Pills against lactation Assistrates side effects. Reservations Instructions for use, contraindications, side effects, reviews. What is better: reaches or bromocriptine

The production of breast milk is a natural process that runs with the birth of a child in a woman and is regulated by prolactin and oxytocin hormones. On average, the lactation lasts 15-18 months and gradually fades.

The involution of lactation is manifested as follows:

the amount of milk produced is significantly reduced, the child ceases to ride even after applying to both milk glands;
a woman is experiencing psychological and physical fatigue, it feels the need to stop feeding;
the child is more likely and often sleeps all night long, skipping night feeding;
a woman calmly transfers long-term breaks between feeding (from 12 o'clock), the chest is not overwhelmed with milk.

If there are signs of natural lactation extrusion, without prejudice to mom and baby.

But in some cases there is a need to stop lactation to its involution. The reason can be:

the age of a child who has already moved to ordinary food;
the need to treat moms with drugs that are incompatible with breastfeeding;
forced separation of mom with a child, etc.

Interruption of breastfeeding can be a serious stress and for mom, and for a baby. It is recommended to stop feeding gradually, reducing the daily amount of applying to the chest. If circumstances require dramatically stop lactation, the mother needs to consult with breastfeeding consultants in order not to harm their body.

The traditional folk methods of stopping milk generation enters the chest dense pulling for several days - while the milk "does not overheam". This method practiced by women for long time, not only gives serious discomfort, but also bears the danger of the inflammatory process.

When breast dragging, blood circulation in the tissues of the mammary glands is disturbed, and the ducts are cleaned with milk clots. Intensive lactation in such conditions leads to the stagnation of milk (), the formation of painful seals in the chest. Next may develop, which requires serious treatment until surgery.

Another "folk" way to stop lactation is to dehydrate the body. Restrictions in food and drink will lead to a decrease in milk generation only with the serious exhaustion of the mother's body. This method extremely negatively affects the physical health of the mother and the state of its nervous system, it cannot be recommended for use.

To reduce the production of milk after the cessation of breastfeeding, it is possible to use the herbs with a diuretic and campphic effect. Excess fluids are removed from the body, without processing milk, and over time, lactation fuses.

In the number of herbs, helping to get rid of excess fluid, includes a lingonberry, tolkin, nine, parsley garden. There are herbs whose action contributes to stopping lactation, in particular, this.

Tightening the chest and reducing the amount of fluid entering the body do not relate to efficient and safe methods for stopping lactation. The production and separation of milk is regulated by hormones, so today the market presents effective, with which the lactation can be stopped. The list of such funds includes the achievement.

Medical intervention should also be taken seriously: you can take tablets only with the permission of the doctor and carefully examined the instructions for the drug. The medicine suppresses the synthesis of prolactin by the pituitary, thanks to which the milk generation stops in a short time.

Medical method: Tablet reception efficiency

Reservations, drug against lactation, should not be taken uncontrollably. The hormonal agent has a number of contraindications and may cause side effects that can extremely negatively affect women's health. Before resorting to medication treatment, a nursing mother should be consulted in a gynecologist or therapist.

The active substance of tablets is a reacgoline, which acts directly on the pituitary gland and suppresses the synthesis of prolactin. Reducing the level of prolactin in the blood of a woman leads to a decrease in milk generation. The results of the reaction of the reaches can be noticed quite quickly - the lactation begins to significantly decrease after three hours after the first reception of the tablet.

The reduction rate of the concentration of the prolactin hormone in the blood directly depends on the dose of the drug that takes the woman. With long-term reception of pills, the pituitary gland produces less and less prolactin.

Cabergoline, active ingredient of the drug, is maintained in the blood for another 1-4 weeks after the discretion of the drug reservation. The longer the course of treatment, the longer in the blood of the woman will be preserved traces of the drug.

Treatment diagram of drug

The termination of lactation by the drug method should be carried out under the control of the doctor. When prescribing a medicinal product, it is necessary to take into account chronic diseases of the patient, pay attention to the current state of its health. The doctor must prevent the possible serious side effects.

The reception scheme is selected individually or assigned according to the instructions. If you need to suppress the established lactation, the drug should be taken 2 times a day at 0, 25 mg (half of the tablet). The course of treatment is 2 days, the total dose of the drug is 1 mg.

When the specified single dosage is exceeded, the risk of orthostatic hypotension increases (dizziness and fainting due to insufficient blood flow to the brain due to reduced blood pressure).

Contraindications

The achievement has serious interference in the functioning of the body, so before taking the drug, it should be verified in the absence of contraindications, which include increased sensitivity to the components of the drug - Cabbergolin, alkaloids of the ardines, etc.

A number of diseases and states are the basis for a particularly attentive purpose of the drug, overwhelming the production of breast milk:

arterial hypertension provoked by pregnancies;
cardiovascular diseases in severe form;
gastrointestinal bleeding, peptic ulcer;
liver failure in hard form;
breath disorders;
serious psychotic disorders;
reception of hypotensive drugs.

Given the condition of the patient's health, the doctor may prescribe a reduced dose of the drug. In this case, to suppress the production of prolactin, it will take longer to take the drug, compensating for the reduction of one-time dosage.

Side effects

Receiving tablets is often accompanied by side effects of varying severity. According to the results of clinical studies, about 14% of women noted a noticeable deterioration in well-being.

Heavy side effects, due to which the drug had to stop, was recorded in 3% of patients.

In the instructions for the drug, the most common manifestations of side effects are indicated. The reaction of the body's body to receive tablets can be expressed as follows:

rapid heartbeat, a noticeable decrease in blood pressure;
abdominal pain, dyspepsia, nausea, vomiting, constipation, gastritis;
drowsiness, dizziness, headache, fast fatigue, fainting, sensitivity disorder (paresthesia), depression;
nasal bleeding, cramps of foot muscles, soreness and heat of the mammary glands (medium).

To create the most comfortable setting for the baby, energized from the mother's chest, it is necessary to pay much more attention to him. The stressful situation negatively affects the health of the child, he can be capricious more than usual, to experience discomfort.

If a nursing mother decided to suppress the lactation by a medication method, it should be ready for the fact that in the coming days it will have to take care of the child, overcoming physical ailments, perhaps quite strong enough.

Before starting acceptance, it is important to examine the instructions in detail and pay attention to the symptoms of the drug overdose.

In the occurrence of hypotension, nausea and vomiting, disorders of digestive, psychosis, signs of confusion or hallucinations, it is necessary to cause vomiting as quickly as possible, rinse the stomach and take a drug that increases blood pressure.

According to the advice of the popular doctor of Komarovsky, the reception of the drug is best planned at the end of the week, trusting the baby on the weekend grandmother or other close people. The medicine is accepted within two days, and it is at this time that the risk of side effects is the most large, the mother decreases pressure and it is preferably more resting.

A woman should not stay at home one - strong dizziness and loss of consciousness are possible. It is important to control the well-being when taking a potent medication and, if necessary, call for ambulance.

Restoration of lactation

Sometimes the suppression of lactation is necessary for a certain period of time, after which the mother can continue to feed the child with breasts. If the cessation of milk production was achieved due to the use of the drug affecting the pituitary gland, over the course of the month should be refracted from natural feeding.

Protection developers did not provide confirmed Cabergolin security information for babies. The active substance, traces of which are long stored in the blood of the mother, can get into breast milk and negatively affect the health and development of the baby.

Prior to the complete removal of Kabergoline from the body of the mother, she should regularly grind breast milk, restoring lactation. Then you can continue to feed the child, providing him with full nutrition and good immunity.

Prolactin is called a hormone, which is produced in a pituitary gland located in the brain. Both for women and for men, the level of this hormone in the blood is extremely important. Its content in the amount of above the norm practically reduces the functioning of the reproductive system of a person. A woman will not be able to become pregnant, and a man can decrease libido and develop impotence.

In order to solve this problem, special medical preparations have been developed, one of which is "achievek". Reviews with elevated prolactin characterize this tool as quite effective.

What is "achievek"?

"Assistrate" is called a drug, designed to fight hyperprolactinemia and a different kind of disease, by it provoked and combined with it. That is, the medication will be effective in such problems as menstruation for several cycles), infertility, galathery (allocation of milk of milk glands, not related to child feeding), prolactin-secreting pituitary adenoma, acromegaly (violation of the functioning of the front lobe of the pituitary, which is accompanied by thickening of brushes, stop, skull).

The main component of the component of the drug - Cabergolin, lactose and leucine are actuated as auxiliary. Forms of the issue of "reaches" - tablets of 0.5 mg, in one package - 8 pieces. The essence of the drug action - blocking the production of prolactin, which, for example, in the female body makes it possible to reap the follicle in a timely manner, restore the menstrual cycle. As a result, a normal ovulation occurs, a woman has the likelihood of pregnancy.

Blood prolactin

When after passing analyzes to hormones in the blood, the treatment of therapeutic measures was found in the blood - most often the applied scheme of therapeutic measures. As for women, the blood for analysis is recommended to take from the 3rd to the 8th day of the menstrual cycle (the countdown is from the first day of menstruation). The analysis should be handed over an empty stomach, preferably no later than 2-3 hours after awakening. Before passing an analysis, it is recommended to exclude large physical exertion, avoid stressful situations, to abandon sex, do not eat sweets.

In the blood of a person prolactin is contained in several forms. The monomer shape of this hormone is the largest share - up to 80%. Dimeric prolactin is contained in an amount of from 5 to 20% of the total volume of hormone, and tetramerous - no more than 5%.

The following indicators of the level of prolactin in the medical environment are considered the norm in the medical environment:

For women not pregnant - 4-49 ng / ml (permissible oscillations depending on the phase of the menstrual cycle);
. For women of pregnant women - 34-386 ng / ml (permissible oscillations depending on the period of pregnancy);
. For men - 2.5-17 ng / ml.

Symptoms and reasons for increased prolactin in women

After the fact of increased prolactin is established, it is necessary to conduct certain studies to establish the reasons. That is, before recommending the "reachars" with increased prolactin, usually the attending physician appoints a tomogram of brain, radiography, an eye examination, etc., and so on.

As a rule, in most cases the cause of the increased content of hormone-prolactin is the following factors:

The presence of prolactinoma (neoplasm in the pituitary gland is usually benign - producing prolactin in large volume).
. Polycystic ovarian.
. Hypothyroidism is the insufficiency of the production of hormones thyroid gland.
. Anorexia (weight lack) and some other internal organs.

Usually the body of the woman signals the elevated level of prolactin by a certain set of symptoms. Of the most frequently noted - deviations in the menstrual cycle, weight gain, quickly coming fatigue, development of depression, sleep disorders.

Next, the patients talk about the appearance of acne and excessive heights of the hair in places that are not characteristic of the female organism (face, area around the nipples, etc.). And the developed infertility, which occurred due to the lack of ovulation or too short lutein phase, also strong grounds for the doctor to appoint "Austhesk". Reviews with most often have a positive orientation and testify to the effectiveness of the drug.

Symptoms and reasons for increased prolactin in men

Unlike women, men have a high level of prolactin content in the composition of blood is secondary in nature - this is most often a consequence of the already existing problem. In the presence of such a factor, as elevated prolactin in men, the "achievek" is appointed to receive in parallel with medicines recommended by the doctor to combat the detected disease.

Improving the level of prolactin in representatives of the strong half can provoke diseases such as prolactinoma (brain tumor, most often a benign, producing prolactin), hypothyroidism (decrease in the function of the thyroid gland), heavy (with impaired functioning) of the liver and kidney disease, reduction of adrenal cortex function, different The genus of the disease and tumors of the brain. In addition, an increase in the level of prolactin in men can be provoked by the reception of some drugs - opiates, neuroleptics, antidepressants, etc.

The main symptom of the excessive content of this hormone in the blood in men is the same as in women - a violation of the reproductive function, in most cases accompanied by deviations in fat and carbohydrate exchanges (obesity). The man decreases sexual attraction, the symptoms of impotence develop. Sometimes the increase in the mammary glands and small allocations of them are recorded.

