Nandrolone Decanoate is a long-acting injectable anabolic-androgenic steroid (AAS) derived from testosterone. It is an esterified prodrug of nandrolone, designed for deep intramuscular administration. In the Indian medical context, it is a prescription-only medicine with a narrow therapeutic window, primarily indicated for the treatment of specific types of anemia and osteoporosis. Its use is strictly regulated due to significant androgenic and anabolic side effects, and a high potential for misuse in sports and bodybuilding.
Adult: **Anemia (renal failure):** 50-100 mg deep IM every 1-4 weeks, adjusted based on hematocrit response. **Osteoporosis (postmenopausal):** 50 mg deep IM every 3-4 weeks. Doses must be individualized to the lowest effective dose.
Note: For deep intramuscular (IM) injection only, preferably in the gluteal muscle. Use a 21-23 gauge needle, 1.5 inches long. Aspirate before injection to avoid intravascular administration. Rotate injection sites to prevent lipoatrophy or abscess formation. The oil-based solution should be at room temperature before administration.
Nandrolone acts as an agonist at the androgen receptor (AR). Upon binding, the receptor-ligand complex translocates to the cell nucleus, dimerizes, and binds to specific DNA sequences (Androgen Response Elements), modulating the transcription of target genes. This leads to increased protein synthesis (anabolic effect) and the development of male sexual characteristics (androgenic effect). Its anabolic-to-androgenic ratio is estimated to be higher than testosterone, meaning it promotes muscle and bone growth with relatively less virilizing effects.
Pregnancy: **Category X:** Contraindicated. May cause virilization of the female fetus. Risk of clitoral hypertrophy, labial fusion, and ambiguous genitalia.
Driving: May cause dizziness, headache, or visual disturbances. Patients should be cautioned about operating machinery or driving until they know how the drug affects them.
| Warfarin / Acenocoumarol | Nandrolone may potentiate anticoagulant effect by reducing synthesis of clotting factors and increasing sensitivity to warfarin. Risk of severe bleeding. | Major |
| Oral Hypoglycemic Agents / Insulin | Anabolic steroids may alter glucose tolerance, requiring dose adjustment of anti-diabetic medication. | Moderate |
| Adrenocorticotropic Hormone (ACTH) / Corticosteroids | Increased risk of severe edema and acne due to additive sodium-retaining effects. | Moderate |
| Cyclosporine, Tacrolimus | Potential increased risk of nephrotoxicity and hepatotoxicity. | Moderate |
| Hepatotoxic drugs (e.g., Paracetamol high dose, Statins, Azole antifungals) | Additive risk of liver damage. | Major |
Same composition (Nandrolone Decanoate (50mg)), different brands: