Do you need Dostinex? Dostinex to stop lactation. The main symptoms of an overdose
It is not always possible to complete breastfeeding naturally: the increased content of prolactin in a woman's body is a lot of trouble. Sometimes, due to some medical prescriptions, women are forced to stop breastfeeding immediately after childbirth. If there is a need for forced termination or suppression of established lactation, the doctor may prescribe Dostinex.
How Dostinex works
Dostinex is designed for postpartum women who need to prevent milk production and for women who are successfully breastfeeding but want to complete lactation. The drug is available in the form of oblong white tablets with a transverse stripe for ease of dividing into the required doses. One tablet can be divided into two doses.
The active substance of Dostinex, cabergoline, acts on the lactotrophic cells of the pituitary gland, which are responsible for the production of prolactin, thereby suppressing its secretion. Cabergoline is rapidly absorbed into the walls of the gastrointestinal tract. After taking the prescribed dose, a decrease in the concentration of the hormone in the blood occurs within 3 hours. Patients diagnosed with prolactinemia notice a pronounced therapeutic effect from 1 to 4 weeks. In women who took the drug after childbirth, the reduced content of lactogenic hormone persists for 2-3 weeks. During Dostinex therapy and until the active substance is completely removed from the body (up to 5 days), breastfeeding should not be resumed.
Features of the correct dosage
Dostinex tablet contains:
- cabergoline 0.5 mg (active ingredient);
- amino acid leucine and lactose (auxiliary components).
Indications for taking the drug:
- completion of established lactation;
- after abortion for the forced suppression of prolactin secretion;
- treatment of infertility, absence of menstruation, hyperprolactinemia.
You should not prescribe the drug yourself. It is necessary to consult a doctor.
The necessary doses are prescribed by the doctor, taking into account the reasons why the suppression of milk production in the mammary glands is required:
- to prevent the formation of milk in the mammary glands, within 24 hours after childbirth (abortion), if a woman does not have the ability or desire to start breastfeeding, a single dose of 1 mg of the substance (2 tablets) is prescribed;
- to complete the established lactation, 1 mg (2 tablets) is taken within 2 days. The tablet is divided into 2 equal parts of 0.25 mg and taken in the morning and evening with a break of 12 hours
- for the treatment of excessive secretion of the hormone prolactin, a weekly schedule of medication is established on strictly allotted days. The days are determined depending on the treatment rules prescribed by the doctor. A single dose is taken once a week (for example, on Mondays). If the dose is divided into 2 doses, choose a different schedule (for example, every Tuesday and Friday). To begin with, appoint a dose of 0.25-0.5 mg of the drug. In the absence of a negative effect on the body, the dosage can be increased by 0.5 mg monthly. On average, 2 mg of the substance per week is enough for the patient to obtain good results. The maximum allowed weekly amount should not exceed 4.5 mg. Once the optimal dose for treatment has been found, it is necessary to regularly check the concentration of lactogenic hormone in the blood. With a positive therapeutic effect, the prolactin level returns to normal after 2-4 weeks.
Contraindications and side effects
Since taking Dostinex has a direct effect on the hormonal background of a woman, therapy should be carried out with caution. There are also a number of contraindications, which include:
- increased susceptibility to the active substance cabergoline, an ergot derivative;
- hepatic, renal failure;
- some diseases of the gastrointestinal tract and cardiovascular system;
- mental disorders, postpartum psychosis;
- pregnancy, breastfeeding;
- patients under 16 years of age (due to the lack of studies for this age group).
In case of an overdose of the drug, vomiting, leg cramps, hypotension, hallucinations are possible
While taking the prescribed doses, the patient does not feel significant discomfort, the effect of cabergoline is moderate. Side effects can manifest themselves in sleep disturbances, lowering blood pressure, abdominal pain, dizziness, and nausea. In the treatment of hyperprolactinemia, painful sensations in the chest, weakness of the body, difficulty in emptying the intestines, inflammation of the gastric mucosa, hot flushes can be added. If pain symptoms do not go away on their own, dosage reduction is recommended. After discontinuation of treatment, it takes 1-2 days to stop the negative effects on the body.
Drug analogs
Since the relative speed of the drug is noted, we can talk about the effectiveness of the drug. Despite the fact that the instructions indicate good tolerance of possible side effects, the patient's nervous, cardiovascular, and digestive systems are negatively affected. There are analogues that have in their composition a component aimed at suppressing the production of lactogenic hormone in the pituitary gland. Side effects also affect the well-being of the woman taking the medication. The main difference between Dostinex analogs is their lower cost.
