How long can you take Dostinex. Weaning from breastfeeding using non-drug methods. Interaction with other drugs

Every woman at some point in her life begins to understand that she is ready to become a mother and that her whole nature strives for this more and more. But not every representative of the fair half of humanity, unfortunately, can realize what she wants on her first attempts. It happens that pregnancy does not occur for some reason. In some cases, hormonal “problems” are to blame for this state of affairs. Often, the inability to get pregnant is caused by an increased amount of the hormone prolactin in a woman’s body. If this is confirmed after a thorough examination and tests, 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. It plays a fairly important role and is involved in the functioning of many body systems, primarily reproductive. If prolactin in a woman’s blood increases significantly, hormonal disbalance, which leads to unpleasant consequences, namely to infertility. In women with increased level prolactin disturbances are always observed menstrual cycle.

Normally, prolactin levels increase if pregnancy occurs, as well as during breastfeeding. If a woman exercises intensely, the level of this hormone in her blood will also be increased. Prolactin may increase by a long period from stress or after positive emotions, as well as as a result of sexual intercourse.

Doctors note and pathological causes increase in prolactin in the blood. These include various diseases, including diseases, cirrhosis of the liver, renal failure, polycystic ovary syndrome), as well as pituitary tumors.

In non-pregnant women with elevated prolactin are noted following symptoms: menstrual irregularities (scanty periods, anovulation), discharge or milk from the breast, infertility, excess hair growth and even decreased libido.

What is Dostinex?

Dostinex - medical drug, which is prescribed to women to reduce the level of prolactin produced. The active substance of dostinex is cabergoline, the inactive substances are leucine and lactose. The drug is produced in the form of tablets of 0.5 mg each. There are 8 tablets in total in the package. This medicine can only be purchased in pharmacies and with a prescription.

Dostinex acts by blocking the production of this hormone, which, in turn, promotes normal and timely maturation of follicles in the ovaries and restores the menstrual cycle. All this leads to normal ovulation occurring in the woman’s body.

A decrease in prolactin levels occurs on average 3 hours after a single dose of Dostinex. The drug is effective from 7 to 28 days. Dostinex is absorbed from digestive tract fast.

In what quantities do you take Dostinex?

Take Dostinex once (maximum twice) once 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 case of hyperprolactinemia (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 her body every month, for which it is necessary to take appropriate tests. As a rule, indicators return to normal within 2-4 weeks after starting to take Dostinex.

Side effects of Dostinex

As a rule, the drug is well tolerated by patients. If the drug is used to normalize prolactin levels, then such “side effects” as headache and dizziness, nausea, constipation, abdominal pain, gastritis, dyspeptic symptoms, general weakness. Also, the mammary glands become hypersensitive and painful, the patient may become depressed, feel hot flashes to the face, and suffer from low blood pressure. blood pressure. True, all these signs are rarely strongly expressed. As a rule, they are weak and pass quite quickly. Especially often side effects occur at the very beginning of treatment - in the first two weeks. By the way, if you reduce the dosage, the symptoms will disappear. Gradually, the amount of medication taken can be increased again to the original dose. When Dostinex is discontinued, absolutely all symptoms disappear after one or two days (but this can only be done with the consent of the attending physician and in no case should you engage in arbitrariness!).

Are these two concepts compatible? This question worries many women, since it often happens that conception occurs during treatment with Dostinex. Then have expectant mother A natural question arises: does the drug harm the tiny embryo and should it be stopped altogether?

The answer will be this: Dostinex and pregnancy are absolutely incompatible. Since many women increased quantity prolactin and, as a consequence, hormonal infertility treatment is started to prepare the body for pregnancy. By taking Dostinex they are trying to significantly reduce prolactin, but if pregnancy has occurred, then this is strictly forbidden. After all - main hormone pregnancy, preserving and supporting it. Therefore, as soon as the woman found out about what arose under her heart new life, you need to immediately inform your gynecologist about this and stop taking the drug. Moreover, women planning a pregnancy are advised to wait a pause of one month after completing the course of treatment, and only after that begin to realize their dreams. This is due to the fact that the drug takes a very long time to be eliminated from the body, and the effect of cabergoline (the active ingredient of Dostinex) on the developing fetus is extremely undesirable.

