Dostinex lactation tablets instruction. Dostinex: instructions for use, analogues and reviews, prices in pharmacies in Russia
As a rule, milk production gradually decreases and by the age of a 2-3-year-old baby it stops completely. This weaning is the most painless for the mother and her baby. But there are times when you need to stop feeding immediately. Then doctors often prescribe special drugs, for example, Dostinex tablets to stop lactation.
Is it necessary to abruptly stop lactation
Abrupt weaning of the baby from the breast becomes the cause of severe stress, not only for the baby, but also for the mother. Therefore, a physiological way of completing lactation is much more preferable - a gradual decrease in the number of applications and sucking time, refusal of night feedings. Thanks to this, the production breast milk decreases gradually, without harming the health of the mother and child, both physical and psychological. Then the pills will not be needed.
To start the process of physiological completion of GV, you need to adjust the baby's regimen according to the following scheme:
- replace one of your daily feedings with a bottle of formula, expressed milk, or baby food. It is better if the baby is fed by one of the relatives - grandmother or dad. It is necessary to make the child understand that there is other food besides milk.
- After three days, complementary foods are substituted for another feeding. Three days later, the next one. Gradually, everything is brought to the point that the child is applied to the breast only before bedtime and at night.
- After that, they begin to replace the "pre-sleep" feeding with complementary foods - either in the afternoon or in the evening. It is better to start in the evening, otherwise the child may refuse to sleep during the day.
- When sleeping together, the mother needs to get up right away, otherwise the baby will have time to hang on the chest.
It is also better to give up night feeds as early as possible - they most of all stimulate the production of prolactin and, accordingly, milk. If the baby wakes up and requires a breast, you can try replacing it with a bottle of compote, juice, plain water or expressed milk.
You can also change your mom's lifestyle to reduce the amount of milk she makes. Dr. Komarovsky recommends the following points:
- include active sports in the daily routine;
- refuse to express;
- reduce the time for breastfeeding;
- remove foods that stimulate lactation from the diet;
- reduce the amount of fluid you drink (but without fanaticism).
When pills are really needed at the end of hepatitis B
But there are times when there is no way to wait for the natural completion of hepatitis B, and you have to turn to specialized medicines. This may be due to the mother's illness and the need to take medications that are unacceptable for breastfeeding.
Also, the reason may be her long departure or a number of diseases in which breastfeeding is contraindicated.
Also, Dostinex is indicated for:
- the need to prevent the arrival of milk after childbirth;
- the need to stop the established GW;
- for disorders and diseases associated with excessive production of the hormone prolactin;
- termination of pregnancy for a long time.
When correct application milk disappears after a few days. The effect lasts from 2 to 4 weeks, depending on the dosage.
Many mothers manage to do without medication when weaning. There is no need to bandage the breast - this is an old barbaric method, due to which blood circulation deteriorates and lactostasis increases. You only need to pump in the early days, gradually reducing the number of pumpings. But this path is inevitably associated with pain and discomfort. In some cases, it can even cause mastitis. Therefore, many mothers still resort to hormonal drugs.
How to take Dostinex against lactation correctly
The drug Dostinex is hormonal, so it should be taken only if it has been prescribed by a doctor and in accordance with the attached instructions. There are two dosage regimens, depending on the reason for the termination of lactation:
- if you need to suppress an already established lactation, take half a tablet twice a day for two days, a total of 1 mg of the drug;
- to prevent the onset of lactation, Dostinex is taken immediately after childbirth once. Dosage - 1 mg (2 tablets) on the second day after childbirth;
The action of Dostinex is provided by its active substance - cabergoline. It causes an increased secretion of dopamine and suppression of prolactin secretion, because it is its antagonist. The composition of the drug is an active cabergoline and two auxiliary substances (leucine and anhydrous lactose).
The decrease in the concentration of the hormone prolactin in the blood after the pill occurs very quickly. You will feel the effect of taking cabergoline in just a couple of hours. The instructions for use inform that cabergoline remains in the blood from seven days to a month after you take the last pill. The longer the reception was continued, the longer the effect lasts. A single dose of a small dose has a short-term effect, which can lead to negative reviews.
Contraindications and side effects
Since Dostinex seriously affects the hormonal background of a woman, suppressing the production of prolactin, it has a number of contraindications:
- age under 16;
- individual intolerance to the main active ingredient, auxiliary components or ergot alkaloids.
Also, negative consequences can be observed with the following health problems:
- liver problems;
- peptic ulcers, stomach or intestinal bleeding;
- severe forms of cardiovascular disease, Raynaud's disease;
- high blood pressure;
- severe mental or intellectual disorders.
The side effects of the drug are quite extensive and have been seen in many women. Their severity also directly depends on the dose of the medicine taken. At the same time, studies have shown that the percentage of those who felt side effects grows with the duration of Dostinex.
Decrease is most often seen blood pressure... It occurs in almost all women, but manifests itself in varying degrees - from almost imperceptible to light-headedness. With a single dose of the drug, the pressure drops by 5-6 hours, after which it returns to normal.
All side effects can be divided into four groups:
- from the gastrointestinal tract - pain and "seething" in the abdomen, nausea, vomiting, constipation;
- drowsiness, bad moodloss of consciousness, dizziness, headache, increased fatigue;
- decrease in pressure;
- others - rash, respiratory failure and other breathing disorders, flushing of the face, leg cramps, vasospasm in the fingers, nosebleeds, fibrosis, mastodynia, edema, dyspnea, liver dysfunction, hemianopsia, mania, mastodynia, valvulopathy, etc.
Sufficient studies on the effect of the drug on the course of pregnancy and fetal development have not yet been carried out, therefore Dostinex is prescribed during pregnancy only in the most extreme cases. And if it occurs against the background of drug treatment, it is canceled.
Some reviews suggest that another, conditionally side effect, can be considered a slight weight loss when taking Dostinex. It is believed that this is due to inhibition of prolactin. However, there is no official data confirming such an effect on weight in Dostinex. Most doctors believe that the short courses with which this drug is prescribed cannot in any way affect the weight and such a reaction of the body is more an individual feature than a rule.
One of the effects of taking Dostinex is to restore fertility (ovulation and all menstrual cycle) with hyperprolactinemia (excess prolactin). Menstruation after Dostinex does not improve immediately - the body needs time to adjust to new conditions. Therefore, a delay after taking the drug is common. But just in case, it is still worth doing a pregnancy test.
With pituitary adenoma, Dostinex, as a rule, eliminates unpleasant symptoms - headaches, vision problems. But some of the reviews say that after a while these symptoms return, and sometimes even stronger than before.
If the drug does not help
It so happens that the prescribed drug does not help - desired effect not achieved, only side effects appeared. In this case, you must seek a second consultation with a doctor. It may be sufficient to adjust the dosage. If even then after Dostinex the milk did not disappear, the doctor may prescribe other analogous drugs.
You can also refer to traditional medicine, which suggests using decoctions of herbs. Sage has proven itself best for this purpose. Infusions of basil, mint, bearberry, lingonberry and parsley also cope well with stopping lactation. Sage broth can be replaced alcohol tincture, extract or essential oil - then the effect of its reception will be noticeable rather quickly.