Table: Dostinex analogues
| Name | Active substance | Side effects |
| Bromocriptine | bromine | Good portability, sometimes possible:
|
| Agalates | cabergoline |
|
| Bergolak | cabergoline |
|
| Bromcamphor | bromcamphor |
|
Reviews
It turned out that I had to stop lactation at the 8th month of feeding the baby for 2 reasons: the milk became tasteless and bitter, the baby simply does not want to drink it; and the second reason - I had to constantly express myself, and there is not so much free time. Considering all these factors, I turned to the gynecologist, who prescribed Dostinex for me, drink 1/2 tablet 2 times a day for 2 days, do not pump and limit myself in fluid intake.
The process of taking pills in all its glory:
I drank the first at 8 pm, did not pump, in the morning everything was fine, milk arrived, but my breasts were still soft. Then, at 8 am, another half of the pill, and then after 30–40 minutes my head began to spin ... I felt terribly sick, since my husband was at home, sat with the child, and Morpheus took me to his place. I slept for an hour, my chest was blown apart, I could not get out of bed at all and bring my hands together (I was told not to express). For a few more hours I simply "existed" and after reading the reviews and forums again, I decided to express for relief (I really didn’t want to get lactostasis or mastitis). Ooh, I felt like a human). The rest of the time I pumped my breasts in the same way so that it does not become stone, and after the next pills I felt just as bad and I lay in a layer.
Result:
Gradually, the milk began to arrive less and less, 3 weeks passed and I can say that the milk almost completely burned out. Of course, I would like everything in 3 days, but apparently "dairy" mothers will not see this. For me, it's better to endure 2 days, lie down with a corpse, than bandage and earn yourself a sore. I take off 1 point only because of side effects.
The question of stopping breastfeeding often worries young mothers. And do not blame me for this, I had to interrupt GV because of health problems, or rather because of taking antibiotics. The main thing is to choose a simple and safe way so as not to harm your body. It's great that now there is such a modern method - pills for stopping lactation - Dostinex based on cabergoline. Its action is based on the fact that it suppresses the production of the hormone prolactin in the pituitary gland, and thus lactation stops. This drug was advised to me in the pharmacy, it is certainly not cheap, but it gets rid of milk in 2-3 days. I took it ½ tablet 2 times a day (every 12 hours), and so on for 2 days. On the first day of intake, the milk was still there, I had to express a little until I was relieved, on the second day there were no strong hot flashes. Literally in 3-4 days the milk completely passed. This drug did not cause any side effects in me, neither a headache, nor nausea. I also heard that Dostinex promotes conception, but I cannot say about it. In any case, each woman decides for herself how to interrupt lactation, but I am for a modern and affordable method. I advise Dostinex)
Breastfeeding is good for the baby and natural for the mother, however, due to medical indications or personal reasons, sometimes it is necessary to refuse it. An excess of milk, which the mother cannot feed the baby, leads to blockage of the ducts (lactostasis), inflammation of the mammary glands and a sharp deterioration in well-being. To maintain women's health, in this case, you need to stop the production of milk (lactation).
The "grandmother's" method - with a cloth or elastic bandage, does not work. Doctors have proven that this procedure does not affect lactation, but disrupts blood circulation in the tissues of the mammary gland, and provokes lactostasis. The correct way out is to stop milk production with Dostinex. It interferes with the production of prolactin responsible for breastfeeding.
In some cases, mommy has to stop lactation in order to maintain her health.Dostinex is an effective remedy for stopping lactation
With the help of Dostinex, lactation can be stopped in a short period. It is a hormonal drug that inhibits prolactin production and stops milk production. There are contraindications for its use, therefore, it is important to consult with your doctor or gynecologist before using it.
The active ingredient of Dostinex is cabergoline. Acting on the function of the pituitary gland, it reduces the production of prolactin, the amount of breast milk is reduced within 3 hours after taking the first pill. Correctly selected dosage of the drug allows you to regulate the rate of decrease in lactation. With prolonged use, less prolactin is produced.
The dosage and time of taking Dostinex is selected taking into account the reasons why it is necessary to reduce lactation.
Cabergoline remains in the blood for up to 4 weeks after the end of drug therapy. The longer the intake time, the longer it is excreted from the mother's body.
Instructions for use with dosages
When prescribing Dostinex tablets, the doctor takes into account the patient's state of health, a history of chronic diseases, and warns of side effects. The regimen is selected individually or according to the instructions for the medicine:
- To prevent lactation immediately after childbirth, 2 tablets of 1 mg are prescribed once.
- To terminate mature lactation - 1/2 tablet (250 mcg) 2 times a day for two days.
- For relief of hyperprolactinemia (increased content of the hormone prolactin in the blood) - 1 tablet (500 mcg) per week. Can be divided into two doses over the course of a week - 250 mcg at a time.