Especially for Olga Rizak

From Guest

I also couldn’t get pregnant for a long time, after Dostinex I immediately became pregnant in the second cycle, my 4.5 year old daughter is now planning a second one, it’s not possible, Prolactin is elevated again, on Monday I’m going to the doctor, I’ll take Dostinex again, I hope that this will help me

From Guest

The doctor also prescribed Dostinex for me. Since prolactin is high and everything that follows from this: obesity, thyroid gland, menstrual cycle is disrupted and there is no ovulation. She says that she urgently needs to get pregnant so that everything can be restored. I don’t know if this is really true or not... I take half a tablet twice a week, he said in 45 days he will re-test prolactin, and if it returns to normal, we will reduce the dose. The drug should not be discontinued abruptly under any circumstances.

From Guest

The doctor prescribed me Dostinex so that my periods would come, since I had not had them for 4 months. After taking two pills, I did an ultrasound and found out that I was pregnant. According to the timing, 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.

There are situations when the mother does not have two weeks at her disposal; it is necessary to urgently stop breastfeeding. medical indications: long-term use of medications incompatible with breastfeeding, mastitis, serious illnesses in a woman and child. In these cases, medications that suppress prolactin production may be prescribed.

Dostinex is an anti-lactation drug, which is considered one of the most powerful drugs with similar action. It is produced by divisions of the famous American company Pfizer. The drug, registered in Russia, from the manufacture of the active substance to the packaging of tablets, is produced by the Italian branch of the company.

The active substance of Dostinex is cabergoline. It was developed more than 30 years ago, so patent protection for the drug no longer applies. Many cheaper analogues of Dostinex are produced all over the world. In Russia, in addition to original medicine you can buy Agalates (manufacturers Teva and Ivex), Bergolak (Veropharm), Kabergolin (OHFK).

The price of Dostinex is about 730 rubles. per bottle with 2 tablets (enough to stop lactation). Analogs are cheaper: Agalates - 430 rubles, Bergolak - 280 rubles. for the same dose.

The active substance of Dostinex is a dopaminomimetic. It stimulates D2-dopamine receptors located in the pituitary gland. The result of such stimulation is a stable, long-term decrease in prolactin production, and therefore suppression of lactation. A single dose of Dostinex allows you to dramatically reduce the amount of milk in the first day. Prolactin levels remain reduced for 1-4 weeks during long-term lactation, and 2-3 weeks in women who have just given birth. Usually this time is enough to completely stop lactation.

The undoubted advantage of Dostinex is the selectivity of its action. The drug does not affect the production of any other hormones except prolactin.

Rules for taking Dostinex tablets

One bottle of Dostinex contains 2 or 8 tablets, each of which contains 0.5 mg of cabergoline. The small package is intended to stop lactation in women who have given birth. Large packaging is convenient for the treatment of pathological hyperprolactinemia, which can be caused by tumors, ovarian diseases, thyroid gland, liver, kidneys and some other reasons.

Useful: To complete lactation, you can use folk remedies. One of the effective ones is -.

How to take:

1. To prevent physiological appearance milk, on the day of birth take 1 mg of cabergoline once.
2. To suppress lactation that has already begun, the same dose is divided into several doses. You need to take half a tablet of Dostinex twice a day. Course – 2 days.
3. If Dostinex is taken to treat pathological hyperprolactinemia, the dose is determined by the attending physician. Typically the weekly dose is in the range of 0.5-2 mg, with a maximum of 4.5 mg.

