NANDROLONE DECANOATE

Clinical safety rating: caution

Comprehensive clinical and safety monograph for NANDROLONE DECANOATE (NANDROLONE DECANOATE).

How it works

Nandrolone decanoate is an anabolic-androgenic steroid (AAS) that binds to androgen receptors (AR). Upon binding, it activates AR-mediated gene transcription, leading to increased protein synthesis, muscle growth, and bone density. It also exhibits some estrogenic activity via partial aromatization and progestogenic effects. It stimulates erythropoietin production in kidneys, increasing red blood cell mass.

What the body does with it

Metabolism	Primarily hepatic via reduction and hydroxylation, involving 5α-reductase (to dihydronandrolone) and 3α-hydroxysteroid dehydrogenase. Major metabolite is 5α-estran-3β,17β-diol. Excreted in urine as glucuronide and sulfate conjugates.
Excretion	Renal: ~90% as metabolites (glucuronide and sulfate conjugates of 19-nortestosterone and its metabolites); fecal: ~6%; due to extensive hepatic metabolism, unchanged drug is not excreted in significant amounts.
Half-life	Terminal elimination half-life: approximately 6-7 days (range 4-14 days) after intramuscular injection; this long half-life supports every 2-4 week dosing intervals.
Protein binding	Approximately 95% bound to plasma proteins, primarily testosterone-estradiol-binding globulin (TeBG) and albumin.
Volume of Distribution	Apparent volume of distribution (Vd/F) is approximately 0.5-1.0 L/kg, indicating distribution into total body water and muscle tissue; crosses placental and blood-brain barriers.
Bioavailability	IM: ~100% (depot formulation releases slowly); oral: very low (<5%) due to extensive first-pass hepatic metabolism, thus not used clinically.
Onset of Action	Intramuscular (IM): ~1-2 weeks for measurable anabolic effects; full clinical effects may require 4-6 weeks of repeated dosing.
Duration of Action	Intramuscular (IM): therapeutic effects persist for 2-4 weeks after a single injection; residual effects may last up to 4-6 weeks due to slow release from the depot.

Classification & Brands

Action Class	Anabolic steroid
Brand Substitutes	Nandrolin 25mg Injection, Ndr 25mg Injection, Velbol 25mg Injection, Martilone 25mg Injection, Sensinorm 25mg Injection

Dosing & administration

50-200 mg intramuscularly every 2-4 weeks

Dosage form	Injectable
Renal impairment	GFR 30-60: reduce dose by 50%; GFR <30: avoid use
Liver impairment	Child-Pugh A: no adjustment; Child-Pugh B: reduce dose by 50%; Child-Pugh C: avoid use
Pediatric use	Not recommended for use in children
Geriatric use	Use with caution; consider reduced starting dose due to increased risk of fluid retention and cardiovascular effects

Use during pregnancy

1st trimester	Consult provider
2nd trimester	Consult provider
3rd trimester	Consult provider

Clinical note

Comprehensive clinical and safety monograph for NANDROLONE DECANOATE (NANDROLONE DECANOATE).

Breastfeeding	Nandrolone decanoate is excreted into breast milk. M/P ratio not determined. Due to potential adverse effects on the infant (androgenic effects, hepatotoxicity), breastfeeding is not recommended during therapy. A 10-day washout period after last dose may be considered.
Teratogenic Risk	Nandrolone decanoate is contraindicated in pregnancy. First trimester: Androgenic effects can cause virilization of female fetus, including clitoromegaly, labial fusion, and ambiguous genitalia. Second and third trimesters: Continued risk of fetal masculinization, potential for premature closure of epiphyseal plates, and growth retardation. Placental transfer occurs.

Warnings & precautions

■ FDA Black Box Warning

None. However, AAS may cause serious cardiovascular, hepatic, and psychiatric adverse effects. Use is contraindicated in pregnancy due to virilization of female fetus.

Side Effect Profile

Serious Effects

Absolute Contraindications

Hypersensitivity to nandrolone or any component, pregnancy (Category X) and breastfeeding, men with carcinoma of the breast or prostate, prepubertal males (may cause precocious puberty), and patients with severe hepatic or renal impairment.

