Stanozolol is a synthetic anabolic-androgenic steroid (AAS) derived from dihydrotestosterone. It is a 17α-alkylated compound, which allows for oral bioavailability by resisting first-pass hepatic metabolism. In the Indian medical context, its legitimate therapeutic use is highly restricted and specific, primarily for hereditary angioedema. It is a Schedule H drug and its use is strictly controlled due to significant abuse potential and serious adverse effects.
Adult: Hereditary Angioedema: Initially, 2 mg three times daily. Maintenance: After a favorable response, reduce by 2 mg every 1-3 months to a maintenance dose of 2 mg daily or every other day. Aplastic Anemia: 2 mg three times daily. Therapy should be intermittent (e.g., 3-6 months followed by a rest period).
Note: Administer orally with or without food. For consistent effect, doses should be spaced evenly throughout the day (e.g., every 8 hours). Tablets should be swallowed whole with a glass of water. Therapy should be cyclical (on/off periods) to mitigate side effects, especially in aplastic anemia.
Stanozolol binds to intracellular androgen receptors (AR) in target tissues. The hormone-receptor complex translocates to the cell nucleus, binds to specific DNA sequences (androgen response elements), and modulates gene transcription. This leads to increased protein synthesis (anabolic effect) and development of male sexual characteristics (androgenic effect). For hereditary angioedema, it increases the synthesis of C1 esterase inhibitor by the liver.
Pregnancy: CATEGORY X. Contraindicated. Can cause virilization of the external genitalia of the female fetus. May have adverse effects on fetal development. Women of childbearing potential must use effective contraception during therapy.
Driving: May cause dizziness, aggression, or mood alterations. Patients should be cautioned about operating machinery or driving until they know how the drug affects them.
| Warfarin, Acenocoumarol | Stanozolol decreases levels of antithrombin III and may potentiate anticoagulant effect, increasing risk of bleeding. INR must be monitored closely. | Major |
| Insulin, Oral Hypoglycemics (e.g., Glimepiride) | Stanozolol may decrease glucose tolerance, reducing hypoglycemic efficacy. Dose adjustment may be needed. | Moderate |
| Cyclosporine, Tacrolimus | Increased risk of hepatotoxicity and nephrotoxicity. May also increase cyclosporine levels. | Major |
| Corticosteroids (e.g., Prednisone) | Additive risk of fluid retention, edema, and hepatotoxicity. | Moderate |
| Hepatotoxic drugs (e.g., Paracetamol high dose, Statins, Azole antifungals) | Additive risk of liver damage. | Major |
| Anticonvulsants (e.g., Phenobarbital, Carbamazepine, Phenytoin) | May increase metabolism of stanozolol, reducing its efficacy. | Moderate |