The instructions for use prohibit combining Dostinex and breastfeeding, so stop breastfeeding after taking the first tablet. The manufacturer has not conducted studies to determine whether cabergoline passes into milk, but does not rule out this possibility and warns that the drug may affect the development of the child. Dostinex is eliminated from the body for about a month, so it is not possible to stop lactation for a week and then resume it again.

Whether it is necessary to express in the first days after taking Dostinex depends on the fullness of the breast. If it has become softer and does not cause any inconvenience, there is no need to express it, the milk will go away on its own. If your breasts are tight and painful, you can express some milk to relieve the tension. You can't completely empty your chest.

Who is the drug prohibited from?

According to the instructions, strict contraindications to taking Dostinex to reduce lactation are:

1. Age up to 16 years. The effect of the drug on the developing organism has not been studied. There is a risk of adverse action.
2. Pregnancy. Pregnant women are allowed to take Dostinex only in extreme cases. After a course of the drug, it is necessary to strengthen contraceptive measures, since pregnancy is undesirable within a month.
3. Hypersensitivity reactions to cabergoline or other ingredients of the tablets - leucine and lactose.
4. Cabergoline is a derivative of one of the ergot alkaloids. If a woman has previously had unwanted reactions for drugs with similar composition, taking Dostinex during lactation is contraindicated. Ergot alkaloids are used to stop uterine bleeding, to prevent migraine attacks, treat parkinsonism. These include ergonovine maleate, methylergonovine maleate, ergotamine hydrotartrate and other active ingredients.

Taking Dostinex can be dangerous in some diseases; women require additional medical supervision:

• hypertension. Dostinex should not be taken together with medications that lower blood pressure;
• ulcer in the acute stage, bleeding;
• serious diseases of the heart, blood vessels, respiratory organs;
• liver failure. Depending on its stage, the dose of Dostinex should be reduced.

One of the effects of the drug, directly related to its pharmacodynamics, is a drop in blood pressure after administration. As a rule, women with lactation experience orthostatic hypotension. This condition is characterized by a drop in pressure with a sudden change in posture and is accompanied by severe symptoms: dizziness, darkening of the eyes, nausea. In the first 6 hours, the risk of fainting cannot be ruled out, so if there are signs of deterioration, you should not pick up the child.

The strength of the pressure drop depends on the dosage of Dostinex. The minimum risk is with a single dose of 0.25 mg.

Side effects

It is not always possible to stop lactation with Dostinex tablets without undesirable consequences for the body. According to the manufacturer, 14% of young mothers experience side effects. If Dostinex is prescribed for a long time, the frequency increases to 68%. According to reviews, 14% of women appreciated side effects as severe, 3% were forced to stop further treatment drug.

After the drug went on sale, the instructions for use of Dostinex were supplemented with other side effects, such as edema, liver dysfunction, alopecia, respiratory diseases, and changes in blood composition. The connection of these actions with Dostinek has not been proven, since the sources of information are patient reviews.

Dostinex is a drug that inhibits the secretion of prolactin.

Composition and release form

Dostinex is available in the form of flat oblong tablets white, one tablet contains 0.5 mg of cabergoline. Auxiliary ingredients include anhydrous lactose and leucine. The tablets are in bottles of 2 or 8 pieces, each bottle in a cardboard box.

Pharmacological action of Dostinex

The active substance included in Dostinex is cabergoline, a derivative of ergoline. This substance has a long-term inhibitory effect on prolactin secretion, produced by stimulating dopamine D2 receptors of pituitary cells.

Indications for use

According to the instructions, the use of Dostinex is indicated to stop lactation or prevent it in the postpartum period - with contraindications to breastfeeding or if this is impossible or unwilling. The drug is also used for:

• Treatment of hyperprolactinemia in women, manifested by infertility, amenorrhea, oligomenorrhea, anovulation, galactorrhea;
• Hyperprolactinemia in men, accompanied by impotence, decreased libido;
• Empty sella syndrome;
• Idiopathic hyperprolactinemia.

And also in the treatment of prolactin-secreting pituitary adenoma.

Directions for use and dosage

According to the instructions for Dostinex, the drug should be taken orally with meals, to prevent lactation - 2 tablets (1 mg) once during the first day after birth, to suppress lactation - 0.25 mg (1/2 tablet) 2 times a day. day, after 12 hours. Daily dose is no more than 1 mg, Dostinex administration lasts 2 days. When treating hyperprolactinemia, the medicine is prescribed in a single dosage of 0.5 mg (1 tablet) once a week, or 0.25 mg (1/2 tablet) in 2 doses (with an interval between doses of 2-3 days). If necessary it is possible gradual increase weekly dosage regimen – 1 tablet (0.5 mg) each month of therapy. The average dose during a course of Dostinex can vary from 0.25 mg (1/2 tablet) to 2 mg (2 tablets) per week, the maximum is no higher than 4.5 mg over a week, divided into two or more doses. During treatment, it is necessary to monitor (at least once a month) the level of prolactin in the blood. According to reviews of Dostinex, normalization of drug concentrations is usually observed after 15-30 days of therapy.

Contraindications

As noted in the instructions for Dostinex, the medication is contraindicated for:

• Children under 16 years of age (due to lack of data on the safety of use);
• Liver failure;
• Hypersensitivity to the components of the drug;
• Late gestosis;
• Postpartum psychosis (including with anamnestic indications).

Use the drug with extreme caution when:

• Serious illnesses of cardio-vascular system;
• Pulmonary, pericardial fibrotic diseases;
• Gastrointestinal pathologies, Raynaud's syndrome.

Also, the medication is prescribed with great caution to patients suffering from arterial hypertension.

Use during pregnancy and lactation

It is not recommended to take Dostinex during pregnancy; before using the drug, it is necessary to exclude its presence, and after the end of therapy, it is necessary to use contraceptive methods for one month. If pregnancy occurs while taking the medication, therapy should be discontinued. When using Dostinex to stop lactation, nursing mothers are advised not to breastfeed, as there is insufficient evidence of the safety of taking it during this period.

Side effects

Numerous reviews about Dostinex indicate large quantities cases of occurrence side effects. This is confirmed by clinical studies - when Dostinex was used to prevent and suppress lactation, the frequency of side effects was almost 15%. When treating hyperprolactinemia for six months, side effects were observed in more than 60% of patients, most often their occurrence was noted in the first weeks of taking Dostinex. In most cases, with further use of the medication or its discontinuation negative reactions disappeared. In some cases, it was necessary to reduce the dosage of the drug to eliminate side effects.

The most common negative effects of using Dostinex, according to reviews, when suppressing and preventing lactation include: nausea, sleep disturbance, dizziness, abdominal pain, hypotension, headache. For the most part, these phenomena are mild and pass quickly. When treating hyperprolactinemia, Dostinex, according to reviews, can provoke the development of: depression, general weakness, muscle cramps lower limbs, constipation, breast tenderness, hypotension, paresthesia, hot flushes, gastritis, nausea, vertigo, fainting, asthenia, nosebleeds.

Interaction with other drugs

Dostinex should not be used simultaneously with butyrophenones, metoclopramide, phenothiazines, thioxanthenes, since they, being dopamine antagonists, weaken the effect of the drug. The combined use of Dostinex with amisulpride is contraindicated, due to the fact that the symptoms of the latter increase. The combined use of the medication with drugs that have hypotensive effect, as well as antibiotics belonging to the group of macrolides that increase the bioavailability of cabergoline.

Dopamine receptor agonist. Cabergoline is a dopaminergic derivative of ergoline, characterized by a pronounced and long-lasting 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 reducing the level of prolactin in the blood plasma, it has a central dopaminergic effect due to stimulation of dopamine D 2 receptors.

A decrease in the level of prolactin in the blood plasma is observed 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. postpartum period. The prolactin-lowering effect 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, is a decrease in blood pressure. With a single use of the drug, the maximum hypotensive effect observed during the first 6 hours and is dose-dependent.

