What are the uses, dosage, and side effects of the HCG injection? Discover the potential benefits and risks of this hormone treatment.

Unlocking the Potential of HCG Injections: A Comprehensive Overview

HCG, or human chorionic gonadotropin, is a hormone that plays a crucial role in various medical applications. This comprehensive guide aims to provide a thorough understanding of the uses, dosage, and potential side effects associated with HCG injections.

Uncovering the Diverse Uses of HCG Injections

HCG injections have a wide range of applications, from treating fertility issues to supporting normal sexual development in boys. Here’s a closer look at the primary uses of this hormone-based treatment:

Addressing Fertility Challenges in Women

HCG injections are often used in combination with other fertility medications, such as menotropins, to stimulate ovulation in women. This treatment can be particularly helpful for those struggling with infertility due to issues with egg release (ovulation).

Facilitating Proper Testicular Development in Boys

In pre-pubescent boys, HCG injections can help ensure the normal descent of the testicles into the scrotum. Additionally, HCG may be used to support healthy sexual development in certain boys.

Navigating the Dosage and Administration of HCG Injections

The dosage and frequency of HCG injections can vary depending on the individual’s age, weight, medical condition, and response to treatment. For boys, the typical regimen involves three weekly injections, while for women, a single dose is often administered after completing menotropin treatment.

It’s important to note that HCG injections should only be administered by a healthcare professional or under their close supervision. Proper preparation and storage of the medication, as well as safe disposal of needles and medical supplies, are crucial for ensuring the safe and effective use of HCG.

Potential Side Effects and Risks Associated with HCG Injections

While HCG injections are generally well-tolerated, there are several potential side effects and risks to be aware of:

Common Side Effects

Headache, restlessness, tiredness, and pain at the injection site are among the most commonly reported side effects. If these symptoms persist or worsen, it’s essential to inform your healthcare provider promptly.

Serious Side Effects

In rare cases, HCG injections may trigger more severe side effects, such as swelling of the hands, ankles, or feet; mental or mood changes; signs of early puberty in boys; and pain or swelling in the breast area (for boys). Seek immediate medical attention if you experience any of these serious side effects.

Ovarian Hyperstimulation Syndrome (OHSS)

One of the most concerning potential complications of HCG treatment is the development of ovarian hyperstimulation syndrome (OHSS). This condition can cause a sudden buildup of fluid in the abdomen, chest, and heart area, and requires immediate medical intervention. Be vigilant for symptoms like severe pelvic pain, nausea, vomiting, weight gain, and decreased urination, and seek emergency care if they arise.

Weighing the Risks and Benefits: Is HCG the Right Choice?

When considering HCG injections, it’s essential to weigh the potential benefits against the risks. Your healthcare provider will carefully evaluate your medical history and current condition to determine if this treatment is appropriate and safe for you. Remember, the decision to use HCG should be made in close consultation with your medical team, considering your unique circumstances and health needs.

Staying Vigilant: Monitoring and Reporting Side Effects

If you are prescribed HCG injections, it’s crucial to remain vigilant and report any side effects or concerning symptoms to your healthcare provider immediately. By proactively monitoring your well-being and communicating with your medical team, you can help ensure the safe and effective use of this medication.

In conclusion, HCG injections can be a valuable tool in addressing specific medical needs, such as fertility issues and testicular development in boys. However, it’s essential to understand the potential risks and side effects associated with this treatment. By working closely with your healthcare provider and remaining attentive to your body’s response, you can make an informed decision and maximize the benefits of HCG injections while minimizing the risks.

HCG Intramuscular: Uses, Side Effects, Interactions, Pictures, Warnings & Dosing

Uses

This medication is a hormone used in boys (before puberty) to cause the normal dropping of the testicles into the scrotum. It is also used in certain boys to help with normal sexual development. It works by causing the testes to release male sex hormones (such as testosterone).This medication is also used in women to treat fertility problems. It is given after finishing another medication (menotropins) to cause the release of an egg (ovulation). It should not be used in women whose ovaries no longer make eggs properly (primary ovarian failure).This medication has not been shown to be effective for weight loss and should not be used for this purpose due to risk of serious side effects.

