An important component in the mechanism of action is the generation of hydrogen peroxide resulting autooksigenatsii. Hydrogen peroxide by interacting with testosterone cypionate results sulfhydryl groups of tissue proteins, promotes tighter helix DNA transcription process and difficulty. Blocks MAO activity that causes accumulation of tyramine and as a consequence, increase in the content of noradrenaline in sympathetic nerve endings and increase blood pressure.

Pharmacokinetics
Quickly and completely absorbed in the gastrointestinal tract penetrates the blood-brain barrier. The maximum concentration is achieved after ingestion for 30-60 minutes.

It is metabolized in the liver and kidneys to form the active metabolite. The half-life is 10 minutes. Excreted mainly by the kidneys (70% excreted in urine in 24 hours, mostly in the form of acid, less than 5% – unchanged) and light in the form of methane and carbon dioxide.

Indications
of Hodgkins disease (Hodgkins disease), non-Hodgkins lymphoma, chronic lymphocytic leukemia, a disease Brill-Simmersa., Malignant brain tumors (neuroblastoma and medulloblastoma).

Contraindications
Hypersensitivity to procarbazine or any other components of the preparation. Bone marrow hypoplasia, pronounced renal dysfunction and / or liver disease, pheochromocytoma, pregnancy and lactation.

Precautions: arrhythmia and other cardiovascular diseases, diabetes, hyperthyroidism, cerebrovascular disorders, paranoid schizophrenia and other conditions involving anxiety, epilepsy, alcoholism, Parkinson™s disease, varicella, herpes zoster and other systemic infections, chronic viral diseases, previous cytotoxic or radiotherapy, sympathectomy in the history of old age.

Dosing and Administration
Inside, after a testosterone cypionate results meal.
When you select a dose and mode of use of the drug in each individual case should be referred to the literature. The application start Natulana monotherapy with 50 mg, the daily increasing to 50 mg daily dose of 250-300 mg. Give medication in 1-2-3 divided doses daily for 15 to 20 days or until the development of leukopenia and thrombocytopenia. With the advent of effective dose was gradually reduced to maintenance, usually 150-50 mg per day. The total dose per course of treatment is typically 4 – 7 g in combination with other antitumor agents Natulan administered at a dose of 100 mg / m2 daily for 10-14 days.

Side effects 

On the part of hematopoiesis: leukopenia, thrombocytopenia, eosinophilia, hemolytic anemia, bleeding and hemorrhage. On the part of the digestive system: nausea, vomiting, anorexia, dysphagia, dry mouth, diarrhea / constipation, abdominal pain, stomatitis, abnormal liver function , cholestatic jaundice. From the nervous system and sensory organs: headache, dizziness, paresthesia, peripheral neuropathy, ataxia (rarely), irritability, hypomanic and manic states, convulsions, hallucinations, depression, nightmares, fatigue, confusion, coma, weakness; diplopia, nystagmus, photophobia, swelling of the optic nerve, intraocular hemorrhage, impaired hearing. Cardio-vascular system: decrease in blood pressure, tachycardia, syncope. On the part of the respiratory system: pneumonia, pleurisy, cough. With the genitourinary system: renal failure , hematuria, amenorrhea, azoospermia. For the skin: dermatitis, pruritus, rash, urticaria, alopecia, hyperpigmentation, feeling hot flushes or redness of the face. Other: arthralgia, myalgia, tremor, immunosuppression (connection testosterone cypionate results infections), fever, gynecomastia , the risk of development of secondary malignant swollen, allergic reactions

Overdosing
Symptoms: nausea, vomiting, enteritis, diarrhea, decreased blood pressure, tremors, convulsions, coma, marked inhibition of bone marrow hematopoiesis, liver dysfunction.
Treatment: induction of vomiting or gastric lavage (in the first hour after overdose), symptomatic therapy, monitoring vital important features (symptoms during overdose and for at least 2 weeks after the normalization of the patient).

Interaction with other medicinal products.
With the simultaneous use of other drugs and myelotoxicity of radiation therapy may additive inhibition of bone marrow function.
Increases activity sympathomimetic, barbiturates, antihistamines, narcotics, antihypertensive drugs, tricyclic antidepressants and phenothiazines. Incompatible with ethanol (development disulfirampodobnoy reaction).
Potentiate the action of hypoglycemic agents and anticonvulsant drugs. The non-specific anti-inflammatory drugs increase the risk of bleeding.

Cautions
Natulanom Treatment is carried out under the supervision of a physician who is experienced in the use of anticancer medicines.

In procarbazine the therapy requires careful monitoring of haematological (before treatment, then 1 every 3-4 days) and biochemical (before treatment, and then 1 time per week) blood indicators.

When violations of the central nervous system (paresthesia, peripheral neuropathy, confusion), leukopenia (<4000 / mm), thrombocytopenia (<100,000 / microliter), allergic reactions, stomatitis, diarrhea, increased bleeding or bleeding Natulanom treatment should be discontinued immediately.

During treatment contraindicated use of alcohol, sleeping pills (barbiturates, benzodiazepines) and sympathomimetic agents. From diet to exclude foods with a high content of tyramine (aged cheeses, wine, beer, yeast / protein extracts, yogurt, bananas).

Men and women of childbearing age during treatment Natulanom and for at least 3 months should use reliable methods of contraception.

During treatment Natulanom must be careful when driving and busy with other potentially hazardous activities that require high concentration and psychomotor testosterone cypionate results speed reactions.