Pharmacokinetics

Suction

After oral administration, cabergoline is rapidly absorbed from the gastrointestinal tract. Cmax 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 the long T1/2. Plasma protein binding is 41-42%.

Metabolism

The main product of cabergoline metabolism identified in urine is 6-allyl-8β-carboxy-ergoline at concentrations up to 4-6% of dose taken. The content of 3 additional metabolites in the urine does not exceed 3% of the dose taken. Metabolic products have a significantly lesser effect in suppressing prolactin secretion compared to cabergoline.

Removal

T1/2, estimated by the rate of excretion in urine, is 63-68 hours in healthy volunteers and 79-115 hours in patients with hyperprolactinemia.

10 days after using the drug, 18% and 72% of the dose taken are found in urine and feces, respectively, with the proportion of unchanged drug in urine being 2-3%.

Release form

Tablets are white, flat, oblong; with markings “P” and “U” separated by a notch on one side and “700” with short notches above and below the number on the other.

Excipients: anhydrous lactose - 75.9 mg, leucine - 3.6 mg.

2 pcs. - dark glass bottles (1) - cardboard packs.
8 pcs. - dark glass bottles (1) - cardboard packs.

Dosage

Dostinex ® should be taken orally, preferably during meals.

To prevent lactation, the drug is prescribed in a dose of 1 mg (2 tablets) once on the first day after birth.

To suppress established lactation, prescribe 0.25 mg (1/2 tablet) 2 times a day for 2 days (total dose is 1 mg). In order to reduce the risk of developing 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 tablet) or 2 doses (1/2 tablet, for example, on Monday and Thursday). The weekly dose should be increased gradually - by 0.5 mg at intervals 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. Maximum dose for patients with hyperprolactinemia is 4.5 mg per week.

Depending on tolerability, the weekly dose can be taken once or divided into 2 or more doses per week. Dividing 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 developing side effects can be reduced by starting Dostinex therapy at a lower dose (0.25 mg once a week), followed by a gradual increase until the therapeutic dose is reached. To improve the tolerability of the drug, if severe side effects occur, 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, dyspepsia, orthostatic hypotension, confusion/psychosis or hallucinations.

Treatment: measures should be taken aimed at removing the drug (gastric lavage) and maintaining blood pressure. It is recommended to prescribe dopamine antagonists.

Interaction

There is no information on interactions between cabergoline and other ergot alkaloids; nevertheless, simultaneous use These medications are not recommended during long-term therapy with Dostinex.

Since Dostinex ® has therapeutic effect by direct stimulation of dopamine receptors, the drug should not be prescribed simultaneously with drugs acting as dopamine antagonists (for example, phenothiazines, butyrophenones, thioxanthenes, metoclopramide), because the latter may weaken the prolactin-lowering effect of Dostinex.

Like other ergot derivatives, Dostinex ® should not be used simultaneously with macrolide antibiotics (for example, erythromycin), as this may lead to an increase in the systemic bioavailability of cabergoline.

Side effects

During clinical trials with the use of 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 per week, divided into 2 doses, for the treatment of disorders associated with hyperprolactinemia, the incidence of adverse events 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. By at least, once, during therapy, severe side effects were observed in 14% of patients; Due to side effects, treatment was discontinued in approximately 3% of patients.

The most common side effects are presented below:

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

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

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

Other: mastodynia, nose bleed, flushing of the facial skin, transient hemianopsia, spasms of blood vessels in the fingers, muscle cramps of the lower extremities (like other ergot derivatives, Dostinex ® can have a vasoconstrictor effect).

With long-term therapy with Dostinex, deviation from the norm of standard laboratory parameters observed rarely; Women with amenorrhea experienced a decrease in hemoglobin levels during the first few months after the return of menstruation.