How to use HCG Solution, Reconstituted (Recon Soln)

This medication is given by injection into a muscle, usually by a health care professional.

The dosage is based on your age, weight, medical condition, and response to treatment.

For boys, use this medication usually 3 times a week or as directed by your doctor. For women, use this medication usually for 1 dose after finishing your menotropins treatment.

Use this medication regularly to get the most benefit from it. To help you remember, mark the day(s) on the calendar when you need to receive the medication.

If you are using this medication at home, learn all preparation and usage instructions from your health care professional. Before using, check this product visually for particles or discoloration. If either is present, do not use the liquid. Inject this medication into a muscle as directed by your doctor. Learn how to store and discard needles and medical supplies safely.

Side Effects

Headache, restlessness, tiredness, or pain at injection site may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.

Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

Tell your doctor right away if you have any serious side effects, including: swelling of the hands/ankles/feet, mental/mood changes (such as depression, irritability), signs of early puberty in boys (such as facial/pubic hair, voice change, acne), pain/swelling of the breast (in boys), unusual vaginal bleeding (women).

This medication may cause a condition known as ovarian hyperstimulation syndrome (OHSS). This condition may occur during or after treatment. Rarely, serious OHSS causes fluid to suddenly build up in the stomach, chest, and heart area. Get medical help right away if you develop the following side effects: severe pain or swelling in the lower abdominal (pelvic) area, severe nausea/vomiting, sudden/rapid weight gain, or decreased urination.

Get medical help right away if you have any very serious side effects, including: chest/jaw/left arm pain, sudden severe headache, confusion, weakness on one side of the body, trouble speaking, sudden vision changes, pain/redness/swelling in the legs.

A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing, shortness of breath.

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

In the US – Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.

In Canada – Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

Precautions

Before using this medication, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before using this medication, tell your doctor or pharmacist your medical history, especially of: early puberty (in boys), blood clots, heart disease (such as chest pain, heart attack), high blood pressure, kidney disease, liver disease, lung problems (such as asthma), migraine, seizure disorder, stroke, unusual vaginal bleeding, problems of the uterus, unexplained ovarian cyst/enlargement, certain type of fertility problem (primary ovarian failure), thyroid problem, adrenal gland problem, cancer of the reproductive organs (breast, uterus, ovary, prostate), brain tumor.

This medication should not be used during pregnancy. If you become pregnant or think you may be pregnant, tell your doctor right away.

When this medication is used in women to treat infertility, it may cause multiple births (such as twins, triplets).

It is unknown if this drug passes into breast milk. Consult your doctor before breast-feeding.

Interactions

Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor’s approval.

A product that may interact with this drug is: gonadorelin.

This medication may interfere with certain lab tests (including luteinizing hormone-LH/follicle stimulating hormone-FSH levels), possibly causing false test results. Make sure lab personnel and all your doctors know you use this drug.

Does HCG Solution, Reconstituted (Recon Soln) interact with other drugs you are taking?

Enter your medication into the WebMD interaction checker

Overdose

If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

Do not share this medication with others.

If you miss a dose, ask your doctor or pharmacist right away for a new dosing schedule.

Store the vials of powder at room temperature away from light and moisture. Store the mixed medication in the refrigerator. Write the date when the medication was mixed on the vial. The mixed medication must be used within 1 to 2 months, depending on the product. Check the product package for the storage time for your product. Keep all medications away from children and pets.

Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

Selected from data included with permission and copyrighted by First Databank, Inc. This copyrighted material has been downloaded from a licensed data provider and is not for distribution, except as may be authorized by the applicable terms of use.

CONDITIONS OF USE: The information in this database is intended to supplement, not substitute for, the expertise and judgment of healthcare professionals. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or anyone else. A healthcare professional should be consulted before taking any drug, changing any diet or commencing or discontinuing any course of treatment.