The regimen for taking the drug is selected individually by the doctor and depends on the patient's state of health, the activity of milk production and a number of other factors. Is it possible to restore lactation after taking Dostinex?
It happens that it is necessary to suppress milk secretion for a while, but not forever (sudden departure of the mother, hospitalization and other reasons). She wants to feed the baby, restore lactation when the health situation or personal circumstances improve. In this case, the doctor will advise you to take a certain dosage, but you should refrain from breastfeeding for a month after you stop taking Dostinex.
In 1-4 weeks, the drug will be completely excreted from the body, and only then can you not deny yourself the joy of breastfeeding the baby. The manufacturer does not provide information on the safety of the active substance cabergoline for a child. It is possible that if the recovery time is not observed, it will enter the baby's body with milk and cause harm.
After 4 weeks after stopping the intake of cabergoline, you can start feeding the baby or switch to full feeding - this will provide close emotional contact, give the baby the necessary strength and immunity, and allow him to grow strong and healthy.
Contraindications
It is strictly forbidden to exceed the dose of Dostinex tablets recommended by the doctor - this leads to dizziness and fainting due to a decrease in blood pressure and insufficient blood flow to the brain. Since the hormonal drug causes serious interference in the female body, it is important to make sure that there are no following contraindications:
- psychotic disorders;
- hypertension;
- sensitivity to drug components;
- severe forms of cardiovascular disease;
- arterial hypertension, preserved after childbirth;
- taking antihypertensive drugs;
- violation of respiratory functions;
- peptic ulcer;
- gastrointestinal bleeding;
- severe forms of liver failure.
High blood pressure may be a contraindication to the appointment of Dostinex to stop lactation In some situations, the doctor is not a supporter of a quick cessation of lactation, stretches the intake of the drug over time. At the same time, the suppression of prolactin and a decrease in the amount of milk are gradual, but more prolonged. A reduced dosage reduces the likelihood of side effects, it is more gently perceived by the body of a young mother.
Side effects
When deciding to suppress breast milk production with medication, a nursing mother should be aware that the state of health while taking medication can significantly worsen (see also:). It is likely that for several days she will have to care for the child, feeling significant discomfort. Switching to artificial feeding, the baby may be capricious, sleep poorly, more than usual need to be rocked in his arms.
Before taking Dostinex tablets, it is important to once again weigh the pros and cons, to make sure that there are no contraindications. The reaction of the female body to it is poorly predictable. The most common side effects are indicated in the annotation to the drug:
- lowering blood pressure;
- soreness of the mammary glands;
- headache, drowsiness;
- cardiopalmus;
- vomiting, nausea;
- nosebleeds;
- bowel problems - constipation, diarrhea;
- depression, fatigue;
- dyspepsia, exacerbation of gastritis;
- leg muscle cramps.
The risk of side effects is quite high What to do in case of a negative reaction to the drug?
While taking Dostinex tablets, a young mother should not stay at home alone. In case of dizziness or loss of consciousness (which is rare), she may need help. If, after taking the medication, mommy feels unwell and nausea, vomiting, hallucinations and confusion appear, you should urgently:
- induce vomiting;
- flush the stomach;
- take medicine to increase blood pressure;
- call an ambulance (in case of a serious condition);
- stop further taking cabergoline before consulting your doctor.
Experienced pediatrician Komarovsky advises to drink Dostinex at a time when the child can be entrusted to grandmother, dad or other close people. Within two days after administration, a decrease in blood pressure is possible, so it is advisable for mom to lie down and rest. It is not easy to do this with an infant in your arms, so the help of loved ones will be very useful.
To make the time of weaning less painful for the baby, it is important to give him maximum attention. If you are not feeling well for long walks, you can breathe fresh air in the yard, play educational toys on the rug, hold the child in your arms. Communication will bring joy and only positive emotions.
The drug "Dostinex" will prevent physiological postpartum lactation and interrupt the smooth production of breast milk. Side effects are observed within 2-10 days from the moment of taking the drug. With its help, a young mother will be able to interrupt breastfeeding or suspend it for a certain time.
Composition
Description of the dosage form
White flat oblong tablets marked “P” and “U”, separated by a notch on one side and “700” with short notches on the top and bottom of the number on the other side.
pharmachologic effect
pharmachologic effect- dopaminomimetic, hypoprolactinemic.Pharmacodynamics
Cabergoline is a dopaminergic derivative of ergoline and is characterized by a pronounced and long-term prolactin-lowering effect due to direct stimulation of D 2 -dopamine receptors of pituitary lactotropic cells. In addition, when taken at higher doses than doses for lowering serum prolactin levels, cabergoline has a central dopaminergic effect due to stimulation of D 2 receptors.
A decrease in the concentration of prolactin in blood plasma is observed within 3 hours after taking the drug 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.
Cabergoline has a strictly selective effect, does not affect the basal secretion of other pituitary hormones and cortisol. The prolactin-lowering effect of the drug is dose-dependent, both in terms of severity and duration of action.
The pharmacodynamic effects of cabergoline, which are not associated with a therapeutic effect, include only a decrease in blood pressure. With a single dose of the drug, the maximum hypotensive effect is observed during the first 6 hours and is dose-dependent.
Pharmacokinetics
Cabergoline is rapidly absorbed from the gastrointestinal tract, C max in plasma is reached after 0.5-4 hours, the connection with blood plasma proteins is 41-42%. T 1/2 of cabergoline, assessed by the rate of excretion by the kidneys, is 63-68 hours in healthy volunteers and 79-115 hours in patients with hyperprolactinemia. Due to the long T 1/2, C ss is achieved after 4 weeks. 10 days after taking the drug in the urine and feces, about 18 and 72% of the dose taken, respectively, are found, and the proportion of the unchanged drug in the urine is 2-3%. 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. It has been found that metabolic products have a significantly lower effect in suppressing the secretion of prolactin in comparison with cabergoline.
Food intake does not affect the absorption and distribution of cabergoline.
Indications for Dostinex ®
prevention of physiological lactation after childbirth;
suppression of already established postpartum lactation;
treatment of disorders associated with hyperprolactinemia, including amenorrhea, oligomenorrhea, anovulation, galactorrhea;
prolactin-secreting pituitary adenomas (micro- and macroprolactinomas); idiopathic hyperprolactinemia; syndrome of an empty sella turcica in combination with hyperprolactinemia.
Contraindications
hypersensitivity to cabergoline or other components of the drug, as well as any ergot alkaloids;
dysfunctions of the heart and respiration due to fibrotic changes or the presence of such conditions in the anamnesis;
with long-term therapy: anatomical signs of the pathology of the valvular apparatus of the heart (such as thickening of the valve leaflet, narrowing of the valve lumen, mixed pathology - narrowing and stenosis of the valve), confirmed by echocardiographic examination (EchoCG) performed before the start of therapy;
lactose intolerance, lactase deficiency, glucose-galactose malabsorption;
use in children and adolescents under the age of 16 (the safety and efficacy of the drug have not been established).
Carefully
Like other ergot derivatives, Dostinex ® should be prescribed with caution in the following conditions and / or diseases: arterial hypertension that develops during pregnancy, for example, preeclampsia or postpartum arterial hypertension (Dostinex ® is prescribed only in cases where the potential benefit from the use of the drug is significant exceeds 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 history); simultaneous use with drugs that have an antihypertensive effect (due to the risk of orthostatic arterial hypotension).
Application during pregnancy and lactation
Since there have been no controlled clinical trials with Dostinex® in pregnant women, prescribing the drug during pregnancy is possible only in cases of extreme necessity, taking into account the benefit / risk ratio for the woman and 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.
According to 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 elimination of the drug in breast milk, however, in the absence of the effect of Dostinex ® to prevent or suppress lactation, mothers should refuse breastfeeding. In case of disorders associated with hyperprolactinemia, Dostinex ® is contraindicated in patients planning breastfeeding.
Side effects
In clinical studies using Dostinex® to prevent physiological lactation (1 mg once) and to suppress lactation (0.25 mg every 12 hours for 2 days), side effects were observed in approximately 14% of women. When Dostinex® was used for 6 months at a dose of 1-2 mg / 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 observed in 14% of patients; due to side effects, treatment was discontinued in about 3% of patients.
The most common side effects are presented below.
From the CCC side: palpitations; rarely - orthostatic hypotension (with prolonged use, Dostinex ® usually has a hypotensive effect); an asymptomatic decrease in blood pressure is possible during the first 3-4 days after childbirth (SBP - not less than 20 mm Hg, DBP - not less than 10 mm Hg).
From the nervous system: dizziness / vertigo, headache, increased fatigue, drowsiness, depression, asthenia, paresthesia, fainting, nervousness, anxiety, insomnia, impaired concentration.
From the digestive system: nausea, vomiting, epigastric pain, abdominal pain, constipation, gastritis, dyspepsia, dryness of the oral mucosa, diarrhea, flatulence, toothache, sensation of irritation of the pharyngeal mucosa.
Others: mastodynia, dysmenorrhea, nosebleeds, rhinitis, flushing of the skin of the face, transient hemianopsia, vasospasm of the fingers and cramps of the muscles of the lower extremities (like other ergot derivatives, Dostinex® can have a vasoconstrictor effect), visual impairment, flu-like symptoms, malaise, periorbital and peripheral edema, anorexia, acne, pruritus, joint pain.