Do I need to express milk after taking Dostinex
The drug Dostinex is designed to stop lactation, it lowers prolactin levels and reduces milk production. As a rule, it is not necessary to express after or before taking the drug, but if there is a lot of milk and painful sensations appear in the breast, it is necessary to express it to a state of relief so as not to provoke the development of lactostasis.
It is also necessary if lactation is interrupted temporarily, for example, for the duration of treatment, and in the future the woman plans to continue breast-feeding.
Dostinex's analogs
There are several drugs that are analogs of Dostinex - these are Bergolac, Bromcriptine, Agalates and Cabergoline. Only a doctor can choose one of the drugs and prescribe it if necessary! Replacing one remedy with another on your own, relying on the fact that they are analogues, is fraught with health!
Bromocriptine or Dostinex
Bromocriptine contains the same active components as Dostinex - cabergoline, so the principle of action and effectiveness are approximately the same.
Cabergoline or Dostinex
Another drug containing the same active ingredient as Dostinex. The cost of the drug is quite high, but at the same time it has good reviews. Although many women note the manifestation of side effects in the form of headaches and nausea.
Bergolak or Dostinex
Bergolac is a generic drug of Dostinex - a drug with the same active substance, proven equivalence with the original (therapeutic, pharmaceutical and biological), but produced by a different manufacturer and under a different name.
Agalates or Dostinex
These two preparations also have the same active substance, while there are two differences - Dostinex has a higher price, but at the same time, according to reviews, it causes fewer side effects.
With the correct prescription and dosage, Dostinex is quite effective drug for emergency stop lactation. However, it has quite a few side effects that are not always harmless enough. Therefore, if possible, it is better to end breastfeeding more gently - after waiting for natural attenuation or with folk remedies and lifestyle changes.
In this article, you can read the instructions for use medicinal product Dostinex... Feedback from website visitors - consumers are presented of this medicine, as well as the opinions of doctors of experts on the use of Dostinex in their practice. A big request to actively add your reviews about the drug: did the medicine help or did not help get rid of the disease, what complications and side effects were observed, which may not have been declared by the manufacturer in the annotation. Dostinex's analogs in the presence of available structural analogs. Use for the termination of lactation and the treatment of hyperprolactinemia in adults, children, as well as during pregnancy and lactation.
Dostinex- dopamine receptor agonist. Cabergoline (the active substance of Dostinex) is a dopaminergic derivative of ergoline, characterized by a pronounced and prolonged prolactin-lowering effect. The mechanism of action is associated with direct stimulation of dopamine D2 receptors of pituitary lactotropic cells. In doses exceeding those for lowering the level of prolactin in blood plasma, it has a central dopaminergic effect due to the stimulation of dopamine D2 receptors.
A decrease in the level of prolactin in blood plasma is noted 3 hours after taking Dostinex and persists for 7-28 days in healthy volunteers and patients with hyperprolactinemia and up to 14-21 days in women in postpartum... Prolactin-lowering action is dose-dependent both in terms of severity and duration of action.
Cabergoline has a strictly selective effect and therefore does not affect the basal secretion of other pituitary hormones, as well as cortisol.
TO pharmacological effects cabergoline, not associated with a therapeutic effect, includes a decrease in blood pressure. With a single use of the drug, the maximum hypotensive effect is observed during the first 6 hours and is dose-dependent.
Pharmacokinetics
After oral administration, Dostinex is rapidly absorbed from the gastrointestinal tract. Food intake does not affect the absorption and distribution of cabergoline. Metabolic products have a significantly lower effect in terms of suppressing the secretion of prolactin compared to cabergoline. 10 days after application of the drug in urine and feces, 18% and 72% of the dose taken, respectively, are found, and the proportion of unchanged drug in urine is 2-3%.
Indications
- prevention of physiological postpartum lactation;
- suppression of established postpartum lactation;
- treatment of disorders associated with hyperprolactinemia, including functional disorders such as amenorrhea, oligomenorrhea, anovulation and galactorrhea;
- prolactin-secreting pituitary adenomas (micro- and macroprolactinomas), idiopathic hyperprolactinemia or the syndrome of "empty" Turkish saddle in combination with hyperprolactinemia.
Release forms
0.5 mg tablets.
Instructions for use and reception scheme
Dostinex should be taken orally, preferably with meals.
To prevent lactation, the drug is prescribed in a dose of 1 mg (2 tablets) once on the first day after childbirth.
To suppress the established lactation, 0.25 mg (1/2 tablet) is prescribed 2 times a day for 2 days (the total dose is 1 mg). In order to reduce the risk of developing orthostatic hypotension in lactating patients single dose Dostinex 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 or 2 doses (1/2 tablet, 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 until the optimal therapeutic effect is achieved. The average therapeutic dose is 1 mg per week, but can range from 0.25 mg to 2 mg per week. The maximum dose for patients with hyperprolactinemia is 4.5 mg per week.
Depending on the tolerance, the weekly dose can be taken once or divided into 2 or more doses per week. The division of the weekly dose into several doses is recommended when prescribing the drug at a dose of more than 1 g per week.
In patients with hypersensitivity to dopaminergic drugs, the likelihood of side effects can be reduced by starting Dostinex therapy at a lower dose (0.25 mg once a week), followed by its gradual increase until the therapeutic dose is reached. To improve the tolerability of the drug in the event of severe side effects, it is possible to temporarily reduce the dose, followed by a gradual increase, for example, by 0.25 mg per week every 2 weeks.
Side effect
- palpitations;
- orthostatic hypotension (at long-term use hypotensive action);
- nausea, vomiting;
- abdominal pain;
- constipation;
- gastritis;
- dyspepsia;
- dizziness;
- headache;
- increased fatigue;
- drowsiness;
- depression;
- asthenia;
- paresthesia;
- fainting;
- mammalgia;
- nose bleed;
- "hot flushes" of blood to the skin of the face;
- transient hemianopsia;
- spasms of the vessels of the fingers;
- muscle cramps lower limbs;
- alopecia;
- swelling;
- liver dysfunction;
- reactions hypersensitivity;
- rash;
- respiratory disorders;
- respiratory failure;
- valvulopathy.
Contraindications
- children and adolescents under 16 years of age (safety and efficacy have not been established);
- hypersensitivity to cabergoline or other components of the drug, as well as to any ergot alkaloids.
Application during pregnancy and lactation
Since controlled clinical research with the use of Dostinex in pregnant women was not carried out, the use of the drug during pregnancy is possible only when the intended benefit to the mother outweighs the potential risk to the fetus.
If pregnancy occurs during treatment with Dostinex, the advisability of discontinuing the drug should be considered, also taking into account the benefit / risk ratio.
The onset of pregnancy should be avoided for at least 1 month after discontinuation of the drug, given its long half-life and limited data on fetal exposure. According to the available data, the use of Dostinex at a dose of 0.5-2 mg per week for disorders associated with hyperprolactinemia was not accompanied by an increase in the frequency of miscarriages, premature births, multiple pregnancies and congenital defects development.
There is no information on the release of the drug in breast milk, however, in the absence of the effect of Dostinex to prevent or suppress lactation, breastfeeding should be abandoned. In case of disorders associated with hyperprolactinemia, Dostinex should not be prescribed to patients who do not want to stop lactation.
special instructions
Before the appointment of Dostinex for the treatment of disorders associated with hyperprolactinemia, it is necessary to conduct a complete study of the function of the pituitary gland.