Testosterone, Weight Loss, Side Effects & More

The Food and Drug Administration (FDA) has approved hCG injections to treat specific medical conditions. In females assigned at birth (FAABs), they can help treat infertility. In males assigned at birth (MAABs), they can treat a type of hypogonadism.

Human chorionic gonadotropin (hCG) is sometimes called “the pregnancy hormone” because of its important role in maintaining pregnancy.

Pregnancy tests check hCG levels in the urine or blood to determine if a person is pregnant or not.

Read on to learn how it can be used for MAABs.

There are a variety of reasons why a doctor might prescribe hCG to a man.

To help address hypogonadism

In men, doctors prescribe hCG to help address the symptoms of hypogonadism, such as low testosterone and infertility. hCG can help the body increase its production of testosterone and sperm, which can help reduce infertility.

To improve testosterone deficiency

Injections of hCG are also sometimes used as an alternative to testosterone products in MAABs with testosterone deficiency.

Testosterone deficiency is defined as testosterone blood levels less than 300 nanograms per deciliter (ng/dL) along with symptoms of low testosterone. These include:

• fatigue
• stress
• a low sex drive
• depressed mood

According to the American Urological Association, hCG is appropriate for those MAABs with testosterone deficiency who also desire to maintain fertility.

Testosterone products boost levels of the hormone in the body but can have the side effects of shrinking the gonads, altering sexual function, and causing infertility.

hCG can help increase:

• gonad size
• testosterone levels
• fertility

Some doctors believe that using testosterone along with hCG may help improve symptoms of testosterone deficiency while preventing some of testosterone’s side effects.

To improve sexual function

hCG may also help improve sexual function in MAABs who don’t experience improvement while on testosterone.

To reverse steroid side effects

Bodybuilders who take anabolic steroids such as testosterone also sometimes use hCG to help prevent or reverse some of the side effects steroids cause, such as gonad shrinkage and infertility.

In men, hCG acts like luteinizing hormone (LH). LH stimulates Leydig cells in the testicles, which results in the production of testosterone.

LH also stimulates production of sperm within structures in the testicles called seminiferous tubules.

As hCG stimulates the testicles to produce testosterone and sperm, the testicles grow in size over time.

Very little clinical research has evaluated hCG in MAABs with low testosterone levels.

In a small 2002 study of older MAABs with partial hypogonadism, hCG increased testosterone levels compared to a placebo control. However, hCG had no effect on sexual function.

In one 2005 study, MAABs taking testosterone along with hCG were able to maintain testosterone production in the testicles.

In a 2013 study, MAABs taking testosterone along with hCG were able to maintain adequate sperm production.

According to a 2018 study, hCG can help MAABs with hypogonadism preserve their fertility, whether it’s used alone or in combination with testosterone. It can help restore sperm production as well.

A small 2019 study concluded that hCG was safe and effective for MAABs who experience the symptoms of hypogonadism but have testosterone levels above 300 ng/dL. Testosterone levels above 300 ng/dL are widely considered normal.

For men, the most common side effects of hCG injections include:

• gynecomastia, or the growth of male breasts
• pain, redness, and swelling at the injection site
• stomach pain
• nausea
• vomiting

In rare cases, people taking hCG have developed blood clots. Although also rare, allergic reactions can occur, including mild skin rashes and severe anaphylactic reactions.

hCG is sometimes used for weight loss. Several products are available that are marketed as over-the-counter (OTC) homeopathic hCG products for weight loss.

However, the FDA has warned that it hasn’t approved hCG products for the purpose of weight loss. Any OTC products claiming to contain hCG aren’t legally authorized, either.

The FDA has also advised consumers that there’s no substantial evidence that hCG works for weight loss.

These products are often used as part of an “hCG diet. ” This typically involves taking hCG supplements while following a low calorie diet of 500 calories per day.

Although this low calorie diet can help reduce weight, there’s no evidence that using hCG products helps.