With long-term therapy with Dostinex ®, deviation from the norm of standard laboratory parameters was observed rarely; women with amenorrhea experienced a decrease in Hb levels during the first few months after menstruation was restored.
In a post-marketing study, the following side effects associated with taking cabergoline were also recorded: alopecia, increased CPK activity in the blood, mania, dyspnea, edema, fibrosis, liver dysfunction and liver function abnormalities, hypersensitivity reactions, rash, respiratory disturbances, respiratory failure , valvulopathy, pathological addiction to gambling, hypersexuality, increased libido, aggressiveness, psychotic disorders, pericarditis, attacks of sudden falling asleep, weight loss or increase, nasal congestion.
Interaction
There is no information on the interaction of cabergoline and other ergot alkaloids, therefore, the simultaneous use of these drugs during long-term therapy with Dostinex ® is not recommended.
Since cabergoline has a therapeutic effect by directly stimulating dopamine receptors, it cannot be administered concurrently with drugs acting as dopamine antagonists (including phenothiazines, butyrophenones, thioxanthenes, metoclopramide), because they can weaken the effect of cabergoline in decreasing prolactin concentration.
Like other ergot derivatives, cabergoline should not be used concomitantly with macrolide antibiotics (eg erythromycin). this can lead to an increase in the systemic bioavailability of cabergoline.
Method of administration and dosage
Inside, while eating.
Prevention of lactation: 1 mg once (2 tablets, 0.5 mg each), on the first day after childbirth.
Suppression of established lactation: 0.25 mg (1/2 table) 2 times a day every 12 hours for two days (total dose - 1 mg). In order to reduce the risk of orthostatic hypotension in breastfeeding mothers, a single dose of Dostinex® should not exceed 0.25 mg.
Treatment of disorders associated with hyperprolactinemia: the recommended starting dose is 0.5 mg per week in one dose (1 table. 0.5 mg each) or in two doses (1/2 table. 0.5 mg each, for example on Monday and Thursday). The increase in the weekly dose should be carried out gradually - by 0.5 mg - at monthly intervals until the optimal therapeutic effect is achieved. The therapeutic dose is usually 1 mg per week, but can range from 0.25 to 2 mg / week. The maximum dose for patients with hyperprolactinemia should not exceed 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 mg / week.
In patients with hypersensitivity to dopaminergic drugs, the likelihood of side effects can be reduced by starting therapy with Dostinex® at a lower dose (for example, 0.25 mg once a week), followed by a gradual increase until the therapeutic dose is reached. To improve the tolerance of the drug in the event of severe side effects, a temporary decrease in the dose is possible, followed by a more gradual increase in it (for example, an increase of 0.25 mg / week every 2 weeks).
Overdose
Symptoms: the development of symptoms of hyperstimulation of dopamine receptors - nausea, vomiting, dyspeptic disorders, orthostatic arterial hypotension, confusion, psychosis, hallucinations.
Treatment: carrying out auxiliary measures aimed at removing the drug (gastric lavage), and, if necessary, maintaining blood pressure. Prescription of dopamine antagonists is possible.
special instructions
Before prescribing Dostinex ® for the treatment of disorders associated with hyperprolactinemia, it is necessary to conduct a complete study of the pituitary gland function.
In addition, an assessment of the state of the CVS, including echocardiography, should be carried out in order to identify dysfunctions of the valve apparatus that are asymptomatic.
As with other ergot derivatives, patients with long-term administration of cabergoline have had pleural effusion / pleural fibrosis and valvulopathy. In some cases, patients received prior therapy with ergotonin dopamine agonists. Therefore, Dostinex ® should not be used in patients with existing signs and / or clinical symptoms of cardiac or respiratory dysfunction associated with fibrotic changes or such conditions in history. You should stop taking the drug if you find signs of the appearance or worsening of blood regurgitation, narrowing of the lumen of the valves or thickening of the valve leaflets (see "Contraindications").
It was found that the erythrocyte sedimentation rate increases with the development of pleural effusion or fibrosis. If an unexplained increase in ESR is found, a chest X-ray is recommended. In making a diagnosis, a study of the concentration of creatinine in blood plasma, an assessment of renal function can also help. After discontinuation of Dostinex®, patients with pleural effusion / pleural fibrosis or valvulopathy showed improvement in symptoms.
It is not known whether cabergoline can worsen patients with signs of blood regurgitation. Cabergoline should not be used in the detection of fibrotic lesions of the valvular apparatus of the heart (see "Contraindications").