When the dose is increased, the patient should be monitored by a physician in order to establish the lowest effective dose that provides therapeutic effect... After selecting an effective dosing regimen, it is recommended to carry out regular (once a month) determination of the level of prolactin in the blood serum. Normalization of prolactin levels is usually observed within 2-4 weeks of treatment.
Orthostatic hypotension may develop after Dostinex is applied. Dostinex is prescribed with caution against the background of therapy with drugs that have an antihypertensive effect.
With long-term therapy, Dostinex should be prescribed in lower doses to patients with severe hepatic impairment (class C on the Child-Pugh scale), for whom long-term Dostinex therapy is indicated. With a single use in such patients of the drug at a dose of 1 mg, there was an increase in AUC compared to healthy volunteers and patients with less severe hepatic impairment.
Pleural effusion / pleural fibrosis and valvulopathy were observed after long-term use of cabergoline. In some cases, patients received prior therapy with ergotinine dopamine agonists. Therefore, Dostinex should be used with caution in patients with existing symptoms and / or clinical symptoms dysfunction of the heart (including a history). After discontinuation of the drug, the patients showed an improvement in the above symptoms.
After discontinuation of Dostinex, a relapse of hyperprolactinemia is usually observed. However, in a number of patients, persistent suppression of prolactin levels is noted for several months. Most women have ovulatory cycles for at least 6 months after discontinuation of Dostinex.
Dostinex restores ovulation and fertility in women with hyperprolactinemic hypogonadism. Since pregnancy can occur even before menstruation is restored, it is recommended to carry out pregnancy tests at least once every 4 weeks during the period of amenorrhea, and after menstruation is restored - every time there is a delay in menstruation by more than 3 days. Women who want to avoid pregnancy should use non-hormonal methods of contraception for the period of treatment with Dostinex, as well as after discontinuation of Dostinex and before the return of anovulation.
Women who have become pregnant should be under the supervision of a doctor for the timely detection of symptoms of an enlarged pituitary gland, since during pregnancy it is possible to increase the size of already existing pituitary tumors.
The use of cabergoline causes drowsiness. In patients with Parkinson's disease, the use of dopamine receptor agonists can induce sudden sleep. In such cases, it is recommended to reduce the dose of Dostinex or discontinue therapy.
Studies on the use of the drug in elderly patients with disorders associated with hyperprolactinemia have not been conducted.
Influence on the ability to drive vehicles and use mechanisms
Patients taking Dostinex who experience drowsiness should be warned that they are advised to refrain from driving and performing work in which reduced attention could create a risk of serious injury or death for them or those around them.
Drug interactions
There is no information on the interaction of cabergoline and other ergot alkaloids; however, the simultaneous use of these medicines during prolonged therapy with Dostinex is not recommended.
Since Dostinex has a therapeutic effect by directly stimulating dopamine receptors, the drug should not be administered simultaneously with drugs acting as dopamine antagonists (for example, phenothiazines, butyrophenones, thioxanthenes, metoclopramide), because the latter can weaken the prolactin-lowering effect of Dostinex.
Like other ergot derivatives, Dostinex should not be used concomitantly with macrolide antibiotics (for example, with erythromycin), since this can lead to an increase in the systemic bioavailability of cabergoline.
Analogues of the drug Dostinex
Structural analogues active substance:
- Agalates;
- Bergolak;
- Cabergoline.
In the absence of analogues of the drug for the active substance, you can follow the links below to the diseases for which the corresponding drug helps, and see the available analogues for the therapeutic effect.
- Instructions for use Dostinex
- Composition of the drug Dostinex
- Indications for Dostinex
- Storage conditions of the drug Dostinex
- Shelf life of the drug Dostinex
Release form, composition and packaging
tab. 500 mcg: 2 or 8 pcs.Reg. No: 1110/97/03/07/12 dated 01.11.2012 - Current
Pills white, flat, oblong; on one side the inscription "РU" is engraved, separated by a notch; the other side is engraved with the inscription "700" and light notches above and below the central number "0".
Excipients: anhydrous lactose, leucine (E641).
2 pcs. - dark glass bottles (1) - cardboard boxes.
8 pcs. - dark glass bottles (1) - cardboard boxes.
Description of the medicinal product DOSTINEX based on the officially approved instructions for use of the drug and made in 2013. Updated date: 27.02.2013
Dostinex is a dopaminergic ergoline derivative with pronounced and long-term prolactin-lowering activity. The mechanism of its action is associated with direct stimulation of dopamine D 2 -receptors of pituitary lactotropic cells, which leads to a decrease in prolactin secretion. This compound reduces the secretion of prolactin in rats at an oral dose of 3-25 μg / kg, and in vitro at a concentration of 45 pg / ml. In addition, cabergoline has a central dopaminergic effect due to the stimulation of dopamine D 2 receptors when used orally at doses higher than those required to lower plasma prolactin levels. The long-term prolactin-reducing effect of cabergoline is probably due to its prolonged presence in the target organ, which can be assumed based on the slow clearance of total radioactivity from the pituitary gland after a single oral dose in rats (T 1/2 is approximately 60 hours). The pharmacodynamic effects of cabergoline have been studied in healthy volunteers, postpartum women and patients with hyperprolactinemia. After a single oral administration cabergoline (at a dose of 0.3-1.5 mg), a significant decrease in serum prolactin levels was observed in each of the studied groups. This effect develops rapidly (within 3 hours after administration) and persists for a long time (up to 7-28 days in healthy volunteers and patients with hyperprolactinemia and up to 14-21 days in women in the postpartum period). The prolactin-lowering effect is dose-dependent in both severity and duration of effect. With regard to the endocrine effects of cabergoline, which are not related to its antiprolactinemic action, the data obtained in humans support experimental data obtained in animals, and indicate that the test substance has a strictly selective effect and does not affect the basal secretion of other pituitary hormones or cortisol. The pharmacodynamic profile of cabergoline did not correlate with the therapeutic effect only in terms of lowering blood pressure. The maximum hypotensive effect of cabergoline with a single dose usually develops within the first 6 hours after taking the drug and is dose-dependent both in relation to the maximum decrease in blood pressure and in relation to the frequency of the effect.
Suction
The pharmacokinetic and metabolic profiles of cabergoline were studied in healthy volunteers of both sexes and in female patients with hyperprolactinemia.
After oral administration of the labeled compound, radioactivity was rapidly absorbed from the gastrointestinal tract, and the peak of radioactivity in plasma was reached in the time interval from 0.5 to 4 h.
Ten days after administration of the compound, about 18% and 72% of the administered radioactive dose were excreted in urine and feces, respectively. The amount of unchanged drug in urine was 2-3% of the administered dose.
Food intake does not affect the absorption and distribution of cabergoline.
Distribution
In vitro experiments have shown that cabergoline at a concentration of 0.1-10 ng / ml binds to blood plasma proteins by 41-42%.