Clinical Precautions

Precautions

Monitor liver function, lipid profile, and periodic blood counts. Cholestatic hepatitis and peliosis hepatis reported. Hypercalcemia may occur in immobilized patients. Edema due to fluid retention. Androgenic effects (hirsutism, acne) in women. Prolonged use may cause azoospermia and oligospermia. Use with caution in patients with cardiac or renal disease.

Clinical Tips & Counseling

Drug interactions

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NANDROLONE DECANOATE

Clinical safety rating: caution

Comprehensive clinical and safety monograph for NANDROLONE DECANOATE (NANDROLONE DECANOATE).

How it works

What the body does with it

Metabolism	Primarily hepatic via reduction and hydroxylation, involving 5α-reductase (to dihydronandrolone) and 3α-hydroxysteroid dehydrogenase. Major metabolite is 5α-estran-3β,17β-diol. Excreted in urine as glucuronide and sulfate conjugates.
Excretion	Renal: ~90% as metabolites (glucuronide and sulfate conjugates of 19-nortestosterone and its metabolites); fecal: ~6%; due to extensive hepatic metabolism, unchanged drug is not excreted in significant amounts.
Half-life	Terminal elimination half-life: approximately 6-7 days (range 4-14 days) after intramuscular injection; this long half-life supports every 2-4 week dosing intervals.
Protein binding	Approximately 95% bound to plasma proteins, primarily testosterone-estradiol-binding globulin (TeBG) and albumin.
Volume of Distribution	Apparent volume of distribution (Vd/F) is approximately 0.5-1.0 L/kg, indicating distribution into total body water and muscle tissue; crosses placental and blood-brain barriers.
Bioavailability	IM: ~100% (depot formulation releases slowly); oral: very low (<5%) due to extensive first-pass hepatic metabolism, thus not used clinically.
Onset of Action	Intramuscular (IM): ~1-2 weeks for measurable anabolic effects; full clinical effects may require 4-6 weeks of repeated dosing.
Duration of Action	Intramuscular (IM): therapeutic effects persist for 2-4 weeks after a single injection; residual effects may last up to 4-6 weeks due to slow release from the depot.

Classification & Brands

Action Class	Anabolic steroid
Brand Substitutes	Nandrolin 25mg Injection, Ndr 25mg Injection, Velbol 25mg Injection, Martilone 25mg Injection, Sensinorm 25mg Injection

Dosing & administration

50-200 mg intramuscularly every 2-4 weeks

Dosage form	Injectable
Renal impairment	GFR 30-60: reduce dose by 50%; GFR <30: avoid use
Liver impairment	Child-Pugh A: no adjustment; Child-Pugh B: reduce dose by 50%; Child-Pugh C: avoid use
Pediatric use	Not recommended for use in children
Geriatric use	Use with caution; consider reduced starting dose due to increased risk of fluid retention and cardiovascular effects

Use during pregnancy

1st trimester	Consult provider
2nd trimester	Consult provider
3rd trimester	Consult provider

Clinical note

Comprehensive clinical and safety monograph for NANDROLONE DECANOATE (NANDROLONE DECANOATE).

Breastfeeding	Nandrolone decanoate is excreted into breast milk. M/P ratio not determined. Due to potential adverse effects on the infant (androgenic effects, hepatotoxicity), breastfeeding is not recommended during therapy. A 10-day washout period after last dose may be considered.
Teratogenic Risk	Nandrolone decanoate is contraindicated in pregnancy. First trimester: Androgenic effects can cause virilization of female fetus, including clitoromegaly, labial fusion, and ambiguous genitalia. Second and third trimesters: Continued risk of fetal masculinization, potential for premature closure of epiphyseal plates, and growth retardation. Placental transfer occurs.

Warnings & precautions

■ FDA Black Box Warning

None. However, AAS may cause serious cardiovascular, hepatic, and psychiatric adverse effects. Use is contraindicated in pregnancy due to virilization of female fetus.