Fibrotic disorders can be asymptomatic. In this regard, the condition of patients receiving long-term therapy with cabergoline should be regularly monitored, and special attention should be paid to the following symptoms:
Pleuro-pulmonary disorders: such as shortness of breath, difficulty breathing, persistent cough, or chest pain;
Renal failure or obstruction of the vessels of the ureters or abdominal organs, which may be accompanied by pain in the side or in the lumbar region and edema of the lower extremities, any swelling or soreness when touched in the abdomen, which may indicate the development of retroperitoneal fibrosis;
Pericardial fibrosis and fibrosis of the valve cusps often present with heart failure. In this regard, it is necessary to exclude fibrosis of the valves of the heart valves (and constrictive pericarditis) when symptoms of heart failure appear.
The patient's condition should be regularly monitored for the development of fibrotic disorders. The first time echocardiography should be performed 3-6 months after the start of therapy. Then this study should 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 (eg physical examination, including cardiac auscultation, radiography, CT) is assessed individually for each patient.
When increasing the dose, patients should be under the supervision of a physician 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 concentration is usually observed within 2-4 weeks of treatment.
After discontinuation of Dostinex ®, a relapse of hyperprolactinemia is usually observed, however, in some patients there is a persistent suppression of prolactin concentration for several months. In most women, ovulatory cycles persist for at least 6 months after discontinuation of Dostinex®.
Dostinex ® restores ovulation and fertility in women with hyperprolactinemic hypogonadism. Since pregnancy can occur before menstruation is restored, it is recommended that pregnancy tests be performed at least once every 4 weeks during the amenorrhea period, and after menstruation has restored, 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, an increase in the size of already existing pituitary tumors is possible.
Dostinex ® should be prescribed in lower doses to patients with severe hepatic impairment (class C according to Child-Pugh classification), for whom long-term drug therapy is indicated.
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.
The use of cabergoline causes drowsiness. In patients with Parkinson's disease, the use of dopamine receptor agonists may induce sudden sleep. In such cases, it is recommended to reduce the dose of Dostinex ® or to stop the therapy.
Studies on the use of the drug in elderly patients with disorders associated with hyperprolactinemia have not been conducted. The safety and efficacy of the drug in children under 16 years of age has not been established.
Every woman at a certain moment in her life begins to understand that she is already ready to become a mother and that her whole nature is striving for this more and more. But not every representative of the beautiful half of humanity, unfortunately, from the first attempts can realize what she wants. It happens that pregnancy does not occur for some reason. In some cases, hormonal "problems" are to blame for this state of affairs. Often, an increased amount of the hormone prolactin in a woman's body leads to the inability to become pregnant. If this is confirmed after a thorough examination and tests performed, the woman is prescribed a course of treatment. As a rule, dostinex is prescribed to reduce the amount of prolactin in the body.
Prolactin - pregnancy hormone
The hormone prolactin, produced mainly by the pituitary gland, cannot be called secondary. He plays a rather important role, participates in the work of many systems of the body, primarily the reproductive. If prolactin in a woman's blood rises significantly, a hormonal failure occurs, which leads to unpleasant consequences, namely, infertility. Women with elevated prolactin levels always have menstrual irregularities.
Normally, prolactin levels increase if pregnancy occurs, as well as during breastfeeding. If a woman is actively involved in sports, then the level of this hormone in her blood will also be increased. Prolactin can be elevated for a short period from stress or after positive emotions, as well as as a result of intercourse.
Doctors also note the pathological reasons for the increase in prolactin in the blood. These include various diseases, including diseases, liver cirrhosis, renal failure, polycystic ovary syndrome), as well as pituitary tumors.
In non-pregnant women with increased prolactin, the following symptoms are noted: menstrual irregularities (scanty periods, anovulation), discharge or milk from the breast, infertility, excessive hair growth, and even decreased libido.
What is Dostinex?
Dostinex (Dostinex) - a medical drug that is prescribed to women to reduce the level of prolactin produced. The active substance of dostinex is cabergoline, the inactive ones are leucine and lactose. The drug is produced in the form of tablets of 0.5 mg each. There are 8 tablets in the package. This medication is available only in pharmacies and with a prescription.
Dostinex acts by blocking the production of this hormone, which, in turn, contributes to the normal and timely maturation of follicles in the ovaries and restores the menstrual cycle. All this leads to the fact that normal ovulation occurs in a woman's body.
A decrease in the level of prolactin occurs on average after 3 hours after a single dose of Dostinex. The drug works from 7 to 28 days. Dostinex is absorbed from the digestive tract quickly.
How much dostinex is taken?
Dostinex is taken one (maximum two) times a week. For the first time, take a dose equal to 0.5-1 tablet of the drug. If dostinex is well tolerated, and the therapeutic effect has not yet been achieved, the dose is gradually increased. In the case of hyperprolactinemia (an increased amount of the hormone prolactin in the blood), the maximum dose of the drug should not exceed 4.5 mg per week. After starting treatment, a woman must monitor the level of this hormone in the body every month, for which it is necessary to take appropriate tests. As a rule, the indicators return to normal within 2-4 weeks after the start of taking dostinex.
