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Androgens may accelerate the progression of sub-clinical prostatic cancer and benign prostatic hyperplasia. Nebido should be used with caution in cancer patients at risk of hypercalcaemia (and associated hypercalciuria), due to bone metastases. Regular monitoring of serum calcium concentrations is recommended in these patients. Cases of benign and malignant liver tumours have been reported in users of hormonal substances such as androgen compounds. If severe upper abdominal complaints, liver enlargement or signs of intra-abdominal haemorrhage occur in men using Nebido, a liver tumour should be included in the differential-diagnostic considerations. Cardiac, hepatic or renal insufficiency. In patients suffering from severe cardiac, hepatic or renal insufficiency or ischaemic heart disease, treatment with testosterone may cause severe complications characterised by oedema with or without congestive cardiac failure. In such case, treatment must be stopped immediately. Hepatic or renal insufficiency. There are no studies undertaken to demonstrate the efficacy and safety of this medicinal product in patients with renal or hepatic impairment. Therefore, testosterone replacement therapy should be used with caution in these patients. Caution should be exercised in patients predisposed to oedema, e. In case of severe complications characterized by oedema with or without congestive heart failure treatment must be stopped immediately (see section 4. Testosterone may cause a rise in blood pressure and Nebido should be used with caution in men with hypertension. As a general rule, the limitations of using intramuscular injections in patients with acquired or inherited bleeding disorders always have to be observed. Testosterone and derivatives have been reported to increase the activity of coumarin derived oral anticoagulants (see also section 4. Testosterone should be used with caution in patients with thrombophilia or risk factors for venous thromboembolism (VTE), as there have been post-marketing studies and reports of thrombotic events (e. In thrombophilic patients, VTE cases have been reported even under anticoagulation treatment, therefore continuing testosterone treatment after first thrombotic event should be carefully evaluated. In case of treatment continuation, further measures should be taken to minimise the individual VTE risk. Nebido should be used with caution in patients with epilepsy and migraine, as the conditions may be aggravated, femistra 1 mg antiestrogens $23.00 arimidex. Improved insulin sensitivity may occur in patients treated with androgens who achieve normal testosterone plasma concentrations following replacement therapy. Certain clinical signs: irritability, nervousness, weight gain, prolonged or frequent erections may indicate excessive androgen exposure requiring dosage adjustment. Pre-existing sleep apnoea may be potentiated. Athletes treated for testosterone replacement in primary and secondary male hypogonadism should be advised that the medicinal product contains an active substance which may produce a positive reaction in anti-doping tests. Androgens are not suitable for enhancing muscular development in healthy individuals or for increasing physical ability.
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