Additionally, this extremely low calorie diet can be unsafe for many people. Possible side effects of extremely restrictive diets include:

• gallstones
• electrolyte imbalances
• arrhythmias

When used appropriately with the guidance of your doctor, hCG is safe.

It shouldn’t be used by MAABs with prostate cancer, certain brain cancers, or uncontrolled thyroid disease.

Talk with your doctor about other medical conditions you may have before using hCG.

hCG is produced from hamster ovary cells. People with an allergy to hamster protein shouldn’t take hCG.

You should avoid all OTC hCG products, since none of them have been FDA approved. The FDA warns against using these products or following the hCG diet.

hCG is an FDA-approved medication for treating specific conditions in both FAABs and men.

In men, it seems to have an important role as an alternative to testosterone for boosting testosterone levels and maintaining fertility.

Some doctors are prescribing it in conjunction with testosterone products for testosterone deficiency to help maintain fertility and sexual function.

Some people are also using hCG for weight loss, often as a component of the hCG diet. However, there’s no reliable evidence that hCG works for this purpose. Due to concerns about its safety, it should be avoided as a weight loss aid.

hCG, human chorionic gonadotropin, indications for the appointment, rules for preparing for the test, interpretation of the results and norm indicators.

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We remind you that independent interpretation of the results is unacceptable, the information below is for reference only.

Human chorionic gonadotropin (hCG, β-hCG, beta-hCG, Human Chorionic Gonadotropin): indications for the appointment, rules for preparing for the test, interpretation of the results and normal indicators.

Chorionic gonadotropin is a hormone produced by the outer shell of the embryo, and is normally determined in the blood and urine of a woman only when pregnancy occurs.

Human chorionic gonadotropin (hCG, beta-hCG, b-hCG, Human Chorionic)

Synonyms: Beta hCG generic.

Human Chorionic Gonadotropin; hCG; Pregnancy Quantitative hCG; Beta hCG; Total beta hCG.

Brief description of the analyte Human Chorionic Gonadotropin…

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Chorionic gonadotropin consists of two subunits – alpha and beta. The beta subunit (β-hCG) used for the immunometric determination of the hormone is unique. To monitor the course of pregnancy, the determination of the beta subunit of hCG is used. The level of beta-hCG in the blood as early as 6-8 days after conception makes it possible to diagnose pregnancy (the concentration of β-hCG in the urine reaches the diagnostic level 1-2 days later than in the blood serum).

hCG has a multifaceted effect on the body of a pregnant woman: it affects the development of the embryo and fetus, stimulates the synthesis of estrogens and androgens by ovarian cells, promotes the functional activity of the chorion and placenta, and ensures the successful course of pregnancy.

The introduction of hCG into the body of non-pregnant women stimulates ovulation and the synthesis of sex hormones necessary for conception. In men, this hormone enhances the formation of seminal fluid, activates the production of gonadosteroids.

In early pregnancy and up to the 2nd trimester, β-hCG supports the production of hormones necessary to maintain pregnancy, and in male fetuses it stimulates cells responsible for the formation and development of the male reproductive system.

Indications for determining the level of hCG in women

1. Absence of menstruation (amenorrhea).
2. Exclusion/confirmation of pregnancy, including ectopic (ectopic).
3. Diagnosis of the condition of the fetus at different stages of pregnancy.
4. Assessment of the state of the placenta at different stages of pregnancy.
5. Dynamic monitoring of fetal development during pregnancy, including in the diagnosis of malformations.
6. Suspicion of the presence of neoplastic diseases of the reproductive system, such as hydatidiform mole (a rare pathology of the fetal egg, in which instead of developing the embryo, chorionic villi grow), chorionepithelioma (a malignant tumor that develops from the epithelium of the villi of the fetal egg).
7. Performing artificial termination of pregnancy.

Indications for determining the level of hCG in men:

The presence of suspicion of tumors of the testicles.

Deadline for this test is 1 working day, excluding the day of taking the biomaterial.

Rules for preparing for a blood test to determine the level of hCG

non-specific: it is enough to refrain from smoking and drinking alcohol on the eve of the procedure, limit stress and intense physical activity for a week; blood donation is carried out on an empty stomach.