Side effects of dostinex
As a rule, the drug is well tolerated by patients. If the drug is used to normalize the level of prolactin, then such "side effects" as headache and dizziness, nausea, constipation, abdominal pain, gastritis, dyspeptic symptoms, and general weakness are possible. Also, the mammary glands become hypersensitive and painful, the patient may become depressed, feel hot flashes in the face, and suffer from low blood pressure. True, all these signs are rarely strongly pronounced. As a rule, they are weak and go away rather quickly. Side effects are especially common at the very beginning of treatment - in the first two weeks. By the way, if the dosage is reduced, the symptoms will disappear. Gradually, the amount of medication taken can be increased again to the original dose. When Dostinex is canceled, absolutely all symptoms disappear after one or two days (but this can be done only with the consent of the attending physician and in no case should one engage in arbitrariness!).
Are these two concepts compatible? This question worries many women, since it often happens that conception occurs against the background of treatment with dostinex. Then the expectant mother has a natural question: does the drug harm a tiny embryo and shouldn't it be canceled altogether?
The answer is: Dostinex and pregnancy are absolutely incompatible. Since many women with an increased amount of prolactin and, as a result, hormonal infertility begin treatment in order to prepare the body for pregnancy. By taking dostinex, they are trying to significantly reduce prolactin, and if pregnancy has begun, then this is absolutely impossible. After all - the main hormone of pregnancy, preserving and supporting it. Therefore, as soon as a woman found out that a new life had arisen under her heart, she should immediately inform her gynecologist about this and stop taking the drug. Moreover, women planning a pregnancy are advised to wait for a pause of one month after the end of the course of treatment, and only after that start realizing their dreams. This is due to the fact that the drug is excreted from the body for a very long time, and the effect of cabergoline (the active substance of dostinex) on the developing fetus is highly undesirable.
Specially for Olga Rizak
From the guest
I, too, could not get pregnant for a long time, after Dostinex I immediately became pregnant in the second cycle, we are planning a second for our 4.5-year-old daughter now, Prolactin is increased again, on Monday I go to the doctor I will drink Dostinex again, I hope that this will help me
From the guest
Here, too, the doctor prescribed Dostinex for me. Since prolactin is high and hence all the consequences: fullness, thyroid gland, menstrual cycle is disrupted and there is no ovulation. She says that she urgently needs to get pregnant in order for everything to recover. I don’t know whether this is really so or not .. I drink 2 r a week, half a pill, I said after 45 days repeated tests of prolactin, and if it returns to normal, we will reduce the dose. The drug should not be abruptly canceled in any case.
From the guest
The doctor prescribed dostinex to me so that my periods would come, since they had not been there for 4 months. After drinking two pills, I made an ultrasound scan and found that I was pregnant. In terms of time, I became pregnant before dostinex, without menstruation. She gave birth to a healthy daughter. I want to say that dostinex did not cause any harm to the fetus.
Quite often, women are faced with various diseases and disorders of the reproductive system, which occur against the background of hormonal disruptions. In addition, in some cases, it is required to stop the lactation process. In both cases, Dostinex will be effective. Reviews about him are mostly positive. Therefore, doctors often prescribe them to patients with certain disorders.
The drug "Dostinex": composition and form of release
The medicine is available in the form of white oblong tablets, which are contained in dark glass vials. Such a bottle can contain either two or eight tablets. The lid should be aluminum and have a plastic insert with porous paper and a drying agent. Each tablet contains 0.5 mg of the main active substance cabergoline. This ergoline derivative acts as a dopamine receptor agonist. Anhydrous lactose and leucine are used as auxiliary components in the production.
The main pharmacological properties of the drug
Quite a few patients are prescribed Dostinex today. The doctors' comments on this drug are extremely positive. But how does it work? It should be noted that the active substance of the drug is rapidly absorbed by the wall of the gastrointestinal tract, regardless of food intake. Approximately 41-42% of cabergoline binds to blood plasma proteins. Its maximum concentration is observed 1-4 hours after administration. Cabergoline directly stimulates the D2 receptors of lactotropic cells in the pituitary gland, while not affecting the basal secretion of other hormones in the hypothalamic-pituitary system. It should be noted that the effect of the drug persists for 1-3 weeks after administration in patients with hyperprolactinemia, as well as in healthy volunteers who participated in the study. In women in the postpartum period, the therapeutic effect lasts for 2-3 weeks, which is quite enough to completely interrupt lactation.