Metabolism
The main metabolite identified in urine was 6-allyl-8p-carboxy-ergoline, the amount of which was 4-6% of the administered dose. Three other metabolites were identified in urine, the total content of which was less than 3% of the administered dose. The metabolites have been found to have a much less pronounced inhibitory effect on prolactin secretion in vitro than cabergoline. The biotransformation of cabergoline was also studied in the plasma of healthy male volunteers treated with [14 C] -cabergoline:
- a rapid and extensive biotransformation of cabergoline was found.
Withdrawal
The low level of excretion of unchanged cabergoline in the urine was also confirmed in studies using a non-radioactive drug. According to the results of assessing the indicators of excretion in the urine, cabergoline has a long T 1/2 (63-68 hours in healthy volunteers - when using radioimmunoassay, 79-115 hours in patients with hyperprolactinemia - when using the HPLC method). Given T1 / 2, a stable state can be achieved after 4 weeks of taking the drug, which was confirmed by the mean plasma C max levels of cabergoline obtained after taking a single dose (37 ± 8 pg / ml) and after 4 weeks of multiple doses (101 ± 43 pg / ml).
Inhibition / suppression of physiological lactation:
- to inhibit physiological lactation soon after childbirth;
- to suppress the already established lactation (after childbirth, when the mother decides to refuse breastfeeding the child, or in cases where breastfeeding is contraindicated for the mother or child for medical reasons; after a miscarriage or abortion).
- for the treatment of disorders associated with hyperprolactinemia, including functional disorders such as amenorrhea, oligomenorrhea, anovulation and galactorrhea;
- prolactin-secreting pituitary adenomas (micro- and macroprolactinomas), idiopathic hyperprolactinemia or the syndrome of "empty" Turkish saddle in combination with hyperprolactinemia, which are the main types of pathology leading to the development of the above-mentioned clinical manifestations.
Treatment of disorders associated with hyperprolactinemia:
The tablets should be taken orally. Since the tolerance of dopaminergic drugs improves when taken with food, it is recommended to take Dostinex with meals.
In patients with a history of intolerance to dopaminergic drugs, the likelihood of developing undesirable manifestations can be reduced if cabergoline therapy is started with lower doses (for example, 0.25 mg once a week), followed by a gradual increase in dosage until the therapeutic dose is reached. In the case of persistent or severe adverse events, it is possible to improve the tolerance of the drug by temporarily reducing the dose, followed by a gradual increase in it (for example, an increase of 0.25 mg per week every two weeks).
For suppression of established lactation The recommended dosage is 0.25 mg (half a 0.5 mg tablet) every 12 hours for 2 days (total dose 1 mg).
The recommended starting dose of cabergoline is 0.5 mg per week in 1 or 2 divided doses (1/2 tab. 0.5 mg) for a week (for example, Monday and Thursday). The increase in the weekly dose should be carried out gradually, preferably by 0.5 mg per week with an interval of 1 month until the optimal therapeutic effect is achieved. The therapeutic dose is usually 1 mg per week, but can range from 0.25 mg to 2 mg per week. In patients with hyperprolactinemia, doses up to 4.5 mg per week were used.
The weekly dose can be administered in 1 dose or divided into 2 or more doses per week, depending on the patient's tolerance. When prescribing the drug in doses exceeding 1 mg per week, it is recommended to divide the weekly dose into several doses.
Patients should be assessed during dose escalation in order to determine the minimum effective dose that has a therapeutic effect. After reaching the therapeutic dose, monthly regular measurement of the serum prolactin level is recommended. Normalization of serum prolactin levels is usually observed within 2 to 4 weeks of treatment.
After withdrawal of cabergoline, a relapse of hyperprolactinemia is usually observed. However, in a number of patients, persistent suppression of prolactin levels was observed for several months. In most women, ovulatory cycles persist for at least 6 months after cabergoline is discontinued.
Patients with severe hepatic impairment lower doses of cabergoline should be used.
Safety and efficacy of the drug in patients under the age of 16 not installed.
Formal studies on the use of cabergoline in elderly people for the treatment of disorders associated with hyperprolactinemia have not been performed.
The adverse reactions reported with cabergoline are listed below by MedDRA organ system class and by frequency, which was determined as follows:
- very often (\u003e 1/10), often (\u003e 1/100 to<1/10), нечасто (от >1/1000 to<1/100), редко (от >1/10 000 to 1/1000), very rarely (<1/10 000), частота неизвестна (не может быть установлена на основании доступных данных).
general information
often - in patients receiving long-term treatment, cabergoline usually has a hypotensive effect;
From the musculoskeletal system: infrequently - convulsive twitching of the leg muscles.
From the hematopoietic system: infrequently - a decrease in hemoglobin level has been reported in women with amenorrhea during the first few months after the resumption of menstruation.
Disorders associated with hyperprolactinemia
From the side of the psyche: often - depression, sleep disturbances;
From the side nervous system: very often - dizziness / vertigo, headache;
On the part of the cardiovascular system: often hot flashes.
From the digestive tract:very often - abdominal pain, dyspepsia, gastritis, nausea;
From the genitals and mammary gland: often - pain in the mammary glands.
Others: very often asthenia / weakness.
Inhibition / suppression of lactation
From the nervous system:very often - dizziness / vertigo, headache, drowsiness;
On the part of the cardiovascular system: very often - valvulopathy (including regurgitation) and concomitant diseases (pericarditis and pericardial effusion);
infrequently - nosebleeds, pleural effusion, pulmonary fibrosis.
From the digestive tract: often - abdominal pain, nausea;
On the part of the organ of vision:frequency unknown - abnormal vision.
Others: very often - asthenia.
Post-marketing surveillance
From the immune system:frequency unknown - hypersensitivity reactions.
From the side of the psyche:frequency unknown - delirium, mental disorder.
From the respiratory system:infrequently - shortness of breath;
From the liver and biliary tract:frequency unknown - liver dysfunction.
On the part of the skin and subcutaneous tissues:infrequently - alopecia, rash.
Others:infrequently - edema, an increase in the level of CPK, abnormalities in laboratory parameters of liver function.
- a history of pulmonary, pericardial and retroperitoneal fibrotic changes;
- hypersensitivity to cabergoline, other components of the drug, or any ergot alkaloids.
- anatomical signs of valvulopathy of any heart valve, identified before treatment with cabergoline by echocardiography (thickening of the valve leaflets, valve narrowing, combined stenosis - valve narrowing).
Long-term use of the drug
Application during pregnancy and lactation
Animal studies of cabergoline have not shown teratogenic effects or effects on general reproductive capacity. However, there are no adequate and well-controlled studies in pregnant women. Cabergoline should only be used during pregnancy if absolutely necessary. If conception occurs during treatment with cabergoline, then discontinuation of treatment should be considered after careful assessment of the risk and benefit to the mother and fetus. Pregnancy should be avoided for at least 1 month after stopping treatment with cabergoline, as it has a long half-life and there are only limited data on the effect of the drug on the fetus, although the use of cabergoline at a dose of 0.5 to 2 mg per week in the treatment of disorders associated with hyperprolactinemia, not accompanied by an increased risk of miscarriage, premature birth, multiple births, or congenital malformations of the fetus.
In rats, cabergoline and / or its metabolites are excreted in milk. Information on excretion in human milk is not available; however, mothers should be advised not to breastfeed if cabergoline has failed to inhibit / suppress lactation. Because the drug suppresses lactation, cabergoline should not be given to mothers with hyperprolactinemia disorders who wish to breastfeed their babies.
