Usage
Nandrolone Decanoate is an anabolic-androgenic steroid (AAS) primarily prescribed for:
- Osteoporosis (loss of bone tissue) in postmenopausal women
- Certain types of anemia, such as anemia of chronic renal failure and aplastic anemia
- Wasting syndromes (cachexia) associated with chronic illness or severe injury, including AIDS-related wasting
- In the past: Palliative treatment of inoperable breast cancer (in women)
It has also been used off-label for promoting muscle growth and strength, but these uses are not generally recommended due to the potential for adverse effects.
Pharmacological Classification: Anabolic-androgenic steroid.
Mechanism of Action: Nandrolone Decanoate binds to androgen receptors in target tissues, including bone and skeletal muscle. This binding promotes protein synthesis, leading to increased muscle mass and bone growth. It also stimulates erythropoiesis (red blood cell production) in the bone marrow.
Alternate Names
- Generic Name: Nandrolone Decanoate
- Other Names: 19-Nortestosterone decanoate, Deca
- Brand Names: Deca-Durabolin, Rolon, others.
How It Works
Pharmacodynamics: Nandrolone Decanoate exerts its effects by binding to androgen receptors. This binding leads to increased protein synthesis, nitrogen retention, and calcium deposition in bone. In the bone marrow, it stimulates erythropoietin production, which in turn promotes red blood cell formation.
Pharmacokinetics:
- Absorption: After intramuscular injection, the drug is slowly released from the oily depot and absorbed into the systemic circulation.
- Metabolism: Nandrolone decanoate is converted to its active metabolite, nandrolone. Nandrolone is further metabolized in the liver primarily via 5α-reductase to 3-norandrosterone and other metabolites.
- Elimination: Metabolites are excreted primarily in the urine, with a small amount eliminated in the feces. The elimination half-life is approximately 6 days.
Mode of Action:
Binds to androgen receptors in target cells, translocates to the nucleus, and interacts with DNA to regulate gene expression, promoting protein synthesis and other anabolic effects.
Receptor Binding: Androgen receptor agonist.
Elimination Pathways: Primarily hepatic metabolism with renal excretion of metabolites.
Dosage
Standard Dosage
Adults:
- Anaemia associated with Chronic Renal Failure:
- Females: 50-100 mg intramuscularly once a week.
- Males: 100-200 mg intramuscularly once a week.
- Osteoporosis: 50mg intramuscularly every 2-4 weeks.
- Other indications: 25-50mg every 2-3 weeks. Higher dosages may be initiated and gradually reduced as needed.
Discontinue if no hematologic improvement is seen in anemia within six months.
Children:
- 2-13 years (anemia associated with chronic renal disease): 25-50 mg intramuscularly every 3-4 weeks.
- Safety and efficacy not well-established in children. Prepubertal children should be monitored carefully for potential effects on growth and development. Not recommended in children below the age of 3 years due to presence of benzyl alcohol as an excipient.
Special Cases:
- Elderly Patients: Dosage adjustments may be required depending on organ function and individual response. Start with lower doses.
- Patients with Renal Impairment: Caution advised. Close monitoring is necessary. Dose adjustments may be required.
- Patients with Hepatic Dysfunction: Caution advised. Close monitoring of liver function is essential. Dose reduction may be required.
- Patients with Comorbid Conditions: Individualized dosing is required. Consider potential drug interactions and the patient’s overall health status.
Clinical Use Cases
Nandrolone Decanoate is not typically used in the clinical settings of intubation, surgical procedures, mechanical ventilation, ICU use, or emergency situations.
Dosage Adjustments
Dosage adjustments may be necessary based on patient response, renal or hepatic function, and other factors. Therapy should ideally be intermittent to minimize the risk of adverse effects.
Side Effects
Common Side Effects:
- Virilization in women (hirsutism, acne, voice deepening, menstrual irregularities, clitoral enlargement).
- Gynecomastia in men.
- Fluid retention (edema).
- Acne.
- Changes in libido.
- Nausea.
- Insomnia.
- Oily skin and hair.
- Injection site reactions.
- Elevated liver enzymes.
Rare but Serious Side Effects:
- Peliosis hepatis (blood-filled cysts in the liver).
- Liver tumors.
- Jaundice.
- Hyperlipidemia.
- Hypertension.
- Cardiomyopathy.
