoate). Maximum 100 mg/week. Not recommended for children <12 years unless benefits clearly outweigh risks. ## Dose Adjustments - **Hepatic impairment:** Avoid in severe disease. Reduce dose if mild–moderate; monitor LFTs closely. - **Renal impairment:** No specific dose adjustment for primary indication (anemia of renal failure), but monitor fluid balance and avoid in nephrotic syndrome. - **Geriatric:** Use lower initial doses (e.g., 50 mg IM weekly) and titrate slowly. ## Contraindications - Pregnancy (known teratogenic and virilizing to female fetus) - Lactation - Prostate or male breast cancer - Female breast cancer with hypercalcemia - Severe hepatic disease or dysfunction - Hypersensitivity to nandrolone or any component - Nephrotic phase of nephritis - Hypercalcemia (pre-existing) ## Adverse Effects - **Frequent:** Virilization (hirsutism, acne, voice deepening, menstrual irregularities), increased libido, edema, injection site pain, dyslipidemia (↑ LDL, ↓ HDL), liver enzyme elevation. - **Serious:** Peliosis hepatis, hepatic neoplasms, cholestatic jaundice, accelerated bone maturation in children, premature epiphyseal closure, hypercalcemia, exacerbation of prostatic hypertrophy/carcinoma, cardiovascular events (hypertension, left ventricular hypertrophy, arrhythmias), glucose intolerance. - **Androgenic:** In males – priapism, testicular atrophy, oligospermia, impotence; in females – clitoromegaly, menstrual irregularities. ## Key Drug Interactions - **Anticoagulants (warfarin):** Enhanced anticoagulant effect (additive or synergistic). - **Oral hypoglycemics/insulin:** May improve insulin sensitivity → increased hypoglycemia risk; monitor glucose. - **Adrenal steroids or corticotropin:** Increased risk of edema (sodium retention). - **CYP3A4 substrates:** Nandrolone may inhibit metabolism; monitor for toxicity of drugs like cyclosporine, tacrolimus. - **Androgen deprivation therapy:** Antagonistic effect. ## Monitoring - Baseline: Hemoglobin/hematocrit, liver function tests, lipid panel, serum calcium, prostate-specific antigen (men >40), pregnancy test (women of childbearing potential). - During therapy: Hb/Hct weekly initially, then monthly; LFTs and lipids every 1–2 months; calcium every 3 months; bone age monitoring in children; monitor for virilization signs. - Perform prostate exam in men and breast exam in women periodically. ## Clinical Pearls - Nandrolone has less androgenic activity than testosterone, but virilization still occurs, especially in women. - For anemia, response is expected within 2–4 weeks; if no response after 6 months, discontinue. - Depot injection (decanoate) has a prolonged effect (2–3 weeks). The phenylpropionate form lasts about 1 week. - Avoid coadministration with other hepatotoxic drugs (e.g., alcohol, methotrexate). - Nandrolone is a controlled substance (most countries Schedule III/IV); misuse carries legal and health risks. - Use the lowest effective dose for the shortest duration to minimize adverse effects. --- *This information is for educational purposes only and does not replace independent professional judgment. Always verify current prescribing information, as dosing, contraindications, and safety data may change. Consult your local clinical guidelines and regulatory requirements.*