Common use of Cautions Clause in Contracts

Cautions. The chronological age at the beginning of therapy should be treatment for girls who have started puberty before the age of 9 years and for boys before the age of 10 years. In girls initial ovarian stimulation at treatment initiation, followed by the treatment-induced oestrogen withdrawal, may lead, in the first month, to vaginal bleeding of mild or moderate intensity. After completing the therapy, development of puberty characteristics will occur. Information with regards to future fertility is still limited. In most girls menses will start on average one year after ending the therapy, which in most cases is regular. Bone mineral density may decrease during GnRH analogue therapy for central precocious puberty. However, after cessation of treatment subsequent bone mass accrual is preserved and peak bone mass in late adolescence does not seem to be affected by treatment. Slipped capital femoral epiphysis can be seen after withdrawal of GnRH analogue The suggested theory is that the low concentrations of estrogen during treatment with GnRH analogues weakens the epiphysial plate. The increase in growth velocity after stopping the treatment subsequently results in a reduction of the shearing force needed for displacement of the epiphysis. The treatment of children with progressive brain tumours should follow a careful individual appraisal of the risks and benefits. Pseudo-precocious puberty (gonadal or adrenal tumour or hyperplasia) and gonadotropin-independent precocious puberty (testicular toxicosis, familial Leydig cell hyperplasia) should be precluded. Allergic and anaphylactic reactions have been reported in adults and children. These include both local site reactions and systemic symptoms. The pathogenesis could not be elucidated. A higher reporting rate was seen in children. Contra-indications: None Side effects: Mild or moderate vaginal bleeding may occur in girls in the first month of treatment. Concurrent use of cyproterone acetate for the first 2 weeks can minimise the risk of vaginal bleeding. Other common adverse effects are injection site reactions and arthralgia. Triptorelin does not have black triangle (▼) status. All serious suspected adverse reactions (even well recognised or causal link uncertain) should be reported to the MHRA. Drug interactions (see also above under cautions): When triptorelin is co-administered with drugs affecting pituitary secretion of gonadotrophins, caution should be given and it is recommended that the patient's hormonal status should be supervised. Drugs that raise prolactin levels should not be prescribed concomitantly as they reduce the level of LHRH receptors in the pituitary. No formal drug-drug interaction studies have been performed. The possibility of interactions with commonly used medicinal products, including histamine liberating products, cannot be excluded. Cost:: At current prices, (Drug Tariff and dm+d browser (▇▇▇▇▇://▇▇▇▇.▇▇▇▇▇▇.▇▇▇.▇▇/DMDBrowser/▇▇▇▇▇▇▇▇▇▇.▇▇#product) Dec 2019) one year’s treatment costs: Triptorelin 3.75 mg every 4 weeks costs £1061.97 Triptorelin 11.25 mg every 12 weeks costs £897