The following have been reported in a post-marketing study: adverse reactions associated with the use of cabergoline: alopecia, increased CPK activity in the blood, mania, dyspnea, edema, fibrosis, liver dysfunction, abnormal liver function tests, reactions hypersensitivity, rash, respiratory problems, 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, empty sella syndrome in combination with hyperprolactinemia.

Contraindications

• children's and adolescence up to 16 years of age (safety and effectiveness of use have not been established);
• hypersensitivity to cabergoline or other components of the drug, as well as to any ergot alkaloids.

Dostinex ® should be prescribed with caution for the following conditions and/or diseases:

• arterial hypertension developed during pregnancy, for example, preeclampsia or postpartum hypertension (Dostinex ® is prescribed only in cases where the potential benefit of the drug significantly outweighs the possible risk);
• severe cardiovascular diseases, Raynaud's syndrome;
• peptic ulcer, gastrointestinal bleeding;
• severe liver failure (lower doses are recommended);
• severe psychotic or cognitive impairment (including history);
• symptoms of impaired cardiac and respiratory function due to fibrotic changes or a history of such conditions;
• simultaneous use with drugs that have a hypotensive effect (due to the risk of developing orthostatic hypotension).

Features of application

Use during pregnancy and breastfeeding

Since there have been no controlled clinical studies using Dostinex in pregnant women, use of the drug during pregnancy is possible only if the expected 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 effects on the fetus. 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 birth, multiple pregnancy And birth defects development.

There is no information about the excretion of the drug in breast milk, however, if there is no effect of using Dostinex to prevent or suppress lactation, breastfeeding should be discontinued. For disorders associated with hyperprolactinemia, Dostinex ® should not be prescribed to mothers who do not want to stop lactation.

Use for liver dysfunction

Use in children

special instructions

Before prescribing Dostinex for the treatment of disorders associated with hyperprolactinemia, it is necessary to carry out full research functions of the pituitary gland.

When increasing the dose, patients should be under medical supervision to determine the lowest effective dose, providing therapeutic effect. Once an effective dosage regimen has been selected, it is recommended to regularly (once a month) determine 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 some patients experience persistent suppression of prolactin levels for several months. For 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 may occur before menstruation returns, it is recommended that pregnancy tests be performed at least once every 4 weeks during the amenorrhea period, and after menstruation returns, whenever menstruation is more than 3 days late. Women wishing to avoid pregnancy should use barrier methods contraception during treatment with Dostinex, as well as after discontinuation of the drug until anovulation recurs. Women who become pregnant should be under medical supervision to promptly identify symptoms of an enlarged pituitary gland, since pre-existing pituitary tumors may increase in size during pregnancy.

Dostinex ® should be prescribed at more low doses patients with severe liver failure(class C on the Child-Pugh scale), for whom long-term drug therapy is indicated. With a single dose of 1 mg administered to such patients, an increase in AUC was observed compared with healthy volunteers and patients with less severe hepatic impairment.

As with other ergot derivatives, after long-term use Pleural effusion/pleural fibrosis and valvulopathy were observed in patients treated with cabergoline. In some cases, patients had received prior therapy with ergotinine dopamine agonists. Therefore, Dostinex ® should be used with caution in patients with existing signs and/or clinical symptoms impaired cardiac function or with a history of such conditions. After discontinuation of Dostinex, patients diagnosed with pleural effusion/pleural fibrosis and valvulopathy experienced improvement in symptoms.

The use of cabergoline causes drowsiness. In patients with Parkinson's disease, the use of dopamine receptor agonists may cause sudden falling asleep. IN similar cases It is recommended to reduce the dose of Dostinex or discontinue therapy.

No studies have been conducted on the use of the drug in elderly patients with disorders associated with hyperprolactinemia.

Use in pediatrics

The safety and effectiveness of the drug in children under 16 years of age have not been established.

Impact on the ability to drive vehicles and operate machinery

Patients taking Dostinex ® who experience drowsiness should be warned that they should refrain from driving a vehicle or performing work (for example, operating machinery) in which decreased alertness could put them or others at risk of serious injury or of death.