If the cause of the development of hyperprolactinemia is prolactinoma, then various manifestations in the field of neurology are quite early. Everything can begin with headaches, dizziness and a slight impairment of vision. If no measures have been taken to resolve the problem, over time, the paralysis of the glazation muscles is developing, the omission of the century, bone in the eyes and the like. In parallel with this symptomatics, the patient decreases performance, irritability, anxiety appears, a tendency to depressive states, the impossibility of concentrating attention, reducing memory. Often men develop type 2 diabetes mellitus, atherosclerosis. All these symptoms, the doctor may consider sufficient grounds for appointing a "Assistsek" medication. Reviews with elevated prolactin in men speak good effect from the use of the drug while complying with the Doctor's recommendations.

"Assistseks" and pregnancy

In general, women in reproductive age should know that pregnancy is one of the main contraindications for the use of the "Assist" tool. Reviews with elevated prolactin (pregnancy itself is the cause of the gradual growth of the level of prolactin in the blood of a woman), whatever they have been positive, should not be misleading a woman.

The level of prolactin in the body of a woman who is carrying a child begins to grow gradually, starting from the 8th week and reaching maximum values \u200b\u200bby a period of 20-25 weeks. This hormone, besides, which prepares women's dairy glands to the future feeding of the baby, also has a strong effect on the formation of the pulmonary tissue of a developing baby.

Before starting treatment, the "Assistory" must necessarily eliminate pregnancy and throughout the course of treatment to use mechanical methods of contraception. If the fact of the occurrence of pregnancy is registered already on the background of the beginning of the course of treatment, it is necessary to stop receiving the "reaches".

The period of semi-anniversary of Cabergolin (the main current component of the medication) is sufficiently long. Therefore, if a woman is further plans to pregnancy, the reception of "reaches" should be discontinued no later than 1 month before the intended conception in order to eliminate the likelihood of developing negative consequences for the fetus.

Medication application schemes

How correctly drinking "reaches" with increased prolactin, should notify your patient. The standard diagram of receiving this medication is one (maximum two) times during the week, while eating. If the reason for the appointment of "reaches" is hyperprolactinemia, the maximum amount of the drug during the week should not be more than 4.5 mg (you should smash several receptions). After the start of the course of therapy, patients must monitor the level of prolactin in the composition of the blood and take the corresponding analyzes monthly. Typically, the indicators come to the norm already after 2-4 weeks from the beginning of treatment.

In the event that a woman for some reason wants to prevent postpartum lactation, 1 mg of the drug is prescribed once on the first day after delivery. How to take "reaches" with increased prolactin if the lactation process already established?

Negative manifestations

In the main mass of cases about the "Assist" media. Reviews with elevated prolactin are positive. The drug in the medium of health workers is considered highly efficient, practically not causing side manifestations. And yet some negative effects are observed. Quite often you can hear about the decrease in blood pressure, head Pacifics and dizziness, insomnia, nausea and pain in the area of \u200b\u200bthe gastrointestinal tract.

Naturally, there are also negative about the preparation "Assectory" reviews with elevated prolactin. Side effects can manifest themselves in the development of gastritis, vomiting, constipation, in the appearance of drowsiness and weakness, in the "tides" of blood into the face, in the appearance of depression and paresthesium, in the painful stress of the mammary glands.

True, it is worth saying that all these manifestations are almost never pronounced. Most side effects are observed at the very beginning of treatment - during the first two weeks. If the dosage is somewhat lowered - negative symptoms will disappear. After that, it is possible to increase the dose to efficiently again. With the complete abolition of "reaches", negative symptoms will disappear within 1-2 days.

Contraindications for the reception of "reaches", overdose

Contraindications of this medicinal product are a bit, but they are. First, hypersensitivity to the components of the drug (to all derived disputes including). Secondly, pregnancy. The question of how to drink "reaches" with increased prolactin during pregnancy, is not worth it - it is unacceptable for a woman waiting for the appearance of a baby. In addition, medication cannot be taken during lactation, if a woman has no good reasons for emergency termination of this process. Next, doctors are not recommended to accept the "reaches" of those guides that have postpartum hypertension and (even a history).

With great care and under constant control to their health condition, patients with cardiovascular problems should be taken, with Reyno, renal and hepatic insufficiency syndrome, with stomach and duodenal ulcers, bold bleeding.

Do not prescribe the drug also to those patients who have a history of mental illness.

In order to prevent exceeding the maximum possible dose, the question of what volumes and how to receive "achievek" with increased prolactin should remain under the control of the attending physician. The fact of the overdose occurred is evidenced by the presence of such states as nausea and vomiting, sudden general weakness, drowsiness, sweating, convulsions of the icy muscles, the development of psychosis, the appearance of hallucinations. As medical measures to eliminate the consequences of the drug overdose, stomach washing, constant monitoring of blood pressure and reception of dopamine antagonists are recommended.

Special information

If the reception of "reaches" with increased prolactin is ineffective, it means that the cause of the development of hyperprolactinemia should be sought in another area of \u200b\u200bthis particular patient.

Women in the case of treatment with this drug over a long period of time, a regular gynecological examination with a mandatory cervical gynecological study and histological examination of the endometrium should be underway.

In the process of treatment, the "reaches" must constantly monitor the blood pressure and the functioning of the gastrointestinal tract due to the potential hazard of the development of bleeding. In addition, patients hosting "reaches" (reviews with elevated prolactin focuses on such facts) should not be engaged or at least for some time need to refrain from classes of potentially hazardous activities that require high concentration of attention and high speed of psychomotor reactions .

Patient Opinion About the Prepare

As mentioned earlier, "the achievement" is a modern and highly efficient drug that does not cause severe side effects. The main contingent of patients taking this drug - women. The most frequent reasons for the purpose of this drug are the presence of prolactinity, the impossibility of becoming pregnant and the cessation of long lactation. In all these cases, the "Assectory" agent reviews with elevated prolactin are positive. The drug suppresses the development of prolactinoma (and in men, too), helps women in a short time to finish the period of delayed and abundant lactation without a threat to the development of mastitis and the need to tie the chest. Women who could not get pregnant due to the reason for the high level of prolactin, significantly exceeding the norm, they suggest that the figure for 2-4 weeks came to the physiological norm, and after the abolition of the "reaches" there was a long-awaited pregnancy.

There are, of course, and reviews about negative reactions to the use of "reaches". However, side effects are almost never brightly pronounced and quickly pass on their own during the abolition of the drug or reduced dose.

