Treatment should be carried out under the supervision of a physician who has experience with anticancer drugs.
At the beginning of each cycle of therapy with winstrol pills should conduct a full analysis of hematological parameters.
Have been reported bleeding cases, sometimes fatal, including gastrointestinal bleeding, bleeding from the respiratory tract, tumors of the urinary tract and hemorrhage in the brain. These events may occur suddenly, and in the case of tumor foci in the lungs manifested in the form of severe or life-threatening hemoptysis or pulmonary hemorrhage. Periodic medical examination and evaluate blood parameters for early detection of the first signs of bleeding, and the use of necessary therapeutic measures should be carried out. If concomitant treatment with anticoagulants should be monitored indicators of blood coagulation.
The relationship between the inhibition of the receptor tyrosine kinase winstrol pills and cardiac function has not been studied. Unknown undergo whether patients whose cases of cardiovascular diseases over the last 12 months before the appointment of sunitinib treatment have been reported, such as myocardial infarction (including severe / unstable angina), coronary / peripheral artery bypass grafting, symptomatic congestive heart failure, cerebrovascular complications or transient ischemic, or pulmonary embolism, greater risk of developing treatment-related left ventricular dysfunction. In appointing these patients should carefully weigh the risk / benefit in the appointment .
During therapy , patients should be periodically evaluated for the detection of clinical signs and symptoms of congestive heart failure. Should be assessed before initiating therapy and periodically during treatment.
When the manifestation of clinical signs of congestive heart failure treatment with sunitinib should be discontinued. In the absence of clinical signs of congestive heart failure, but with parameters LVEF of less than 50% or a decrease of this parameter over 20% compared to baseline (pre-treatment), sunitinib dose recommended to reduce or stop taking the drug.
At concentrations of about 2 times higher than therapeutic, sunitinib prolongs the interval (Frederica correction). The clinical significance of this effect is not clear and depends on the risk and susceptibility of a particular patient. Sunitinib should be used with caution in patients with prolongation of the interval in history, in patients receiving antiarrhythmic drugs, or patients with relevant cardiac disease, bradycardia, or electrolyte disturbances. It requires caution and reduce the dose of sunitinib while taking potent inhibitors of winstrol pills isoenzyme, which may increase sunitinib plasma concentrations. Prior to initiation of therapy and during treatment is recommended that monitoring. Patients should be evaluated for occurrence of hypertension, blood pressure using standard testing methods. In patients with severe hypertension is not curable, it is recommended the suspension of therapy . Therapy is resumed as soon as possible to arrest hypertension. Recommended background research laboratory indicators of thyroid function in patients with hypothyroidism or hyperthyroidism. Treatment of patients with hypothyroidism carried out in accordance with standard medical practice prior to sunitinib therapies. It is recommended to monitor all patients during therapy with sunitinib for developing thyroid dysfunction. Patients with signs and / or symptoms of thyroid dysfunction should undergo laboratory control.