As a rule, milk production gradually decreases and by the age of 2-3 years the baby stops completely. This type of weaning is the most painless for the mother and her child. But there are situations when it is necessary to stop feeding immediately. Then doctors often appoint special drugs, for example, Dostinex tablets to stop lactation.

Abrupt weaning of a child from the breast causes severe stress, and not only for the baby, but also for the mother. Therefore it is much more preferable physiological method completion of lactation - gradual reduction in the number of attachments and sucking time, refusal of night feedings. Thanks to this, production breast milk decreases gradually, without causing harm to the health of mother and child, both physical and psychological. Then you won't need pills.

To start the process of physiological completion of breastfeeding, 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 father. It is necessary to make it clear to the child that there is other food besides milk.
• After three days, complementary foods are replaced with another feeding. In another three days - the next one. Gradually, everything is brought to the point that the baby is put to the breast only before bedtime and at night.
• After this, they begin to replace “pre-sleep” feedings with complementary foods - either during the day or in the evening. It is better to start with the evening ones, otherwise the child may refuse to sleep during the day.
• At sleeping together, the mother needs to get up immediately, otherwise the baby will have time to hang on her chest.

It is also better to give up night feedings as early as possible - they are the ones who most stimulate the production of prolactin and, accordingly, milk. If the baby wakes up and demands the breast, you can try replacing it with a bottle of compote, juice, plain water or expressed milk.

In addition, to reduce the amount of milk produced, you can change the mother's lifestyle. Dr. Komarovsky recommends the following points:

• include in the daily routine active activities sports;
• refuse pumping;
• reduce breastfeeding time;
• remove foods that stimulate lactation from the diet;
• reduce the amount of liquid you drink (but without fanaticism).

When do you really need pills at the end of breastfeeding?

But there are times when it is not possible to wait for the natural completion of breastfeeding, and you have to turn to specialized medications. This may be due to the mother's illness and the need to take medications that are inappropriate during breastfeeding.

Also, the reason could be her long stay or a number of illnesses for which breastfeeding is contraindicated.

Dostinex is also indicated for:

• the need to prevent milk from coming in after childbirth;
• the need to stop established breastfeeding;
• for disorders and diseases associated with excessive production of the hormone prolactin;
• termination of a long-term pregnancy.

At correct use The milk disappears within a few days. The effect lasts from 2 to 4 weeks, depending on the dosage.

Many mothers manage to do without medications during weaning. There is no need to bandage the breasts - this is an old barbaric method, due to which blood circulation worsens and lactostasis increases. You just need to pump in the first 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 prescribed by a doctor and following the enclosed instructions. There are two dosage regimens, depending on the reason for cessation of lactation:

• if you need to suppress already established lactation, take half a tablet twice a day for two days, for a total of 1 mg of the drug;
• to prevent the onset of lactation, take Dostinex immediately after childbirth once. Dosage – 1 mg (2 tablets) on the second day after birth;

The action of Dostinex is ensured by its active substance – cabergoline. It causes increased secretion of dopamine and suppression of prolactin secretion, since it is its antagonist. The composition of the drug is the active cabergoline and two excipients(leucine and anhydrous lactose).

The decrease in the concentration of the hormone prolactin in the blood after taking the pill occurs very quickly. You will feel the effect of taking cabergoline in just a couple of hours. The instructions for use report that cabergoline remains in the blood from seven days to a month after you drink it last pill. The longer the treatment was continued, the longer the effect lasts. A single dose of a small dose causes a short-lived effect, which may cause negative reviews.

Contraindications and side effects

Since Dostinex seriously affects hormonal background women, suppressing the production of prolactin, it has a number of contraindications:

• age up to 16 years;
• individual intolerance to the main active ingredient, auxiliary components or ergot alkaloids.

Also Negative consequences may occur with the following health problems:

• liver problems;
• peptic ulcers, stomach or intestinal bleeding;
• severe forms cardiovascular diseases, Raynaud's disease;
• high blood pressure;
• severe mental or intellectual disorders.