Agonist dopamine receptors. Cabergoline - a dopaminergic derivative of ergolin, is characterized by a pronounced and long-term prolactinous effect. The mechanism of action is associated with a direct stimulation of docking D 2-receptors of lactotropic pituitary cells. In doses exceeding those to reduce the level of prolactin in the blood plasma, it has a central dopaminergic effect due to stimulation of dopamine D 2-receptors.

The reduction in the level of prolactin in the blood plasma is observed 3 hours after the reaction of the achievement and persists within 7-28 days in healthy volunteers and patients with hyperprolactineia and until 14-21 days - in women in the postpartum period. Prolctifying effect is dose-dependent both in terms of severity and duration of action.

Cabbergoline has a strictly electoral action and, therefore, does not affect the basal secretion of other pituitary hormones, as well as cortisol.

The pharmacological effects of Cabergolin, not related to therapeutic effect, there is a decrease in blood pressure. With a single use of the drug, the maximum hypotensive effect is noted during the first 6 hours and is dose-dependent.

Pharmacokinetics

Suction

After the intake, the cabergoline is quickly absorbed from the gastrointestinal tract. C max in plasma is achieved through 0.5-4 hours. Meals do not affect the absorption and distribution of Cabergolin.

Distribution

C SS is achieved after 4 weeks of therapy due to a long T 1/2. Bonding with plasma proteins is 41-42%.

Metabolism

The main product of Cabergolin metabolism identified in the urine is 6-allyl-8β-carboxy-ergoline at a concentration of up to 4-6% of the adopted dose. The content in the urine of 3 additional metabolites does not exceed 3% of the adopted dose. Metabolism products have a significantly smaller effect on the suppression of prolctin secretion compared to Kabrigolin.

Election

T 1/2, estimated by the velocity with urine, is 63-68 hours in healthy volunteers and 79-115 hours in patients with hyperprolactineia.

10 days after the use of the drug in the urine and feces, respectively, 18% and 72% of the adopted dose are found, and the proportion of unchanged drug in the urine is 2-3%.

Form release

White tablets, flat, oblong; With the labeling "P" and "U", separated by notch, on the one hand and "700" with short notches on top and bottom of the number - on the other.

Auxiliary substances: anhydrous lactose - 75.9 mg, leucine - 3.6 mg.

2 pcs. - Dark glass vials (1) - packs cardboard.
8 pcs. - Dark glass vials (1) - packs cardboard.

Dosage

Reservable ® should be taken inward, preferably during food intake.

To prevent lactation, a drug is prescribed in a dose of 1 mg (2 tab.) One day on the first day after delivery.

To suppress the steady lactation, 0.25 mg (1/2 tab) is prescribed 2 times / day for 2 days (the total dose is 1 mg). In order to reduce the risk of developing orthostatic hypotension in lactating patients, a single dose of reaches should not exceed 0.25 mg.

For the treatment of disorders associated with hyperprolactinemia, the drug is prescribed at a dose of 0.5 mg per week in 1 (1 tab.) Or 2 reception (1/2 tab., For example, on Monday and Thursday). An increase in the weekly dose should be carried out gradually by 0.5 mg with an interval of 1 month to the achievement of an optimal therapeutic effect. The average therapeutic dose is 1 mg per week, but can fluctuate in the range from 0.25 mg to 2 mg per week. The maximum dose for patients with hyperprolactineia is 4.5 mg per week.

Depending on tolerance, the weekly dose can be taken once or divided into 2 or more techniques per week. The division of the weekly dose into several techniques is recommended when prescribing the drug at a dose of more than 1 g per week.

In patients with increased sensitivity to dopaminergic drugs, the likelihood of the development of side effects can be reduced by starting the treatment with a reachable dose (0.25 mg 1 time per week), followed by a gradual increase to it before reaching the therapeutic dose. To improve the tolerability of the drug in the occurrence of pronounced side effects, a temporary decrease in the dose is possible, followed by a gradual increase in it, for example, by 0.25 mg per week every 2 weeks.

Overdose

Symptoms: nausea, vomiting, dyspeptic disorders, orthostatic hypotension, confusion / psychosis confusion or hallucination.

Treatment: Events should be held to eliminate the drug (stomach wash) and to maintain blood pressure. The appointment of dopamine antagonists is recommended.

Interaction

There is no information on the interaction of Cabergolin and other alkaloids of the ardines; Nevertheless, the simultaneous use of these medicines during long-term therapy is not recommended.

Since the reaches ® has a therapeutic effect by direct stimulation of dopamine receptors, the drug cannot be prescribed simultaneously with drugs acting as dopamine antagonists (for example, phenothiazines, butthrofenons, thiochannel, metoclopramide), because The latter can weaken the prolact inflicting effect of the achievement.

Like other derivatives, the reaches ® cannot be used simultaneously with the antibiotics of the macrolide groups (for example, with erythromycin), as this may lead to an increase in the systemic bioavailability of Cabergolin.

Side effects

During clinical studies with the use of achievements to prevent physiological lactation (1 mg once) and to suppress lactation (0.25 mg every 12 hours for 2 days), side effects were marked at about 14% of women. When applying the reaches for 6 months at a dose of 1-2 mg per week, divided into 2 receptions, for the treatment of disorders associated with hyperprolactinemia, the frequency of side effects was 68%. The side effects arose mainly during the first 2 weeks of therapy and in most cases disappeared as therapy continues or a few days after the cancellation of the reaches. Side effects were usually transient, by severity - weakly or moderately expressed and carried a dose-dependent character. At least once, during therapy, severe side effects were observed in 14% of patients; Due to side effects, treatment was discontinued about 3% of patients.

The most frequent side effects are presented below:

From the side of the cardiovascular system: heartbeat; rarely - orthostatic hypotension (with long-term use, the drug has a hypotensive effect); Asymptomatic decrease in blood pressure during the first 3-4 days after delivery (systolic - more than 20 mm Hg, diastolic - more than 10 mm Hg).

From the digestive system: nausea, vomiting, pain in the epigastric area, abdominal pain, constipation, gastritis, dyspepsia.

From the CNS and the peripheral nervous system: dizziness / vertigo, headache, increased fatigue, drowsiness, depression, asthenia, paresthesia, fainting.

Others: Mastodynium, Nasal bleeding, Blood bakes to the skin of the face, transient hemiananopsy, spasms of the blood vessels, the convulsions of the muscles of the lower extremities (like other derivatives, the reaches ® can have a vesseloring effect).

