1. Clinical Overview
Stanozolol is a synthetic anabolic-androgenic steroid (AAS) derived from dihydrotestosterone. It is a 17α-alkylated steroid, making it orally bioavailable but also hepatotoxic. In India, its legitimate medical use is extremely limited and highly regulated due to significant abuse potential and severe adverse effects. It is primarily indicated for hereditary angioedema, though this use is rare and superseded by safer alternatives.
| Onset | Duration | Bioavailability |
|---|---|---|
| Oral: 1-2 hours; Intramuscular: Variable, but effects may be noticed within days of repeated administration. | Oral: 8-12 hours; Intramuscular: Several days to weeks due to depot formulation. | Oral: Approximately 30-40% due to first-pass metabolism. Intramuscular: Near 100% from depot site. |
2. Mechanism of Action
Stanozolol binds to intracellular androgen receptors in target tissues (muscle, liver, skin, bone marrow). The drug-receptor complex translocates to the nucleus, binds to DNA, and modulates gene transcription, leading to an increase in protein synthesis (anabolic effect) and androgenic effects. It also increases the production of C1 esterase inhibitor in patients with hereditary angioedema.
3. Indications & Uses
- Hereditary Angioedema (Type I & II) - Prophylaxis of attacks (now largely replaced by danazol and newer therapies like icatibant, C1-inhibitor concentrates)
4. Dosage & Administration
Adult Dosage: For Hereditary Angioedema: 2 mg orally three times daily to start, may be reduced to 2 mg daily or every other day for maintenance. Doses up to 20mg/day have been used historically but are not recommended. Intramuscular: 50mg every 2-3 weeks (depot). NOTE: 20mg tablet strength is HIGH and typically associated with misuse, not standard medical therapy.
Administration: Oral tablets: Take with or without food. For medical use, doses are typically divided throughout the day. Intramuscular: Deep IM injection into gluteal muscle. Patients must be counseled extensively on risks vs. minimal benefits.
5. Side Effects
Common side effects may include:
- Acne, oily skin
- Increased facial/body hair (hirsutism) in females
- Deepening of voice in females
- Menstrual irregularities (oligomenorrhea, amenorrhea)
- Increased libido
- Aggression, mood swings ('roid rage')
- Insomnia
- Headache
- Edema/fluid retention
- Reduced HDL ('good') cholesterol, Increased LDL ('bad') cholesterol
6. Drug Interactions
| Drug | Effect | Severity |
|---|---|---|
| Warfarin, Acenocoumarol | Stanozolol may potentiate anticoagulant effect, increasing risk of bleeding. Monitor INR closely. | Major |
| Insulin, Oral Hypoglycemics (e.g., Glimepiride) | Stanozolol may decrease glucose tolerance, reducing hypoglycemic efficacy. Monitor blood sugar. | Moderate |
| Corticosteroids (e.g., Prednisolone) | Additive risk of fluid retention, edema, and worsening of lipid profile. | Moderate |
| Cyclosporine, Tacrolimus | Stanozolol may increase serum levels of these immunosuppressants via CYP3A4 inhibition, increasing toxicity risk. | Moderate |
| Hepatotoxic drugs (e.g., Paracetamol high dose, Statins, Azole antifungals) | Additive risk of liver damage. Avoid combination. | Major |
| Anticonvulsants (e.g., Phenobarbital, Carbamazepine, Phenytoin) | May increase metabolism of Stanozolol via CYP3A4 induction, reducing its efficacy. | Moderate |
7. Patient Counselling
- DO take exactly as prescribed by your doctor. Do not increase dose or duration.
- DO get regular blood tests for liver function (LFTs), lipid profile, and complete blood count.
- DO inform all your doctors and surgeons that you are taking this medication.
- DON'T share this medicine with anyone, especially athletes or bodybuilders.
- DON'T consume alcohol in any form.
- DON'T use if you are pregnant, planning pregnancy, or breastfeeding.
- DO report any signs of jaundice (yellow eyes/skin, dark urine), unusual bleeding, or severe mood changes immediately.
8. Toxicology & Storage
Overdose: Symptoms are an extension of side effects: Severe nausea/vomiting, significant edema, acute hypertensive crisis, severe headache, marked hepatotoxicity (jaundice, abdominal pain), extreme aggression or psychosis, priapism, and signs of cardiovascular strain (chest pain).
Storage: Store at room temperature (15-30°C), protected from light and moisture. Keep in the original container, tightly closed. Keep out of reach of children and adolescents due to high abuse potential. Do not flush or pour down the drain. Dispose of unused tablets as per local pharmaceutical waste regulations.