The side effects of the drug are quite extensive and have been noticed in many women. Their severity also directly depends on the dose of medication taken. At the same time, studies have shown that the percentage of those experiencing side effects increases with the duration of Dostinex use.

Most often, a decrease in blood pressure is noticed. It occurs in almost all women, but manifests itself in varying degrees- from almost imperceptible to a pre-fainting state. With a single dose of the medicine, the pressure drops for 5-6 hours, after which it returns to normal.

All side effects can be divided into four groups:

• from the outside gastrointestinal tract– pain and “seething” in the abdomen, nausea, vomiting, constipation;
• drowsiness, Bad mood, loss of consciousness, dizziness, headache, increased fatigue;
• decreased blood pressure;
• others - rash, respiratory failure and other breathing disorders, flushing of the face, leg cramps, vascular spasms in the fingers, nosebleeds, fibrosis, mastodynia, edema, dyspnea, liver dysfunction, hemianopsia, mania, mastodynia, valvulopathy, etc.

Sufficient research on the effect of the drug on the course of pregnancy and fetal development has not yet been carried out, therefore Dostinex during pregnancy is prescribed only in the most extreme cases. And if it occurs during treatment with the drug, its use is canceled.

Some reviews say that another, conditionally side effect, can be considered a slight weight loss when taking Dostinex. It is believed that this is due to the inhibition of prolactin. However, Dostinex does not have official data confirming such an effect on weight. Most doctors believe that the short courses with which this drug is prescribed cannot in any way affect weight and such a reaction of the body - rather individual feature than the rule.

One of the effects of taking Dostinex is the restoration of fertility (ovulation and the entire menstrual cycle) in case of hyperprolactinemia (excess prolactin). Menstruation does not improve immediately after Dostinex - the body needs time to adapt to new conditions. Therefore, a delay after taking the drug is common. But just in case, it’s still worth taking a pregnancy test.

For pituitary adenoma, Dostinex usually eliminates unpleasant symptoms– headaches, vision problems. But some reviews say that after some time these symptoms return, and sometimes even stronger than before.

If the drug does not help

It happens that the prescribed drug does not help - desired effect not achieved, only side effects appeared. In this case, you must consult a doctor again. It may be enough to adjust the dosage. If even then the milk does not disappear after Dostinex, the doctor may prescribe other analogue drugs.

You can also contact folk medicine, which suggests using herbal decoctions. Salvia officinalis has proven itself best for this purpose. Infusions of basil, mint, bearberry, lingonberry and parsley also work well to stop lactation. Sage decoction can be replaced alcohol tincture, extract or essential oil– then the effect of taking it will be noticeable quite 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, there is no need to express after or before taking the drug, but if there is a lot of milk and breasts appear painful sensations, you need to express it to a state of relief, so as not to provoke the development of lactostasis.

You also need to express milk if lactation is interrupted temporarily, for example, during treatment, and in the future the woman plans to continue breast-feeding.

Dostinex's analogs

There are several drugs that are analogues of Dostinex - these are Bergolak, Bromocriptine, Agalates and Cabergoline. Only a doctor can choose one of the drugs and prescribe it if necessary! Replacing one product with another on your own, relying on the fact that they are analogues, is fraught with health consequences!

Bromocriptine or Dostinex

Bromocriptine contains the same active components, like Dostinex - cabergoline, so their principle of action and effectiveness are approximately the same.

Cabergoline or Dostinex

Another drug containing the same active substance, like Dostinex. The cost of the drug is quite high, but it has good reviews. Although many women note side effects such as headaches and nausea.

Bergolak or Dostinex

Bergolak is a generic 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 drugs also have the same active substance, 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 lot of side effects, which are not always quite harmless. Therefore, if possible, it is better to end breastfeeding more gently - by waiting for natural attenuation or with the help of folk remedies and lifestyle changes.