With prolonged therapy with the use of the achievement, the deviation from the norm of standard laboratory indicators was rarely observed; In women with Amenorrhea, there was a decrease in the level of hemoglobin during the first few months after the restoration of menstruation.

Indications

prevention of physiological postpartum lactation;
suppression of the established postpartum lactation;
treatment of violations associated with hyperprolactinemia, including amenorrhea, oligomenore, annotulation and galathery;
prolactinsection adenomes of pituitary glands (micro and macroprolactinoma), idiopathic hyperprolactinemia, "empty" syndrome of the Turkish saddle in combination with hyperprolactineia.

Contraindications

children's and adolescent age up to 16 years (safety and efficiency of application are not established);
increased sensitivity to cabergoline or other components of the drug, as well as to any breath alkaloids.

Aestopera ® should be prescribed with caution in the following conditions and / or diseases:

arterial hypertension, developed against the background of pregnancy, for example, preeclampsia or postpartum arterial hypertension (the reaches ® is appointed only in cases where the potential benefit from the use of the drug significantly exceeds the possible risk);
severe cardiovascular diseases, Reina syndrome;
peptic ulcer, gastrointestinal bleeding;
heavy liver failure (it is recommended to use lower doses);
severe psychotic or cognitive disorders (including a history);
symptoms of impaired heart function and respiration due to fibrous changes or the presence of such states in history;
simultaneous use with drugs that have a hypotensive effect (due to the risk of orthostatic hypotension).

Features of application

Application in pregnancy and breastfeeding

Since controlled clinical studies with the use of achievements in pregnant women were not carried out, the use of the drug during pregnancy is possible only when the alleged benefit for the mother exceeds the potential risk to the fetus.

If pregnancy has come against the background of treatment with the achievement, it should be considered the feasibility of canceling the drug, also considering the benefit / risk ratio.

The occurrence of pregnancy should be avoided during at least 1 month after the termination of the use of the drug, given its long-lasting half-life and the presence of limited data on the effect on the fruit. According to the available data, the use of reaches in a dose of 0.5-2 mg per week about violations associated with hyperprolactineia was not accompanied by an increase in the frequency of miscarriage, premature genera, multiple pregnancies and congenital malformations.

There is no information about the release of the drug with breast milk, however, in the absence of the effect of the use of the achievement to prevent or suppress lactation, it is necessary to abandon breastfeeding. In case of violations associated with hyperprolactinemia, the reaches ® should not be prescribed mothers who do not want to stop lactation.

Application with violations of liver function

With caution, the drug is used in severe hepatic failure (lower doses are recommended).

Application in children

Contraindication: Children's and adolescent age up to 16 years (safety and efficiency is not installed).

special instructions

Before the appointment of the achievement, in order to treat violations associated with hyperprolactinemia, it is necessary to carry out a complete study of the function of the pituitary gland.

With an increase in the dose, patients must be under the supervision of a doctor in order to establish the smallest effective dose, providing the therapeutic effect. After the effective dosing mode is selected, it is recommended to carry out regular (1 time per month) determination of the concentration of prolactin in serum. Normalization of the level of prolactin is usually observed within 2-4 weeks of treatment.

After cancellation, hyperprolactinemia is usually observed, but some patients have a resistant suppression of the level of prolactin for several months. Most women have ovulatory cycles are saved for at least 6 months after the cancellation of the reaches.

Reservations ® Restores ovulation and fertility in women with hyperprolactinemic hypogonadism. Since pregnancy may occur before the restoration of menstruation, it is recommended to carry out tests for pregnancy at least once every 4 weeks during the amenorrhea period, and after the restoration of menstruation - each time the menstruation delay is noted for more than 3 days. Women wishing to avoid pregnancy should use barrier methods of contraception during the treatment of the achievement, as well as after the cancellation of the drug before repetitions. Women who have a pregnancy should be under the supervision of a doctor for the timely identification of the symptoms of the increase in pituitary gland, since during pregnancy it is possible to increase the size of the already existing pituitary tumors.

Aestiors ® should be prescribed at lower doses to patients with severe liver failure (class with for the Child-Pugh scale), which showed long therapy with the drug. With a single application, such patients with a dose of 1 mg, an increase in AUC compared to healthy volunteers and patients with less severe liver failure was noted.

As with the use of other derivatives, after a long-term reception of Kabergolin, patients had pleural effusion / pleural fibrosis and holvulopathy. In some cases, patients received preceding therapy with ergotinine dopamine agonists. Therefore, the reaches ® should be used with caution to patients with available features and / or clinical symptoms of a heart function disorders or with such conditions as a history. After stopping the reception of the achievement in patients with a diagnosis of pleural effusion / pleural fibrosis and holvulopathy, an improvement in the symptoms was noted.

The use of Cabergolin causes drowsiness. In patients with Parkinson's disease, the use of dopamine receptor agonists can cause sudden falling asleep. In such cases it is recommended to reduce the dose of reaches or stop therapy.

Research on the use of the drug in elderly patients with disorders associated with hyperprolactinemia has not been carried out.

Use in pediatrics

The safety and efficacy of the drug in children under 16 is not installed.

Impact on the ability to driving vehicles and control mechanisms

Patients receiving the achievements ®, who have drowsiness, should be warned that it is recommended to refrain from driving a car and from performing work (for example, with mechanisms), in which reduced attention could create for them or the surrounding risk of serious damage or of death.

Breastfeeding or lactation continues, as a rule, before the child execution is 2 years. This is on WHO recommendations. But the longer this period in the life of a woman, the more difficult it is completed. Many mothers are trying to relieve it, taking "milk pills" reaches. But it is necessary, what are the pros and cons of drug therapy in this case, in which dosages do you need to drink this drug and who is it contraindicated?

How to drink reaches for termination of breast milk

Dosage and reception mode depends on whether lactation has already begun, whether it was established. If it is the first day after miscarriage in the late periods (when milk can also come) or childbirth, there will be enough one-time reception in the amount of 1 mg (2 tablets) at a time. Receiving reaches for the suppression of lactation will help to fully. With the established lactation, this dosage is divided into 4 receptions, 0.25 mg, that is, half the tablet 2 times a day for two days. After taking the drug, a long time remains in the blood and continues to act, suppressing the secretion of prolactin - lactation hormone.