The determination of hCG in the blood is possible already on the 6-8th day after conception. The use of urinary test systems (rapid pregnancy tests) will be informative starting from the 7th day after the fertilization of the egg. To confirm the result, it is recommended to re-determine the level of the hormone a few days after the first analysis.

You can take a blood test for hCG (thyroid stimulating hormone, thyrotropin, Thyroid StimulatingHormone, TSH) at the nearest INVITRO medical office. The list of offices where biomaterial is accepted for laboratory testing is presented in the “Addresses” section.

Reasons leading to high levels of β-hCG

1. Multiple pregnancy.

2. Wrong timing of pregnancy.

1. Pathological pregnancy: the appearance of edema, increased blood pressure, loss of protein in the urine (preeclampsia), convulsions (eclampsia), toxicosis.
2. The presence of a pregnant woman with chronic diseases (for example, diabetes mellitus).
3. Multiple fetal malformations (in such a situation, the determination of the level of β-hCG is used together with other indicators, the so-called “triple test”. This study is used as a screening, and not for diagnosis.).

Reasons for fixing a decrease in the level of β-hCG

1. Incorrectly established terms of pregnancy.
2. Ectopic pregnancy.
3. Frozen pregnancy.
4. Threat of miscarriage.
5. Fetal or placental disorders (including placental insufficiency).
6. Intrauterine fetal death (in this case, it is informative to determine the level of the hormone in the first and second trimesters).

During abortions, the level of β-hCG is also monitored, the dynamics of growth / fall of which can be used to judge the completeness of the manipulation.

Determining the level of hCG, in addition to establishing the fact of pregnancy in the early stages, is part of the screening examination of pregnant women in the first trimester, along with ultrasound.

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Screening ultrasound 1st trimester of pregnancy (11-13 weeks 6 days)

Examination necessary to monitor the growth and development of the fetus in the first trimester of pregnancy.

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In gynecological practice, human chorionic gonadotropin is used to treat infertility, stimulate ovulation, and synthesize sex steroids. In urology, it is used in the treatment of cryptorchidism (undescended testicles) and infertility associated with impaired spermatogenesis.

Quantitatively, β-hCG is determined in the blood, for a qualitative determination, special test systems (pregnancy tests) are used, and in this case, urine serves as a biomaterial.

Quantitative determination of the level of hCG allows you to monitor the course of pregnancy in dynamics. To do this, obstetrician-gynecologists have developed tables for increasing the level of hCG, depending on the duration of pregnancy in weeks. The sensitivity of the determination is in the range of 1.2-1125000 mU/ml.

Reference values ​​of hCG levels in dynamics by gestational age

Values ​​ranging from 5 to 25 mU / ml do not allow unambiguous confirmation or denial of pregnancy, therefore, a second study is required after two days.

Since the hormone is produced by the placenta, during normal pregnancy, with placental pathology (for example, with fetoplacental insufficiency – a violation of the development of the fetus and placenta), with multiple pregnancies, the values ​​of β-hCG will differ. With a normal pregnancy until the fifth week, the level of the hormone rises exponentially: every two days its concentration doubles, reaching a peak by the 11th week of gestation. Accordingly, in a multiple pregnancy, the level of β-hCG will be even higher than in a single pregnancy.

If the indicator deviates from the norm, additional ultrasound of the pelvic organs (uterus, appendages) is required.

US examination of pelvic organs (uterus, adnexa)

Ultrasound scanning of the organs of the female reproductive system to assess the shape and size, as well as exclude pathology.

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However, with a normal hCG value, additional examinations may also be needed:

1. Ultrasound diagnosis of pregnancy (required to confirm pregnancy, clarify the term).

Ultrasound diagnosis of pregnancy

Examination to confirm pregnancy and determine the place of attachment of the ovum (to exclude ectopic pregnancy).