Like other ergot derivatives, cabergoline should be used with caution in patients with severe cardiovascular disease, Raynaud's syndrome, peptic ulcer or gastrointestinal bleeding, and in patients with a history of severe mental illness, especially psychosis.
Liver failure
In long-term treatment of patients with severe hepatic impairment, cabergoline should be prescribed in lower doses. In patients with severe hepatic impairment (severity class C on the Child-Pugh scale), who took a single dose of 1 mg, there was an increase in AUC when compared with volunteers and persons with a lesser degree of hepatic impairment.
Orthostatic hypotension
After taking cabergoline, orthostatic hypotension may develop. During therapy with drugs that have an antihypertensive effect, cabergoline should be prescribed with caution.
Fibrosis / Valvulopathy
As with other ergot derivatives, cases of pleural effusion / pneumofibrosis and valvulopathy have been reported with long-term administration of cabergoline. Several of these reports related to patients previously treated with ergoline dopamine receptor agonists. Therefore, in patients with a history or current of signs and / or clinical symptoms characteristic of respiratory or cardiac disorders associated with the formation of fibrous tissue, cabergoline should be used with caution. With the development of pleural effusion / fibrosis, increased ESR... In case of an unexplained increase in ESR above normal, it is recommended to conduct x-ray examination organs chest... To facilitate the diagnosis of fibrotic changes, you can also use the determination of the content of creatinine in blood plasma. Discontinuation of cabergoline after a diagnosis of pleural effusion / fibrosis or valvulopathy has been reported to improve signs and symptoms of the disease.
Long-term use of the drug
Before starting long-term use of the drug: all patients should undergo a cardiovascular assessment, including echocardiography to determine the presence of asymptomatic valvular disease. It is also necessary to conduct an initial determination of erythrocyte sedimentation rate or other markers of inflammation, lung function / radiography, and renal function before starting treatment. It is not known whether taking cabergoline in patients with valvular regurgitation can worsen the underlying disease. If fibrotic changes in the heart valves are diagnosed, patients should not be treated with cabergoline.
During long-term use of the drug: fibrotic changes may be asymptomatic; it is necessary to regularly monitor the condition of patients for possible manifestations progressive fibrosis. Therefore, attention should be paid to signs and symptoms during treatment:
- pleuropulmonary disorders such as dyspnea, shortness of breath, persistent cough, or chest pain;
- renal failure or ureteral / abdominal vascular occlusion, which may present with pain in the lumbar region / sides of the body and edema of the lower extremities, as well as possibly abdominal masses or soreness, which may indicate retroperitoneal fibrosis;
- heart failure: Cases of valvular or pericardial fibrosis often manifest as heart failure. Therefore, when such symptoms appear, valve fibrosis (and constrictive pericarditis) should be ruled out.
It is of great importance to conduct proper clinical diagnostic control for the development of fibrotic changes. After starting treatment, the first echocardiography must be completed within 3-6 months; thereafter, the frequency of control echocardiography should be determined according to the appropriate individual clinical assessment with special emphasis on the aforementioned signs and symptoms, and should be performed at least every 6-12 months.
If the echocardiogram reveals new signs or negative dynamics on the part of valve regurgitation, restriction of valve leaflet mobility or thickening of the valve leaflets, treatment with cabergoline should be discontinued.
The need for others clinical methods monitoring (for example, physical examination, including cardiac auscultation, x-rays, computed tomography) must be determined individually.
Additional relevant laboratory research, such as the erythrocyte sedimentation rate and determination of the content of creatinine in the blood plasma, should be carried out when it is necessary to confirm the diagnosis of fibrotic changes.
Drowsiness / Sudden onset of sleep
Cabergoline administration has been associated with the development of drowsiness. Prescribing dopamine receptor agonists may be associated with sudden sleep episodes in patients with Parkinson's disease. In this case, you should reduce the dose or stop the drug treatment.
Inhibition / suppression of physiological lactation
Like other ergot derivatives, cabergoline should not be used in women with pregnancy-related hypertension, such as preeclampsia or postpartum hypertension, unless the potential benefit outweighs the potential risk.
It is not recommended to exceed a single dose of cabergoline, equal to 0.25 mg, in nursing mothers when carrying out treatment aimed at suppressing already established lactation, in order to prevent possible development orthostatic hypotension.
Treatment of disorders associated with hyperprolactinemia
Before starting treatment with cabergoline, a complete examination of the pituitary gland is indicated.
Cabergoline restores ovulation and fertility in women with hyperprolactinemic hypogonadism. Since pregnancy can occur even before menstruation is restored, it is recommended to carry out pregnancy tests at least once every 4 weeks during the period of amenorrhea, and after the restoration of menstruation, every time there is a delay in menstruation by more than 3 days. For women who want to avoid pregnancy, the use of mechanical methods of contraception should be recommended during the period of treatment with cabergoline, as well as after its cancellation and before the return of anovulation. Women who have become pregnant should be under the supervision of a doctor for precautions, for the timely detection of symptoms of an enlarged pituitary gland, since during pregnancy it is possible to increase the size of already existing pituitary tumors.
Psychiatric disorders
There have been reports of cases of pathological passion, increased sex drive and hypersexuality in patients taking dopamine agonists, including cabergoline. These events were generally reversible with dose reduction or drug withdrawal.
Influence on the ability to drive a car and use mechanisms
Patients receiving cabergoline treatment who experience drowsiness should be advised to refrain from driving or engaging in such activities when impaired attention could lead to the risk of serious injury or death for them or others (for example, operating machinery) before until they stop feeling so sleepy.
Non-clinical safety data
Almost all of the data obtained in a series of preclinical safety studies are a consequence of central dopaminergic effects or long-term suppression of prolactin secretion in species with a special hormonal physiology that differs from that of humans (rodents). Preclinical studies of cabergoline indicate a wide range of safety of this compound in rodents and monkeys, as well as the absence of teratogenic, mutagenic and carcinogenic potential in it.
Symptoms: nausea, vomiting, dyspeptic disorders, orthostatic hypotension, confusion / psychosis, or hallucinations.
Treatment: measures should be taken to eliminate the drug (gastric lavage) and to maintain blood pressure. Prescription of dopamine antagonists is recommended.
There is no information on the interaction of cabergoline and other ergot alkaloids; however, the concomitant use of these drugs during long-term cabergoline therapy is not recommended.
Since cabergoline exerts its therapeutic effect due to direct stimulation of dopamine receptors, it should not be administered simultaneously with drugs with dopamine-antagonistic activity (such as derivatives of phenothiazine, butyrophenone, thioxanthene, metoclopramide), because this may weaken the effect of lowering prolactin levels with cabergoline.
Like other ergot derivatives, cabergoline should not be used concomitantly with macrolide antibiotics (eg erythromycin), as this may increase the systemic bioavailability of cabergoline.
PFIZER EXPORT B.V., representative office, (Kingdom of the Netherlands)
Representation Hprivate limited liability company "Pfizer Export B.V. " in the Republic of Belarus
Dopamine receptor agonist. Cabergoline is a dopaminergic derivative of ergoline, characterized by a pronounced and prolonged prolactin-lowering effect. The mechanism of action is associated with direct stimulation of dopamine D 2 receptors of lactotropic cells of the pituitary gland. In doses exceeding those for lowering the level of prolactin in the blood plasma, it has a central dopaminergic effect due to the stimulation of dopamine D 2 receptors.