If you doubt how to properly accept the achievements to stop breastfeeding, or milk after taking the drug in the dosages recommended in the manual continues to come to a reception to the gynecologist. Perhaps in your case you need a different dosage, or you take preparations or biologically active additives that reduce the efficiency of the achievement.

If you use bromocriptine to stop lactation, this is another popular drug to repay the formation of milk, then you can not wait for the result in a couple of days. It is recommended to receive for 2 weeks, and sometimes longer if the milk after the end of the drug intake reappears.

Do you need to make stopping the lactation of the achievement

It would seem that the drug is very effective and long-term action, but nevertheless, it is unlikely that it is unlikely to do without the fit. Milk will accumulate in glands and lactostasis will arise. However, plugging to the production of milk, so it is necessary to empty the mammary glands only in acute necessity - if there is strong heat and soreness.

If the reaches for lactation are already accepted and this happened, it will have to be imprisoned. Even through pain. Since it is not recommended to feed the child after taking the drug. It is not known what impact he will have on a children's body.

If it grinds the milk, you need to take an anesthetic. For example, "Nurofen". And before this procedure, hold the chest under warm water to speed up the influx of milk to the nipple. Some women are generally said that the plot is most comfortable under the warm shower. Try!

And after can be made on the mammary glands cold compress. It will remove pain and will not provoke the production of a new "party" of milk.

Application of the drug Austility: pros and cons

Since this is a rather serious medicinal product, with a number of side effects and contraindications, it is necessary to drink it only in extreme cases, if it is impossible to stop the lactation in a different time. For example, a medical support is suitable for women who have had dead children or miscarriage on a large period of pregnancy, if HIV has been detected, tuberculosis or other dangerous disease that can be converted to a child with milk.

Contraindications for stopping lactation as a reaches:

age under 16 years old;
the intolerance of Cabergolin and the alkaloids of the ardor.

With caution and in the presence of good readings, reception is possible in the following states:

heart defects;
rectal bleeding of unknown origin;
arterial hypertension;
severe liver failure;
asthma;

The last item will certainly cause questions. How then to stop breastfeeding with the help of the achievement, if it is contraindicated with lactation? This contraindication is relevant only in some cases. For example, a doctor may assign this medicine to a woman with a completely different goal than getting rid of lactation. After all, the prolctin secretion inhibitors are accepted in some diseases, for example, the pituitary microense. In this case, the woman should decide what is more important for it - to treat the main disease or feed the baby.

Pills from lactation Australia can also cause the following health problems (temporary, before the removal of the drug from the body):

fainting;
sharp decline in pressure;
feeling of nasal congestion;
dizziness;
pain in the stomach;
constipation;
convulsions;
drowsiness and fast fatigue;
nose bleed.

But all this is quite rare side effects, if the reacted tablets for stopping lactation are accepted in recommended dosages and a short time. However, it is necessary to take into account the fact that the reception of the drug is a reason to temporarily abandon travel behind the wheel of vehicles and work requiring the concentration of attention.

As you can see, there are quite a lot of nuances. If possible, the cessation of lactation with drugs is better to replace the natural way to complete breastfeeding. Or use non-drug tools to reduce lactation.

Agonist dopamine receptors. Prolctin secretion inhibitor

Active substance

Release form, composition and packaging

Pills White, flat, oblong; With the labeling "P" and "U", separated by notch, on the one hand and "700" with short notches on top and bottom of the number - on the other hand.

Auxiliary substances: lactose - 75.9 mg, leucine - 3.6 mg.

2 pcs. - Dark glasses of type I (1) bottles - packs cardboard.
8 pcs. - Dark glasses of type I (1) bottles - packs cardboard.
2 pcs. - Dark glass bottles of type I (1) - cardboard packs with the control of the first opening.
8 pcs. - Dark glass bottles of type I (1) - cardboard packs with the control of the first opening.
2 pcs. - Flakes from high density polyethylene (1) - packs cardboard.
8 pcs. - Flakes from high density polyethylene (1) - packs cardboard.
2 pcs. - High density polyethylene bottles (1) - Cardboard packs with first autopsy control.
8 pcs. - High density polyethylene bottles (1) - Cardboard packs with first autopsy control.

pharmachologic effect

Cabergoline - a dopaminergic derivative of ergolin, is characterized by a pronounced and long-term prolactinous effect, due to direct stimulation of dope D 2-receptors of lactotropic cells of pituitary gland. In addition, when taking doses exceeding such to reduce the concentration of prolactin in the blood, the canbergoline has a central dopaminergic effect, due to the stimulation of dopamine D 2 receptors.

The decrease in the concentration of prolactin in the blood plasma is observed 3 hours after taking the drug and persists within 7-28 days in healthy volunteers and patients with hyperprolactinemia, and until 14-21 days - in women in the postpartum period.

Cabergoline has a strictly electoral action, does not affect the basal secretion of other pituitary and cortisol hormones. The bargoline prolactinaceous effect is dose-dependent both in terms of severity and duration of action.

The pharmacological effects of Cabergolin, not related to the therapeutic effect, only decreased blood pressure applies. With a single reception of the drug, the maximum hypotensive effect is observed during the first 6 hours and is dose-dependent.

Pharmacokinetics

Suction and distribution

After taking inside, the canbergoline is quickly absorbed from the gastrointestinal tract. C max in plasma is achieved through 0.5-4 hours. Bonding with plasma proteins is 41-42%. C SS is achieved after 4 weeks of therapy due to a long T 1/2.

Meal does not affect the suction and distribution of Cabergolin.

Metabolism

The main product of Cabergolin metabolism identified in the urine is 6-allyl-8β-carboxy-ergoline at a concentration of up to 4-6% of the adopted dose. The content in the urine of 3 additional metabolites does not exceed 3% of the adopted dose. It has been established that metabolic products have a significantly smaller effect on the suppression of the prolctin secretion compared to Kabrigolin.

Election

T 1/2, estimated by the speed of the kidneys, is 63-68 hours in healthy volunteers and 79-115 hours in patients with hyperprolactinemia.

10 days after receiving the canbergoline in the urine and feces, respectively, 18% and 72% of the adopted dose are found, and the share of unchanged Cabbergoline in the urine is 2-3%.

