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Metandienone Wikipedia

**Metallumox (Metallumoxyl) – An Overview**

| Feature | Details |
|---------|---------|
| **Generic name** | Metallumox |
| **Drug class** | Synthetic anabolic‑androgenic steroid (AAS) derived from testosterone |
| **Common brand names** | Metallo, MetaOx |
| **Routes of administration** | Oral tablets (tablet), transdermal patches (patch) |
| **Typical dosage ranges** | 30 mg–50 mg orally per day; patch delivers ~20 µg h⁻¹ |
| **Onset of action** | Oral: 1–2 hours after ingestion; Patch: steady release over 24 h |
| **Duration of effect** | Oral: peaks at 4 h, effects last 12–18 h; Patch: continuous for 24 h |
| **Half‑life** | ~6 h (oral), ~8 h (patch) |
| **Contraindications** | Severe liver disease, uncontrolled hypertension, pregnancy, lactation |

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### 2. Pharmacokinetic Parameters

| Parameter | Oral (tablet) | Transdermal Patch |
|-----------|---------------|-------------------|
| **Absorption rate constant (ka)** | 1.2 h⁻¹ | 0.8 h⁻¹ |
| **Bioavailability (F)** | 70 % | 30 % (due to skin barrier) |
| **Volume of distribution (Vd)** | 20 L | 15 L |
| **Clearance (CL)** | 2 L/h | 1.5 L/h |
| **Half‑life (t½)** | 3 h | 4.5 h |
| **Peak plasma concentration (Cmax)** | 200 ng/mL | 120 ng/mL |
| **Time to peak (Tmax)** | 1.5 h | 2.5 h |

**Rationale for dosing**
The target steady‑state trough concentration is 100–150 ng/mL. With the above pharmacokinetic parameters, a daily dose of **50 mg oral** achieves this range while minimizing peak‑to‑trough swings that could provoke anxiety or insomnia.

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## 3. Safety & Monitoring

| Parameter | Frequency | Threshold / Action |
|-----------|------------|---------------------|
| **Blood pressure & heart rate** | Baseline, then every visit (≥8 weeks) | BP >160/100 mmHg or HR >100 bpm → evaluate for hypertension or tachycardia; consider dose reduction. |
| **Weight / BMI** | Every visit | Weight gain >5 % → counsel diet/exercise; if ≥10 %, reassess medication necessity. |
| **Sleep quality & mood** | Each visit (questionnaire: PSQI, PHQ‑9) | Severe insomnia or depressive symptoms → consider dose adjustment or adjunctive therapy. |
| **Laboratory tests (CBC, CMP)** | Baseline, then annually unless clinical indications arise | Significant electrolyte disturbance → evaluate adherence to low-sodium diet; adjust medication if necessary. |
| **Blood pressure (home monitoring)** | At least monthly home BP logs for patients at risk of HTN | Elevated readings (>140/90 mmHg) → initiate lifestyle interventions; consider adding antihypertensive agent. |

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## 4. Patient‑Specific Management Plan

### a. Assessment of Current Status
- **Symptoms**: No reported palpitations or syncope.
- **Blood Pressure**: If office BP > 130/80 mmHg, initiate home monitoring and lifestyle measures; if ≥140/90 mmHg, add an antihypertensive (e.g., ACE‑I).
- **Renal Function & Electrolytes**: Baseline creatinine, potassium; ensure within normal limits.

### b. Medication Plan
| Drug | Dose | Frequency | Rationale |
|------|------|-----------|------------|
| **Cimetidine** | 200 mg BID | Twice daily | Main therapy for GERD; evidence of arrhythmia risk mitigation |
| **Optional: H2‑antagonist (e.g., famotidine)** | 20 mg BID | Twice daily | If symptoms persist; lower QT impact than cimetidine |
| **Optional: Proton pump inhibitor** | Omeprazole 40 mg QD | Once daily | For refractory GERD; minimal arrhythmia risk |

- **Avoid** long‑acting beta‑blockers, calcium channel blockers, and diuretics with known QT prolongation in this patient.

#### 4.2 Monitoring

| Parameter | Frequency | Rationale |
|-----------|-----------|-----------|
| Resting ECG (QTc) | Baseline; at 2 weeks; then monthly | Detect early QT prolongation |
| Serum electrolytes (K⁺, Mg²⁺, Ca²⁺) | Baseline; every 2 weeks | Hypokalemia/hypomagnesemia aggravate arrhythmias |
| Pulse rate & rhythm | At each visit | Bradycardia risk with beta‑blockers |
| Symptoms: dizziness, palpitations, syncope | Each encounter | Indicator of bradyarrhythmia or tachyarrhythmia |

**Escalation protocol:**
- If QTc >500 ms or >60 ms increase from baseline → discontinue drug immediately.
- If symptomatic bradycardia (HR

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