A decrease in the level of prolactin in blood plasma is noted 3 hours after taking Dostinex and persists for 7-28 days in healthy volunteers and patients with hyperprolactinemia and up to 14-21 days in women in the postpartum period. Prolactin-lowering action is dose-dependent both in terms of severity and duration of action.
Cabergoline has a strictly selective effect and therefore does not affect the basal secretion of other pituitary hormones, as well as cortisol.
The pharmacological effects of cabergoline, which are not associated with a therapeutic effect, include a decrease in blood pressure. With a single use of the drug, the maximum hypotensive effect is observed during the first 6 hours and is dose-dependent.
Pharmacokinetics
Suction
After oral administration, cabergoline is rapidly absorbed from the gastrointestinal tract. C max in plasma is reached after 0.5-4 hours. Food intake does not affect the absorption and distribution of cabergoline.
Distribution
C ss is achieved after 4 weeks of therapy due to prolonged T 1/2. Plasma protein binding is 41-42%.
Metabolism
The main metabolic product of cabergoline identified in urine is 6-allyl-8β-carboxy-ergoline at a concentration of up to 4-6% of the dose taken. The content of 3 additional metabolites in urine does not exceed 3% of the dose taken. Metabolic products have a significantly lower effect in terms of suppressing the secretion of prolactin compared to cabergoline.
Withdrawal
T 1/2, assessed by the rate of excretion in the urine, is 63-68 hours in healthy volunteers and 79-115 hours in patients with hyperprolactinemia.
10 days after application of the drug in urine and feces, 18% and 72% of the dose taken, respectively, are found, and the proportion of unchanged drug in urine is 2-3%.
Release form
Tablets are white, flat, oblong; marked "P" and "U", separated by a notch on one side and "700" with short notches at the top and bottom of the number on the other.
Excipients: anhydrous lactose - 75.9 mg, leucine - 3.6 mg.
2 pcs. - bottles of dark glass (1) - packs of cardboard.
8 pcs. - bottles of dark glass (1) - packs of cardboard.
Dosage
Dostinex ® should be taken orally, preferably with meals.
To prevent lactation, the drug is prescribed at a dose of 1 mg (2 tablets) once on the first day after childbirth.
To suppress the established lactation, 0.25 mg (1/2 tab.) Is prescribed 2 times / day for 2 days (the total dose is 1 mg). To reduce the risk of orthostatic hypotension in lactating patients, a single dose of Dostinex 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 doses (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 until the optimal therapeutic effect is achieved. The average therapeutic dose is 1 mg per week, but can range from 0.25 mg to 2 mg per week. The maximum dose for patients with hyperprolactinemia is 4.5 mg per week.
Depending on the tolerance, the weekly dose can be taken once or divided into 2 or more doses per week. The division of the weekly dose into several doses is recommended when prescribing the drug at a dose of more than 1 g per week.
In patients with hypersensitivity to dopaminergic drugs, the likelihood of side effects can be reduced by starting Dostinex therapy at a lower dose (0.25 mg once a week), followed by its gradual increase until the therapeutic dose is reached. To improve the tolerability of the drug in the event of severe side effects, it is possible to temporarily reduce the dose, followed by a gradual increase, for example, by 0.25 mg per week every 2 weeks.
Overdose
Symptoms: nausea, vomiting, dyspeptic disorders, orthostatic hypotension, confusion / psychosis, or hallucinations.
Treatment: measures should be taken to eliminate the drug (gastric lavage) and to maintain blood pressure. Prescription of dopamine antagonists is recommended.
Interaction
There is no information on the interaction of cabergoline and other ergot alkaloids; however, the simultaneous use of these drugs during long-term therapy with Dostinex is not recommended.
Since Dostinex ® has a therapeutic effect by direct stimulation of dopamine receptors, the drug should not be administered concurrently with drugs acting as dopamine antagonists (for example, phenothiazines, butyrophenones, thioxanthenes, metoclopramide), because the latter can weaken the prolactin-lowering effect of Dostinex.
Like other ergot derivatives, Dostinex ® should not be used concomitantly with macrolide antibiotics (for example, with erythromycin), as this may increase the systemic bioavailability of cabergoline.
Side effects
In clinical studies with Dostinex to prevent physiological lactation (1 mg once) and to suppress lactation (0.25 mg every 12 hours for 2 days) side effects were noted in approximately 14% of women. When Dostinex was used for 6 months at a dose of 1-2 mg per week, divided into 2 doses, for the treatment of disorders associated with hyperprolactinemia, the incidence of side effects was 68%. Side effects occurred mainly during the first 2 weeks of therapy and in most cases disappeared as therapy continued or a few days after Dostinex was discontinued. Side effects were usually transient, mild or moderate in severity and dose-dependent. At least once during therapy, severe side effects were noted in 14% of patients; due to side effects, treatment was discontinued in about 3% of patients.
The most common side effects are presented below:
On the part of the cardiovascular system: palpitations; rarely - orthostatic hypotension (with prolonged use, the drug has a hypotensive effect); asymptomatic decrease in blood pressure during the first 3-4 days after childbirth (systolic - more than 20 mm Hg, diastolic - more than 10 mm Hg).
From the side digestive system: nausea, vomiting, epigastric pain, abdominal pain, constipation, gastritis, dyspepsia.
From the side of the central nervous system and peripheral nervous system: dizziness / vertigo, headache, increased fatigue, drowsiness, depression, asthenia, paresthesia, fainting.
Others: mastodynia, epistaxis, flushing of the face, transient hemianopsia, vasospasm of the fingers, muscle cramps of the lower extremities (like other ergot derivatives, Dostinex ® may have a vasoconstrictor effect).
With prolonged therapy with Dostinex, deviation from the norm of standard laboratory parameters was rarely observed; women with amenorrhea experienced a decrease in hemoglobin levels during the first few months after menstruation was restored.
In a post-marketing study, the following adverse reactions associated with the use of cabergoline were recorded: alopecia, increased CPK activity in the blood, mania, dyspnea, edema, fibrosis, liver dysfunction, liver function abnormalities, hypersensitivity reactions, rash, respiratory disturbances, respiratory failure, valvulopathy.
Indications
- prevention of physiological postpartum lactation;
- suppression of established postpartum lactation;
- treatment of disorders associated with hyperprolactinemia, including amenorrhea, oligomenorrhea, anovulation and galactorrhea;
- prolactin-secreting pituitary adenomas (micro- and macroprolactinomas), idiopathic hyperprolactinemia, syndrome of "empty" Turkish saddle in combination with hyperprolactinemia.
Contraindications
- children and adolescents under 16 years of age (safety and efficacy have not been established);
- hypersensitivity to cabergoline or other components of the drug, as well as to any ergot alkaloids.