Indications

prevention of physiological postpartum lactation;
suppression of the established postpartum lactation;
treatment of violations associated with hyperprolactinemia, including amenorrhea, oligomenore, annotulation and galathery;
prolactinsection adenomes of pituitary glands (micro and macroprolactinoma), idiopathic hyperprolactinemia, "empty" syndrome of the Turkish saddle in combination with hyperprolactineia.

Contraindications

increased sensitivity to canbergoline or other components of the drug, as well as to any breath alkaloids;
impaired heart and respiration function due to fibrous changes or the presence of such states in history;
with long-term therapy: anatomical signs of the pathology of the valve apparatus of the heart (such as the thickening of the valve sash, the narrowing of the valve lumen, the mixed pathology is a narrowing and stenosis of the valve), confirmed by echocardiographic research (ECCG), carried out before the start of therapy;
lactose intolerance, lactase deficiency, glucose-galactose malabsorption;
children's and adolescent age up to 16 years (safety and efficiency of application are not established).

The reaches should be appointed carefully For the following conditions and / or diseases:

arterial hypertension, developed against the background of pregnancy, for example, preeclampsia or postpartum arterial hypertension (the achievement is appointed only in cases where the potential benefit from the use of the drug significantly exceeds the possible risk);
severe cardiovascular diseases, Reina syndrome;
peptic ulcer, gastrointestinal bleeding;
heavy liver failure (it is recommended to use lower doses);
severe psychotic or cognitive disorders (including a history);
simultaneous use with drugs that have a hypotensive effect (due to the risk of orthostatic hypotension).

Dosage

Take inside, while eating.

Lactation prevention:1 mg (2 tab.) Once upon the first day after delivery.

Suppression of steady lactation: 0.25 mg (1/2 tab.) 2 times / day every 12 hours for 2 days (the total dose is 1 mg). In order to reduce the risk of developing orthostatic hypotension in breastfeeding mothers, a single dose of the drug is not to exceed 0.25 mg.

Treatment of disorders associated with hyperprolactinemia: The recommended initial dose is 0.5 mg per week in 1 (1 tab.) or 2 reception (1/2 tab., For example, on Monday, on Thursday). An increase in the weekly dose should be carried out gradually by 0.5 mg with an interval of 1 month to the achievement of an optimal therapeutic effect. The therapeutic dose, as a rule, is 1 mg per week, but can fluctuate in the range from 0.25 mg to 2 mg per week. The maximum dose for patients with hyperprolactineia is 4.5 mg per week.

In patients with increased sensitivity to dopaminergic drugs, the probability of developing side effects can be reduced by starting therapy with the preparation of reaches at a lower dose (0.25 mg 1 time per week), followed by gradually increasing it to achieve the therapeutic dose. To improve the tolerability of the drug in the occurrence of pronounced side effects, a temporary decrease in the dose is possible, followed by a gradual increase in it, for example, by 0.25 mg per week every 2 weeks.

Side effects

During clinical studies with the use of the drug prevent physiological lactation (1 mg once) and for lactation suppression (0.25 mg every 12 hours for 2 days) adverse reactions were observed about 14% of women. When the preparation is used to be reached within 6 months at a dose of 1-2 mg per week, divided into 2 receptions, for the treatment of disorders associated with hyperprolactinemia, the frequency of adverse reactions was 68%. The side effects arose mainly during the first 2 weeks of therapy and in most cases disappeared as therapy continues or a few days after the cancellation of the preparation. The adverse reactions were usually transient, by severity - weakly or moderately expressed and carried a dose-dependent character. At the very least, once during therapy, severe side effects were observed in 14% of patients; Because of the adverse reactions, the treatment was discontinued about 3% of patients.

The most frequent adverse reactions are presented below.

From the side of the cardiovascular system: feeling of heartbeat; In some cases, orthostatic hypotension (with long-term use, the reaches usually has a hypotensive effect); Perhaps asymptomatic reduction of blood pressure during the first 3-4 days after delivery (systolic - not less than 20 mm Hg, diastolic - not less than 10 mm Hg).

From the nervous system: Dizziness / Vertigo, headache, increased fatigue, drowsiness, depression, asthenia, paresthesia, fainting, nervousness, anxiety, insomnia, violation of the concentration of attention.

From the digestive system: Nausea, vomiting, pain in the epigastric area, abdominal pain, constipation, gastritis, dyspepsia, dry oral mucosa, diarrhea, meteorism, toothache, feeling of irritation of the mucous membrane of the pharynx.

Others: Mastodynium, nasal bleeding, "tides" of blood to the skin of the face, transient hemiananopsy, spasms of the blood vessels, the convulsions of the muscles of the lower extremities (as well as other derivatives, the reaches can have a vesseloring effect), impairment, influenza-like symptoms, malaise, periorubital and peripheral edema , anorexia, acne, skin itch, pain in the joints.

With long-term therapy with the use of the drug, the rejection of the standard laboratory indicators was rarely observed; In women with Amenorrhea, there was a decrease in the level of hemoglobin during the first few months after the restoration of menstruation.

In the post-marketing study, the following adverse reactions are registered related to the use of Kabergoline: alopecia, an increase in the activity of KFK in the blood, mania, dysnae, swelling, fibrosis, liver function disorders, deviations of the liver function, reaction of increased sensitivity, rash, respiratory disorders, respiratory failure, Valvulopathy, pathological addiction to gambling, hypersexuality, elevated libido, aggressiveness, psychotic disorders, pericarditis, sudden fallback attacks, decrease or increase in body weight, nasal congestion.

Overdose

Symptoms (most likely symptoms of hyperstimulation of dopamine receptors): nausea, vomiting, dyspeptic symptoms, orthostatic arterial hypotension, confusion, psychosis, hallucinations.

Treatment: Events aimed at eliminating the non-said drug (stomach washing) and, if necessary, to maintain blood pressure. Administration of antagonists is recommended.

Medicinal interaction

There is no information on the interaction of Cabergolin and other alkaloids, therefore, the simultaneous use of these drugs during long-term therapy the preparation is not recommended.

