Treatment with should be initiated and carried out under the supervision of a doctor who has experience in the treatment of multiple sclerosis.
Since fingolimod reduces the number of lymphocytes in the blood (by redistributing them in the secondary lymphoid organs), the number of lymphocytes in the peripheral blood can be used to evaluate the different lymphocyte populations in patients treated with the drug.
Patients receiving fingolimod, to determine the number of mononuclear cells requires large volumes of blood sampling (due to the reduction in the number of circulating lymphocytes). Prior to initiating therapy fingolimod for 6 months, you should regularly conduct a study of the clinical analysis of blood leukocyte formula. Infections Since the use of the drug may increase the risk of infection during treatment withtrenbolone acetate pricein patients with symptoms of infection should be carried out effective diagnostic and therapeutic interventions.
Resuming treatment with should only if the benefits of therapy outweighs the potential risk. Patients who do not have a history of documented data transferred chickenpox or the full course of vaccination against the virus Varicella zoster (VZV), before the start of therapy should be evaluated for the detection of antibodies to VZV. If necessary, the vaccination is carried out for 1 month prior to initiation of therapy for the prevention of post-vaccination complications. Macular edema Because drug therapy may develop macular edema in the first 3-4 months of taking the drug Neskler ® , it is recommended to carry out an eye examination. Patients with a history of uveitis, as well as in patients with concomitant diabetes, there is an increased risk of macular edema. Since the use of the drug in patients with RRMS and concomitant diabetes mellitus have not been studied, patients with diabetes or uveitis history recommended ophthalmologic examination prior to and during therapy with . In identifying patients impairment during therapy with the drug, it is necessary to inspect fundus, especially the macular area. In the case of macular edema of drug treatment should be discontinued. The risk of recurrent macular edema when resuming therapy with has not been studied. Resuming treatment with should only if the benefits of therapy outweighs the potential risk to the patient.Diabetes Research on the use of the drug in patients with diabetes was conducted. Caution should be exercised when administering the drug in these patients because of the risk of macular edema, to avoid the development of which is required to hold regular ophthalmologic control. All patients should be performed electrocardiography to dosing and during the 6-hour monitoring period. With the development of bradyarrhythmias during therapy with the drug if necessary must be initiated by the appropriate actions provided observation of the patient until the relief of the violation. if necessary, drug therapy in the first dose monitoring period necessary to extend monitoring at least until the next morning, and it is necessary to repeat the monitor after applying the second dose trenbolone acetate price. Additional monitoring is also required in the following cases:
- if the heart rate at 6 hours after administration of the drug is <45 beats / min, or is the lowest value for the entire period of observation;
- with new-onset AV blockade II degree or higher on the ECG at 6 hours after dosing;
- or if the QTc interval on the electrocardiogram is > 500 msec.