Dostinex ® should be administered with caution in the following conditions and / or diseases:
- arterial hypertensionthat developed during pregnancy, for example, preeclampsia or postpartum arterial hypertension (Dostinex ® is prescribed only in cases where the potential benefit of using the drug significantly outweighs the possible risk);
- severe cardiovascular disease, Raynaud's syndrome;
- peptic ulcer, gastrointestinal bleeding;
- severe hepatic impairment (lower doses are recommended);
- severe psychotic or cognitive impairment (including a history);
- symptoms of dysfunction of the heart and respiration due to fibrotic changes or the presence of such conditions in history;
- simultaneous use with drugs that have an antihypertensive effect (due to the risk of orthostatic hypotension).
Application features
Application during pregnancy and lactation
Since there have been no controlled clinical studies with Dostinex in pregnant women, the use of the drug during pregnancy is possible only when the intended benefit to the mother outweighs the potential risk to the fetus.
If pregnancy occurs during treatment with Dostinex, the advisability of discontinuing the drug should be considered, also taking into account the benefit / risk ratio.
Pregnancy should be avoided for at least 1 month after discontinuation of the drug, given its long half-life and limited data on fetal exposure. According to the available data, the use of Dostinex at a dose of 0.5-2 mg per week for disorders associated with hyperprolactinemia was not accompanied by an increase in the frequency of miscarriages, premature births, multiple pregnancies and congenital malformations.
There is no information on the release of the drug in breast milk, however, in the absence of the effect of Dostinex to prevent or suppress lactation, breastfeeding should be abandoned. For disorders associated with hyperprolactinemia, Dostinex ® should not be prescribed to mothers who do not want to stop lactation.
Application for violations of liver function
The drug is used with caution in severe hepatic impairment (lower doses are recommended).Application in children
Contraindication: children and adolescents under 16 years of age (safety and efficacy have not been established).special instructions
Before the appointment of Dostinex for the treatment of disorders associated with hyperprolactinemia, it is necessary to conduct a complete study of the function of the pituitary gland.
When increasing the dose, patients should be under medical supervision in order to establish the lowest effective dose that provides a therapeutic effect. After an effective dosing regimen has been selected, it is recommended to carry out a regular (once a month) determination of the concentration of prolactin in the blood serum. Normalization of prolactin levels is usually observed within 2-4 weeks of treatment.
After discontinuation of Dostinex, a relapse of hyperprolactinemia is usually observed, but in some patients there is a persistent suppression of prolactin levels for several months. In most women, ovulatory cycles persist for at least 6 months after Dostinex is discontinued.
Dostinex ® restores ovulation and fertility in women with hyperprolactinemic hypogonadism. Since pregnancy can occur before menstruation has returned, it is recommended that pregnancy tests be performed at least every 4 weeks during the amenorrhea period, and after menstruation has returned, whenever menstruation is delayed by more than 3 days. Women wishing to avoid pregnancy should use barrier methods of contraception during treatment with Dostinex, as well as after discontinuation of the drug until anovulation recurs. Women who have become pregnant should be under the supervision of a doctor for the timely detection of symptoms of an enlarged pituitary gland, since during pregnancy it is possible to increase the size of already existing pituitary tumors.
Dostinex ® should be prescribed in lower doses to patients with severe hepatic impairment (class C on the Child-Pugh scale) who are indicated for long-term drug therapy. With a single dose of 1 mg to such patients, there was an increase in AUC compared to healthy volunteers and patients with less severe hepatic impairment.
As with other ergot derivatives, patients have experienced pleural effusion / pleural fibrosis and valvulopathy after long-term administration of cabergoline. In some cases, patients received prior therapy with ergotinine dopamine agonists. Therefore, Dostinex ® should be used with caution in patients with existing signs and / or clinical symptoms of cardiac dysfunction or with a history of such conditions. After discontinuation of Dostinex, patients with a diagnosis of pleural effusion / pleural fibrosis and valvulopathy showed improvement in symptoms.
The use of cabergoline causes drowsiness. In patients with Parkinson's disease, the use of dopamine receptor agonists can induce sudden sleep. In such cases, it is recommended to reduce the dose of Dostinex or discontinue therapy.
Studies on the use of the drug in elderly patients with disorders associated with hyperprolactinemia have not been conducted.
Use in pediatrics
The safety and efficacy of the drug in children under 16 years of age has not been established.
Influence on the ability to drive vehicles and use mechanisms
Patients taking Dostinex® who experience drowsiness should be warned that they are advised to refrain from driving a car and from performing work (for example, with machinery), in which reduced attention could create for them or others the risk of serious injury or of death.
In Russia, 62% of women prefer breastfeeding (as of 2014), but there are situations when it is necessary to stop milk production in a short time.
One of the best-selling drugs for stopping lactation is Dostinex. How does it work? How to take it correctly: to suppress established lactation and to prevent the appearance of milk? How long does it take for milk to disappear, and is it possible to feed a child while taking the drug? Can I take?
Composition and purpose of the drug
Lactation is a complex physiological process in which hormones produced by the hypothalamus play the main role. Prolactin starts milk production, and oxytocin drives it through the ducts and delivers it to the outside of the gland.
Dostinex for interrupting lactation is prescribed to mothers as an emergency aid in urgently stopping feeding. It can be used from the first days of colostrum production or in case of complications associated with an excess of prolactin.
The active substance of Dostinex is cabergoline (an ergoline derivative), additional components are lactose, leucine. The drug is available in the form of tablets weighing 0.5 mg, white, odorless.
Act
The active substance of the drug directly acts on D2-like dopamine receptors of lactotropic cells of the adenohypophysis. As a result, the production of prolactin is inhibited, the concentration in the blood drops, milk is not produced.
Dostinex begins to act within 3 hours after taking the first dose, cabergoline remains in the blood for 14-28 days. The severity and duration of the effect depends on the dosage. The drug acts selectively, does not regulate the work of the adjacent lobes of the pituitary gland.
Cabergoline provokes a decrease in blood pressure. With a single dose of Dostinex, the hypotensive symptom appears after 2-3 hours. The pressure is normalized within a day.
Indications
- Stopping postpartum lactation (before feeding).
- Suppression of established milk production at the feeding stage.
- Galactorrhea (spontaneous milk flow).
- Menstrual irregularities - oligomenorrhea, amenorrhea.
- Endocrine infertility (anovulation).
- Pituitary prolactinoma.
- Hyperprolactinemia of unknown nature ( increased content hormone prolactin in the blood).
Dostinex - hormonal drug, therefore, it is used only as directed by a doctor, when there are objective reasons for stopping lactation. It is also recommended for mothers diagnosed with HIV infection, hepatitis C (at stages with high viral load), to eliminate the risk of infection of the child. It is prescribed in cases of necessary termination of pregnancy at a later date.
Gynecologists recommend natural ways to suppress prolactin after childbirth: by gradually refusing to feed, without stress for the baby. Dostinex during lactation is prescribed in emergency situations, for example, when the mother is away from the child for a long time, or. The flow of milk stops temporarily, there is a chance for a return to breastfeeding.
How to take it right to stop lactation: instructions
Since there have been cases of side effects from taking, the appointment of the drug is recommended in situations where possible risks justified by the need for urgent suppression of lactation. Dostinex is taken strictly according to indications, exceeding the dosage is fraught with dangerous complications.
Reception scheme
The instructions for use highlight 2 reception schemes, depending on the purpose:
- To suppress established lactation - half a tablet every 12 hours for a course of 2 days.