Since Kabergolin has a therapeutic effect by direct stimulation of dopamine receptors, the drug cannot be prescribed simultaneously with drugs acting as dopamine antagonists (including phenothiazines, butthrofenons, thiocantnes,), because They can weaken the action of Cabergolin, aimed at reducing the concentration of prolactin.

Like other derivatives, Cabbergoline can not be used simultaneously with the antibiotics of the macrolide group (for example, C), as this may lead to an increase in the systemic bioavailability of Cabergolin.

special instructions

Before appointing the drug is a reaches in order to treat violations associated with hyperprolactinemia, it is necessary to carry out a complete study of the function of the pituitary.

In addition, the state of the cardiovascular system should be estimated, including ECCG in order to identify violations of the valve apparatus function flowing asymptomatic.

As with the use of other derivatives, after a long-term reception of Kabergolin, patients had pleural effusion / pleural fibrosis and holvulopathy. In some cases, patients received preceding therapy with ergotonin dopamine agonists. Therefore, the achievement should not be used in patients with existing features and / or clinical symptoms of the impaired heart or respiratory function associated with fibrous changes or with such states as a history. Cancellation of the drug should be canceled in the case of the detection of signs of the appearance or deterioration of blood regurgitation, narrowing of the enlightenment of the cladlan or thickening of the valve flaps.

It was found that ESO increases with the development of pleural effusion or fibrosis. In case of detection of an inexplicable increase in ESO, it is recommended to perform a radiographic study of the chest. In the formulation of the diagnosis, the study of creatinine concentration in blood plasma, assessment of the renal function can also help. After stopping the reception of the drug, the achievements in patients with the presence of pleural effusion / pleural fibrosis or holvulopathy was an improvement in symptoms.

It is not known whether Cabbergoline can worsen the condition of patients with signs of blood regurgitation. Cabergoline should not be used in the detection of fibrous lesions of the valve apparatus of the heart.

Fibrotic disorders can develop asymptomatic. In this regard, it should be regularly monitored by the condition of patients receiving long-term therapy from Cabergolin and pay special attention to the following symptoms:

porero-pulmonary violations: such as shortness of breath, difficulty breathing, non-coming cough or;
renal failure or obstruction of the vessels of ureterals or abdominal organs, which can be accompanied by pain in the side or in the region of the lower back and edema of the lower extremities, any swelling or soreness during palpation in the abdomen area, which may indicate the development of retroperitoneal fibrosis;
pericardial fibrosis and fibrosis of heart valves are often manifest with heart failure. In this regard, it is necessary to exclude fibrosis of the valve valves (and the content pericarditis) when symptoms of heart failure appear.

Monitor the patient's condition should be monitored for the development of fibrotic disorders. The first time ECOCH should be conducted 3-6 months after the start of therapy. This study must be carried out depending on the clinical assessment of the patient's condition, paying special attention to the symptoms described above, at least every 6-12 months of therapy.

The need for other monitoring methods (for example, physical examination, including the auscultation of the heart, radiography, computed tomography) is estimated individually for each patient.

With an increase in the dose, patients must be under the supervision of a doctor in order to establish a minimum effective dose that provides the therapeutic effect.

After the effective dosing mode is selected, it is recommended to carry out regular (1 time per month) determination of serum prolactin concentration. Normalization of prolactin concentration is usually observed within 2-4 weeks of treatment.

After the cancellation of the drug is usually observed by hyperprolactinemia relapse, but some patients have a resistant suppression of prolactin concentration for several months. Most women have ovulatory cycles are preserved for at least 6 months after the abolition of the preparation is reached.

The reaches restores ovulation and fertility in women with hyperprolactinemic hypogonadism. Since pregnancy may occur before the restoration of menstruation, it is recommended to carry out pregnancy tests at least 1 time in 4 weeks during the amenorrhea period, and after the restoration of menstruation - each time the menstruation delay is noted for more than 3 days. Women who want to avoid pregnancy should use barrier methods of contraception during the treatment with the preparation of the reaches, as well as after the cancellation of the drug before repetitions. Women who have a pregnancy should be under the supervision of a doctor for the timely identification of the symptoms of the increase in pituitary gland, since during pregnancy it is possible to increase the size of the already existing pituitary tumors.

The reaches should be prescribed at lower doses to patients with severe hepatic insufficiency (class C according to childcare classification), which showed long therapy with the drug. With one-time application, in such patients, the drug at a dose of 1 mg was noted an increase in AUC compared to healthy volunteers and patients with less severe liver failure.

The use of Cabergolin causes drowsiness. In patients with Parkinson's disease, the use of dopamine receptor agonists can cause sudden falling asleep. In such cases, it is recommended to reduce the dose of the drug to the reaches or stop therapy.

Research on the use of the drug in elderly patients with disorders associated with hyperprolactinemia has not been carried out.

Use in pediatrics

Safety and efficacy of the drug children and adolescents under 16 not installed.

Impact on the ability to driving vehicles and control mechanisms

Patients taking the preparation of the achievements should refrain from managing vehicles and mechanisms and other potentially hazardous activities requiring the concentration of attention and speed of psychomotor reactions.

Pregnancy and lactation

Since the controlled clinical studies with the use of the drug, the reaches of pregnant women were not conducted, the prescription of the drug during pregnancy is possible only in cases of extreme necessity, taking into account the benefit / risk ratio for a woman and the fetus.

If pregnancy has come against the preparation of the drug, it is necessary to consider the feasibility of canceling the drug, also considering the benefit / risk ratio.

According to the available data, the use of reaches in a dose of 0.5-2 mg per week about violations associated with hyperprolactineia was not accompanied by an increase in the frequency of miscarriage, premature genera, multiple pregnancies and congenital malformations.

There is no information about the release of the drug with breast milk, however, in the absence of the effect of using the drug, the achievements to prevent or suppress lactation should be abandoned to breastfeeding. In case of disorders associated with hyperprolactinemia, the achievement is contraindicated in patients planning breastfeeding.

Childcare

Contraindication: Children's and adolescent age up to 16 years (safety and efficiency is not installed).

When violations of the liver function

Carefully Apply the drug during severe liver failure (lower doses are recommended).

Conditions of vacation from pharmacies

The drug is released by the prescription.

Terms and Storage Terms

The drug should be stored in an inaccessible place at temperatures not higher than 25 ° C. Shelf life - 2 years. Do not use after the expiration date.