RUB 2,390

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2. Screening ultrasound of the 1st trimester of pregnancy (11-13 weeks 6 days) – to assess the characteristics and confirm the normal development of the fetus.

Screening ultrasound of the 1st trimester of pregnancy (11-13 weeks 6 days)

Examination necessary to monitor the growth and development of the fetus in the first trimester of pregnancy.

RUB 3,090

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3. Screening ultrasound of the 1st trimester of multiple pregnancy (11-13 weeks 6 days) – to confirm the presence of several fetuses, determine their characteristics; It is necessary for planning the subsequent actions of the doctor and the management of pregnancy.

Screening ultrasound of the 1st trimester of multiple pregnancy (11-13 weeks 6 days)

Examination to assess the growth and development of fetuses, their position in the uterus, and make a plan for further pregnancy management.

RUB 3,990

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4. Fetal ultrasound according to indications (before the 20th week) – performed in case of suspected ectopic pregnancy.

Fetal ultrasound according to indications (before the 20th week)

Additional ultrasound, which is prescribed in the presence of concomitant pathologies to monitor the condition of the fetus.

RUB 2,790

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5. Lab tests to be performed in the first trimester are collected in the Pregnancy: 1st trimester (1-13 weeks) profile.

For professional assistance in interpreting the results, contact

obstetrician-gynecologist

.

Sources:

1. www.invitro.ru
2. Clinical guidelines “Ectopic (ectopic) pregnancy”. Developed by: Russian Society of Obstetricians-Gynecologists, Association of Obstetric Anesthesiologists-Resuscitators. – 2021.
3. Clinical guidelines “Premature birth”. Developed by: Russian Society of Obstetricians-Gynecologists, Association of Obstetric Anesthesiologists-Resuscitators. – 2020.

IMPORTANT!

The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.
For a correct assessment of the results of your analyzes in dynamics, it is preferable to do studies in the same laboratory, since different laboratories may use different research methods and units of measurement to perform the same analyzes.

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Vaccination against pneumococcal infection in Dolgoprudny

Vaccination against pneumococcal infection in Dolgoprudny | Medical Clinic Your Health

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Description

Pneumococci are common causative agents of pneumonia. This is a dangerous disease with many possible complications. The infection causes inflammation in the lung air sacs, or alveoli, which fill with fluid and pus. For people over 65 there is a risk of death. To avoid infection, vaccination against pneumococcal infection is carried out. You can get vaccinated at the clinic “Your Health” in Dolgoprudny. We have experienced specialists and offer high-quality pneumonia vaccines.

Indications and contraindications

The pneumococcal vaccine is not considered routine. But doctors recommend doing it to children at the age of 2, 4, 6, and then 12-15 months. Patients under 65 years of age are vaccinated with a single dose. Preparations and its volumes are selected individually:

• people with HIV;
• asthma;
• chronic heart disease and other diseases

Vaccination against pneumonia is contraindicated in patients who have had an allergy to the components of the drug. Before putting the vaccine, you should consult a doctor and find out if there are any restrictions and conditions that can cause complications.

Types of vaccines

The type of vaccine is selected for each patient individually, depending on his age, the presence of concomitant diseases, bad habits and other factors. There are 2 types of drugs: PCS13 and PSV23.

The first, pneumococcal conjugate vaccine, targets young children, people over 65, and older patients with underlying conditions. It creates immune protection against 13 strains of infection.

PPV23, or pneumococcal polysaccharide vaccine, is for people over 65, smokers, and people with certain chronic conditions. It protects against 23 strains of the infection that causes bacterial pneumonia.

It should be understood that the pneumococcal vaccine does not reduce the risk of disease, but reduces the number of invasive and non-invasive pathologies such as endocarditis, meningitis, sinusitis and others. The effectiveness of drugs varies depending on the age of the patient, the presence of chronic diseases, the state of the immune system and other factors.

The pneumococcal vaccine rarely causes side effects, but the following can potentially occur after administration of the drug:

• swelling, redness at the injection site;
• chills, fever;
• headache;
• fatigue;
• muscle pain.