- To prevent the appearance of milk - 2 tablets in one dose within 48 hours after the birth of the baby.
The required dose of the drug to stop lactation is 1 gram. A day after taking the last dose, you can apply the baby to the breast, but in this case, the effectiveness of the therapy comes to naught, since the milk will come again due to the inhibition of the action of cabergoline.
Do I need to express milk?
If the treatment is effective, the milk will burn out on the first day. But if lactation is abundant and accompanied by pain, it is permissible to pump to eliminate the risks of lactostasis. Also, milk outflow is needed when lactation is temporarily stopped, for example, when a woman is receiving antibiotics. You need to express milk correctly: do kneading massage more often, including before the procedure. It is not necessary to express to the last drop, the task is to relieve the heaviness in the breast, the remaining milk will burn out. If lactation continues on the first day, do not panic. Gradually, by the end of the second day, the discharge should stop.
Engorgement of the mammary glands, heaviness, aches are the first symptoms of complications in which the help of a doctor is required. The signs characterize lactostasis. The advanced forms of the disease provoke infection of the body,.
How long does it take for breast milk to disappear?
The time to stop lactation depends on the level of the hormone prolactin in the woman's blood: before taking the drug, it is advisable to check its level. On average, it takes a week to two to stop lactation.
Can I feed while taking Dostinex
There are no reliable data on the elimination of cabergoline in breast milk, but with residual manifestations of lactation while taking Dostinex, natural feeding is excluded. First, due to the opposite effect - the sucking reflex provokes the production of oxytocin, the flow of breast milk. Secondly, the lack of study of the effect of the main substance on the child's body.
What if it doesn't help?
In 15% of reviews on the drug, it is noted that Dostinex did not help stop lactation, only side symptoms appeared. In this case, consultation with a gynecologist is required.
In half of the cases, the drug works after increasing the dosage. If Dostinex is ineffective, analogs are prescribed (for example, Bromocriptine): drugs are produced by other manufacturers, contain the same active substance, but in some cases they act more effectively, without side symptoms. However, such drugs (generics) have not undergone clinical trials and can cause unpredictable side effects.
If Dostinex or analogues do not help stop lactation, some desperate women turn to traditional medicine. Alternative therapy includes:
- Essential oil of medicinal sage.
- Infusion of mint, lemon balm.
- Bearberry extract, basil.
- Lingonberry, parsley.
The herbs are mixed, brewed with boiling water, infused for 30-40 minutes. Take half a glass (1 tablespoon per 200 ml), 2 times a day - in the morning on an empty stomach and before bedtime.
Dostinex with lactostasis
In the first days after childbirth, a woman produces up to 500 ml of milk per day. In this case, the newborn drinks less than half, since the sucking reflex has not yet been developed. Residual fluid stagnates in the ducts, provoking blockage and inflammation of the glands - lactostasis. With stagnant milk without signs of infection, mechanical methods of relieving the symptom are recommended - massage, compresses, herbal preparations. Usually, after 4-6 weeks, the ratio of milk production and consumption by the baby is restored, the problem disappears on its own.
But if lactostasis is complicated by an abscess, pills are prescribed to suppress lactation. Dostinex is recommended for a daily course: 0.25 mg every 12 hours. The drug is prescribed in cases where the risks of complications from milk production exceed the need for natural feeding.
Comprehensive treatmente includes:
- Magnesia for relaxation of muscle fibers ducts.
- Dimexide, to relieve swelling and inflammation.
- - etiotropic therapy.
- Dostinex lactation pills - for temporary suspension of the load on the glands.
- Manual massage of breasts.
Recovery of lactation after Dostinex
If the therapy was temporary, after Dostinex, relaxation is recommended (return to natural feeding), especially when the baby is less than six months old. Recovery is permissible only after complete recovery and discontinuation of medication.
- Massage your breasts daily.
- Apply the baby to the breast every 4 hours, even if the milk burns out after Dostinex.
- Drink a day normal amount fluids (contraindication - edema, renal failure).
- Take biogenic stimulants to restore lactation - a mixture of the Milky Way, Mlekoin.
- In the menu, include unpolished rice, black currants, dill, green tea with lemon balm and mint.
- Avoid drafts.
You can stimulate the mammary glands with a shower: circular motion warm spray for 5 minutes on each side. It is better to do the procedure before bedtime. After a shower, wrap a scarf around your chest, drink a cup of warm tea, and lie under a blanket for 1.5-2 hours. Women with experience in restoring lactation note that milk rises gradually, in the first 7-10 days signs of prolactin activity do not appear. But if you apply the child every day, every 3-4 hours, the result will definitely appear.
In the first weeks after recovery, after feeding the baby, you need to drink mixture or expressed milk. It is important to continue the prevention of stagnation in the mammary glands (massage, warming compresses).
Side effects
When used correctly, Dostinex works for sure, but has side effects that often bother mothers. If unpleasant symptoms appear, it is recommended to stop treatment.
After taking Dostinex, every 6th woman has adverse reactions that subside after the pills are canceled. In 3% of cases, the treatment continued with a reduced dosage, the rest of the patients are not recommended to take the drug due to personal intolerance.
Reactions:
- Tachycardia.
- Decrease in blood pressure.
- Weakness, drowsiness.
- Deconcentration of attention.
- Nervousness.
- Paresthesia - tingling, goosebumps.
- Asthenic syndrome.
- Digestive dysfunction - nausea, vomiting, flatulence, dyspepsia.
- Violation of the menstrual cycle.
- Spasms, muscle cramps.
Within 3-6 hours after administration, a vasoconstrictor effect is manifested, which provokes tingling, cooling of the limbs. Malaise, drowsiness, irritability are caused by a sharp change in hormonal levels. After the body has adapted to the new state, the side effects should fade away. When prescribed for suppression of lactation, the drug is rarely canceled due to a short course.
Contraindications
Before prescribing a drug, a patient must be tested for attribution to a risk group adverse reactions... Changes in hormonal levels primarily affect the mental, cardiovascular systems, causes irreversible complications.
At-risk groups:
- Individual sensitivity to drug components (including ergot alkaloids).
- Fibrosis of the heart, lungs.
- Pathology heart valve (if any) - leaf thickening, stenosis, narrowing of the lumen.
- Active mental illness.
- Lactase deficiency.
- Lactose intolerance.
- Malabsorption of glucose - galactose.
- Patients under 16 years old.
A reduced dose is prescribed for renal, liver failure, mental disorders in the anamnesis. Dostinex is not recommended for simultaneous use with drugs that provoke a decrease in blood pressure.
Conclusion
It is important to understand that this is a big shock for the baby. Therefore, the preferred method of suppressing lactation is physiological, with a gradual reduction in portions and a reduction in the number of applications. The action of Dostinex, directed at the receptors of the pituitary gland, provokes the destabilization of the hormonal background. Taking the drug is justified only by the urgent need for drug treatment.
Bibliography:
- Breastfeeding in the modern world - Materials of the II All-Russian scientific-practical conference with international participation, 2016 .-- 106 p.
- How to calculate statistics on breastfeeding in Russia - by Yakovlev Ya.Ya. (10.03.2019).
- Dostinex - by Drugs.com (checked 1/24/2019).