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Nandrolone: Uses, Benefits & Side Effects


Nandrolone (also known as "Nand" or "Deca-Durabolin")


A quick‑reference guide for parents and caregivers



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1. What is nandrolone?




Term Full name Classification Common brand(s)


Nandrolone 19-Nortestosterone An anabolic‑steroid hormone (derived from testosterone) Deca‑Durabolin®, Nandrolone Decanoate, Nandrolone Phenylpropionate



Pharmacology





Mode of action: Binds to androgen receptors → ↑ protein synthesis & muscle growth.

Metabolism: Primarily hepatically conjugated; excreted in bile and urine.

Half‑life: ~3–4 days (decanoate ester).

Routes of administration: Intramuscular injection; oral formulations rarely used due to first‑pass hepatic toxicity.



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2. Clinical Use & Therapeutic Indications




Indication Typical dose / regimen Rationale


Anemia (e.g., β‑thalassemia, sickle cell disease) 1–2 mg/kg IM once every 3–4 weeks Stimulates erythropoiesis → reduced transfusion burden.


Aplastic anemia / bone marrow failure 2–3 mg/kg daily for 5 days; repeat cycle Enhances red‑cell production, may improve platelet & neutrophil counts.


Chronic kidney disease (CKD)‑related anemia 1 mg/kg IM once per week or every 14 days Improves hemoglobin and quality of life.


Other indications (e.g., chemotherapy‑induced anemia, post‑splenectomy) – individualized dosing based on response.


> Key points:

> • Dosing varies widely; start with the lowest dose that achieves target hemoglobin.

> • Monitor hemoglobin every 2–4 weeks initially to avoid excessive rise (> 1.5 g/dL in a week).




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3. Monitoring Requirements



Parameter Frequency (first year) Rationale


Hemoglobin / hematocrit Every 2–4 weeks during titration; then every 8–12 weeks once stable Prevents over‑correction and hyperviscosity


Reticulocyte count With hemoglobin or when significant change in Hb Indicates marrow response


Platelet count At same intervals as CBC Detect thrombocytosis or thrombocytopenia (risk of thrombotic events)


Iron studies (serum ferritin, transferrin saturation) Every 6–12 months Avoid iron overload from multiple transfusions


Kidney and liver function tests At least annually Monitor organ function, especially in patients with comorbidities


Bone marrow aspirate/biopsy Indicated if unexplained cytopenias or abnormal morphology Not routine; indicated for diagnostic clarification


Quality of life assessment Annually Evaluate impact on daily functioning and guide treatment decisions


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4. Decision‑Tree Algorithm for Transfusion Initiation


Below is a simplified decision‑tree to aid clinicians in deciding when to initiate transfusion therapy. The algorithm incorporates clinical presentation, laboratory thresholds, patient factors, and safety measures.




START
│
├─> Assess Clinical Status:
│ • Symptomatic anemia (fatigue, dyspnea, chest pain)
│ OR
│ • Hemoglobin Evaluate Hemoglobin Level:
│ • Hb ≥ 8 g/dL: No transfusion needed (monitor).
│ • 6 g/dL ≤ Hb Check for Contraindications:
│ • Known severe transfusion reaction or IgA deficiency with low
│ anti-IgA antibodies. (If present, use washed units.)
│
├─> Decide on Unit Type:
│ • Standard packed RBCs: most common, unless special indication.
│ • Washed cells or leukocyte-reduced: if history of severe reactions,
│ IgA deficiency, or high risk for febrile non-hemolytic transfusion reaction.
│
├─> Request the unit and proceed with transfusion per hospital protocol.
└───────────────────────────────────────────────────────────────────────────────

Key decision points:
1. Need for transfusion (clinical trigger).
2. Presence of contraindication to standard units.
3. Selection of unit type based on patient risk factors.



Step 4: Summarize key take‑away messages that a resident should remember about managing the patient in this scenario.





Avoid unnecessary transfusions:


Use clinical indicators (e.g., hemoglobin

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