Nandrolone Decanoate

Approved Indications:

• Anemia of Chronic Renal Failure:
• Indicated for the treatment of anemia associated with chronic kidney disease, especially in patients unresponsive to erythropoietin therapy.
• Postmenopausal Osteoporosis:
• Used to increase bone mineral density and reduce the risk of fractures in postmenopausal women.
• Palliative Treatment of Breast Cancer in Women:
• As adjuvant therapy for hormone-responsive advanced or inoperable breast carcinoma.
• Catabolic and Debilitating Conditions:
• Adjunct in the management of wasting diseases such as severe trauma, chronic infections, burns, and post-surgical recovery, to prevent muscle loss.

Clinically Accepted Off-Label Uses:

• HIV/AIDS-Related Wasting Syndrome:
• Used under supervision to restore lean body mass and strength in severely cachectic patients.
• Cachexia Due to Malignancy or Chronic Illness:
• Employed in supportive care to enhance physical performance and reduce fatigue.

Note: Use for athletic performance enhancement or bodybuilding is prohibited, unsafe, and not medically endorsed.

Route of Administration: Intramuscular (IM) injection only (deep gluteal muscle)

Adults:

• Anemia of Chronic Renal Failure:
• 100 to 200 mg IM every 1 to 2 weeks (men)
• 50 to 100 mg IM every 1 to 2 weeks (women)
• Duration: Typically 3 to 6 months or until response
• Postmenopausal Osteoporosis:
• 50 mg IM every 3 to 4 weeks
• Minimum course: 6 months
• Advanced Breast Cancer in Women (Palliative):
• 50 to 100 mg IM every 1 to 2 weeks
• Catabolic States / Wasting Disorders:
• 100 to 200 mg IM every 2 to 4 weeks depending on severity

Pediatric Use:

• Not routinely recommended. Use only in select cases (e.g., refractory anemia) with dose adjustments:
• 1–2 mg/kg IM every 1–2 weeks under specialist supervision

Elderly:

• Use with caution. Start at the lower end of the dose range.
• Monitor for cardiovascular, prostate, and hepatic adverse effects.

Renal Impairment:

• No routine dose adjustment required.
• Monitor fluid retention and hemoglobin levels closely.

Hepatic Impairment:

• Contraindicated in patients with significant hepatic dysfunction.
• Use cautiously in mild impairment with liver function monitoring.

Nandrolone Decanoate is a long-acting anabolic androgenic steroid (AAS). After intramuscular injection, the decanoate ester is slowly hydrolyzed into active nandrolone. It exerts its effects by binding to intracellular androgen receptors, promoting protein synthesis, increasing nitrogen retention, stimulating erythropoiesis, and inhibiting catabolic processes. These effects result in increased muscle mass, enhanced bone density, and improved red blood cell production. Compared to testosterone, nandrolone has a higher anabolic and lower androgenic activity, minimizing masculinizing effects while maintaining therapeutic efficacy.

• Absorption:
• Slow and sustained release from the IM site; peak levels in 24–48 hours
• Bioavailability:
• 100% via IM route (not active orally)
• Distribution:
• Widely distributed in muscle and fat tissue
• Crosses placenta; not recommended during pregnancy
• Protein Binding:
• 50%, mainly to sex hormone-binding globulin (SHBG)
• Metabolism:
• Primarily hepatic metabolism via reduction and conjugation pathways
• Converts to active and inactive metabolites, including dihydronandrolone (weaker androgen)
• Half-Life:
• 6 to 12 days (depot release from injection site)
• Excretion:
• Primarily via urine (metabolites), small amount through feces

• Pregnancy:
• FDA Category X
• Contraindicated due to risk of fetal harm, including virilization of female fetuses. Should not be used in pregnant women.
• Lactation:
• Not recommended during breastfeeding.
• Potential for serious adverse effects in the infant; may suppress lactation.

• Primary Class: Anabolic Steroid
• Subclass: Synthetic Androgen (19-nortestosterone derivative)

• Hypersensitivity to nandrolone or formulation components
• Pregnancy or lactation
• Known or suspected breast carcinoma in men
• Known or suspected prostate cancer
• Severe hepatic dysfunction
• Nephrotic syndrome with edema
• Hypercalcemia or hypercalciuria
• History of thromboembolic disease
• Uncontrolled heart failure or recent myocardial infarction

• Cardiovascular Risks:
• Risk of fluid retention, edema, hypertension, and thromboembolism; monitor BP and cardiac status
• Hepatotoxicity:
• Though less than with 17α-alkylated steroids, liver enzymes may elevate; monitor liver function regularly
• Endocrine Effects:
• Suppression of endogenous testosterone and spermatogenesis; may cause infertility
• Virilization in Women:
• Risk of hirsutism, voice deepening, acne, and menstrual irregularities
• Pediatric Growth Effects:
• May cause premature epiphyseal closure; monitor growth and bone age
• Psychiatric Effects:
• Mood swings, aggression, irritability, and depression reported
• Laboratory Monitoring Required:
• Hemoglobin/hematocrit, liver enzymes, lipid profile, electrolytes, PSA in males

Common:

• Endocrine:
• Decreased libido, testicular atrophy, menstrual disturbances
• Metabolic:
• Water and sodium retention, weight gain
• Skin:
• Acne, oily skin, seborrhea
• Musculoskeletal:
• Muscle cramps, increased bone density (desired effect)

In Females:

• Voice changes, facial hair growth, menstrual irregularities, clitoral enlargement

Serious / Rare:

• Liver dysfunction or hepatocellular carcinoma (rare)
• Polycythemia (especially with long-term use)
• Thromboembolism, stroke, or myocardial infarction
• Mood disorders, aggression, suicidal ideation
• Premature epiphyseal closure in adolescents

• Oral Anticoagulants (e.g., warfarin):
• Enhanced anticoagulant effect; monitor INR closely
• Insulin and Oral Hypoglycemics:
• May enhance hypoglycemic response; adjust diabetic medication accordingly
• Corticosteroids:
• Increased risk of edema and fluid retention
• Hepatotoxic Agents (e.g., alcohol, isoniazid):
• Additive liver toxicity risk
• Cyclosporine:
• May increase nephrotoxicity risk
• CYP450 System:
• Metabolized hepatically, but not significantly via CYP3A4; major enzyme interactions are rare

• Global Regulatory Position:
• Banned for non-medical use by WADA and all professional sports bodies
• WHO & National Guidelines:
• Reserved for medically indicated conditions only; long-term use requires careful monitoring
• Recent Focus:
• Emphasis on cardiac and liver monitoring due to emerging reports of AAS-induced cardiomyopathy and hepatotoxicity

• Storage Temperature: 20°C to 25°C (68°F to 77°F)
• Permitted Range: 15°C to 30°C
• Light Sensitivity: Store in original packaging to protect from light
• Do Not Freeze
• Handling Precautions:
• Inspect for particulate matter or discoloration
• Gently warm to room temperature if crystals form
• Vial Use: Use aseptic technique; discard unused portion if multi-dose vial is opened for extended periods