By the way, the effect and its duration directly depend on the dose of the drug, as well as the intensity of adverse reactions. In most women, the treatment was associated with a decrease in blood pressure, but this effect disappeared 5-6 hours after taking the pill. The body is completely cleared of the drug approximately four weeks after the start of administration. The drug and its metabolites are excreted along with urine and feces.
Indications for use
Most often, this medicine is used in order to suppress or prevent physiological lactation, which inevitably occurs after childbirth. In fact, there are many conditions in which a mother simply cannot breastfeed her baby. In such cases, Dostinex is simply irreplaceable. In addition, an indication for taking the drug is hyperprolactinemia. After all, such a disorder is associated with the occurrence of problems such as galactorrhea, amenorrhea, oligomenorrhea and anovulation. The drug is also used to treat pituitary adenoma, which is accompanied by stimulation of prolactin synthesis. Indication for use is the so-called empty Turkish saddle syndrome.
Instructions for use
In no case should you use the drug yourself. To begin with, it is imperative to consult a doctor - only a specialist can prescribe Dostinex lactation pills, as well as correctly determine the daily dose and regimen of the drug. The amount of medication directly depends on what problem needs to be eliminated. If it is necessary to prevent the appearance of lactation, then a single dose of the medication immediately after childbirth will be sufficient - the dose in this case is 1 mg. In the event that lactation has already begun, then patients are advised to take 0.25 mg every twelve hours for two days. The treatment regimen for hyperprolactinemia looks completely different. Women with a similar disease are advised to take the medicine 1-2 times a week. The initial dose should not exceed 0.5 mg at a time. With a positive reaction, the amount of the drug can be increased to 4.5 mg per week, although this depends on the tolerance of the drug and the presence of side effects. With continuous treatment with hormonal drugs, it is recommended to do tests to determine the level of prolactin every two weeks. As a rule, after discontinuation of therapy, hyperprolactinemia returns, but in some women, the therapeutic effect can last up to six months.
It is best to take pills with meals, as this reduces the intensity of side effects. Although the medicine can be used at any time of the day.
Contraindications to therapy
Of course, this drug has a number of contraindications. It should be noted right away that it is by no means used to treat patients with hypersensitivity to any ergot alkaloids. In addition, it is not recommended for girls under 16 years of age, as well as for women during pregnancy (only if the expected benefit outweighs the possible risk). Contraindications include some diseases, including peptic ulcer, severe liver failure, gastrointestinal bleeding, Raynaud's syndrome, and some diseases of the cardiovascular system. The drug is not prescribed to patients with arterial hypertension, fibrotic changes in the tissues of the heart and respiratory organs. It is not recommended to take Dostinex together with antihypertensive drugs.
Are there any side effects?
Like all hormonal medicines, this medicine can cause a number of side effects. For example, many patients complain of a drop in blood pressure. The consequences of treatment can also include increased heart rate, drowsiness, dizziness, headaches, fatigue, asthenia, depression, fainting. Many patients are interested in another important point - Dostinex and weight. After all, it's not a secret for anyone that taking hormones is often associated with a quick set of extra pounds. However, clinical studies have not found such a link. But the drug sometimes still affects the work of the digestive tract, causing nausea, vomiting, constipation, gastritis, abdominal pain, dyspepsia. Potential side effects can also include muscle cramps, vasospasm of the fingers, nosebleeds, flushing of the face, swelling, baldness, decreased hemoglobin levels in the blood, as well as the appearance of a rash and respiratory problems. In the event of severe adverse reactions, you should consult a doctor. In some cases, it is advisable to stop taking the drug, but sometimes it will be enough just to reduce a single dose.
The main symptoms of an overdose
Overdose of this medication can be dangerous to the health and life of patients. Taking too much medication is usually accompanied by dizziness, confusion, and sometimes hallucinations. In addition, various digestive disorders can occur, including nausea and vomiting. In some cases, orthostatic hypotension is observed. In any case, it is best to rush a patient in this condition to the hospital. As a rule, for a start, measures are taken in order to rid the body of the drug that has not yet had time to be absorbed - most often the stomach is washed. In addition, blood pressure medications and dopamine antagonists are prescribed to patients.
The drug "Dostinex": patient reviews
In fact, many doctors prescribe this particular drug. After all, if it is necessary to correct the level of hormones or stop lactation, then sometimes the only solution is Dostinex. Most of the reviews about him are positive. Indeed, the effect of it appears quickly, especially when it comes to stopping breastfeeding. In a few days, you can completely stop lactation - this is noted by almost all patients. However, the likelihood of developing side effects is high. Many women complain that a few hours after taking the drug they feel weakness, nausea, and dizziness. On the other hand, all adverse reactions disappear over time. The advantages of the drug include the fact that it does not need to be taken often. As for the disadvantages, they include not only a large number of contraindications and side effects, but also the relatively high cost of the drug.