Long-Term Effects:
- Premature epiphyseal closure in children.
- Cardiovascular disease.
- Infertility.
- Prostate enlargement.
Adverse Drug Reactions (ADR)
- Severe virilization.
- Hepatotoxicity.
- Allergic reactions.
Contraindications
- Pregnancy.
- Breastfeeding.
- Prostate cancer in males.
- Male breast cancer.
- Breast cancer in females with hypercalcemia.
- Hypersensitivity to nandrolone decanoate or any of the excipients (including peanut oil and soy).
- Nephrosis or the nephrotic phase of nephritis.
- Liver disease with impaired bilirubin excretion.
- Heart failure.
Drug Interactions
Nandrolone Decanoate can interact with several medications, including:
- Anticoagulants (e.g., warfarin): Increased risk of bleeding.
- Antidiabetic agents (e.g., insulin): May alter blood glucose control.
- Corticosteroids: Increased risk of fluid retention.
- CYP3A4 substrates: May affect the metabolism of these drugs.
Interactions may also occur with other drugs, OTC medications, supplements, and food. Consult a comprehensive drug interaction database for a detailed list. Alcohol consumption should be avoided or limited.
Pregnancy and Breastfeeding
- Pregnancy Safety Category: X (Contraindicated). Nandrolone Decanoate can cause virilization of the female fetus.
- Breastfeeding: Contraindicated. Nandrolone Decanoate may be excreted in breast milk and can have adverse effects on the infant.
Drug Profile Summary
- Mechanism of Action: Binds to androgen receptors, promoting protein synthesis, bone growth, and red blood cell production.
- Side Effects: Virilization, gynecomastia, fluid retention, acne, changes in libido, nausea, liver dysfunction.
- Contraindications: Pregnancy, breastfeeding, prostate/breast cancer, severe renal/hepatic disease, heart failure.
- Drug Interactions: Anticoagulants, antidiabetic agents, corticosteroids.
- Pregnancy & Breastfeeding: Contraindicated.
- Dosage: Varies depending on the indication and patient characteristics. See dosage section for details.
- Monitoring Parameters: Liver function tests, lipid profile, blood pressure, hemoglobin, prostate-specific antigen (PSA) in men, signs of virilization in women.
Popular Combinations
Nandrolone Decanoate is sometimes combined with other AAS for performance enhancement, but these combinations are not medically recommended and can increase the risk of adverse effects.
Precautions
- Pre-screening for contraindications is essential.
- Monitor liver function, lipid profile, and blood pressure regularly.
- Monitor for signs of virilization in women and gynecomastia in men.
- Use with caution in patients with pre-existing medical conditions, including liver or kidney disease.
- Monitor growth and development in children.
- Patients should be advised to avoid alcohol and maintain a healthy lifestyle.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Nandrolone Decanoate?
A: The dosage varies depending on the indication and patient characteristics. See the detailed dosage guidelines above.
Q2: What are the common side effects of Nandrolone Decanoate?
A: Virilization in women, gynecomastia in men, fluid retention, acne, changes in libido, and nausea.
Q3: Is Nandrolone Decanoate safe during pregnancy?
A: No, it is contraindicated during pregnancy due to the risk of virilization of the female fetus.
Q4: Can Nandrolone Decanoate be used in children?
A: It can be used in children for certain types of anemia, but careful monitoring of growth and development is essential.
Q5: What are the contraindications for using Nandrolone Decanoate?
A: Prostate/breast cancer, pregnancy, breastfeeding, severe kidney/liver disease, and heart failure.
Q6: Does Nandrolone Decanoate interact with other medications?
A: Yes, it can interact with anticoagulants, antidiabetic agents, and corticosteroids.
Q7: How is Nandrolone Decanoate administered?
A: It is administered via deep intramuscular injection.
Q8: What are the long-term risks of Nandrolone Decanoate use?
A: Cardiovascular disease, infertility, and premature epiphyseal closure in children are potential long-term risks.
Q9: How often should Nandrolone Decanoate be administered?
A: The frequency of administration varies depending on the indication and dosage. It can range from once a week to once every 3-4 weeks.
Q10: What should patients be monitored for during Nandrolone Decanoate therapy?
A: Liver function, lipid profile, blood pressure, hemoglobin, and signs of virilization or gynecomastia.
