Parlodel
Parlodel (Bromocriptine)Pharmacological action
An inhibitor of secretion of Parlodel.
Parlodel inhibits secretion of a hormone of a forward share of a pituitary body - Prolactinum, not influencing on levels of others hormones if they are in norm limits. However, it can reduce the raised levels of a hormone of growth ( a somatotropic hormone) at sick of an acromegalia.
In the postnatal period Prolactinum is necessary to begin with and lactemia maintenance. During other periods of a life the augmentation of secretion of Prolactinum leads to a pathological lactemia and-or to disturbances of an ovulation and a menstrual cycle.
Parlodel as the specific inhibitor of secretion of Prolactinum, can be applied to the prevention or suppression of a physiological lactemia, and also for treatment of the pathological conditions caused by a hypersecretion of Prolactinum. At an amenorrhea and-or anovulatory menstrual cycles (accompanied or not accompanied by a galactorrhea) Parlodel can be applied for the purpose of restoration of a menstrual cycle and an ovulation.
During reception of Parlodel for the purpose of lactemia suppression necessity for application of such traditional measures, as restriction of the use of a liquid disappears. Besides, Parlodel does not break a postnatal involution of a uterus and does not enlarge risk of thromboembolisms.
At sick of an acromegalia, besides depression of concentration of a hormone of growth and Prolactinum in plasma, Parlodel favorably influences clinical implications and tolerance to a glucose.
Parlodel, restoring normal character of secretion of a luteinizing hormone, promotes reduction of expression of clinical implications at a syndrome of polycystic ovaries.
At the same time at patients with the raised concentration of Prolactinum it reduces secretion of this hormone.
Parlodel reduces a tremor, a rigidity, slowness of movements and other symptoms of a parkinsonism at all stages of disease. Efficiency of a preparation usually remains throughout many years (by present time good results of therapy are described at the duration of treatment reaching of 8 years).
Parlodel reduces expression of symptoms of the depression often observed at sick parkinsonism. It is caused by the antidepressive properties inherent in it which presence has been confirmed in controllable researches at patients with the endogenous or psychogenic depression, not suffering a parkinsonism.
Indications
- An amenorrhea (accompanied and not accompanied by a galactorrhea), an oligomenorrhea;
- A syndrome of polycystic ovaries;
- Anovulatory cycles (in addition to antiestrogens).
Premenstrual syndrome:
- Morbidity of mammary glands, the edemas bound to a phase of a cycle, a meteorism, mood disturbances.
- Preoperative preparation for reduction of volume of a tumour and simplification of its excision;
- Postoperative treatment if Prolactinum level remains raised.
Acromegalia:
- As an additional agent in a complex with radial therapy and operative treatment or, in special cases, as alternative to surgical or radial treatment.
Lactemia suppression:
- Prevention or the termination of a postnatal lactemia under medical indications;
- Prevention of a lactemia after abortion;
- A beginning puerperal mastitis.
Good-quality diseases of mammary glands:
- Good-quality nodal and-or cystic changes, especially fibro-kistoznaja a mastopathy.
Illness Parkinson:
Dosage regimen
Parlodel always should be accepted during meal.
At disturbances of a menstrual cycle, female sterility prescribe on 1.25 mg (1/2 tablet.) 2-3 times/day; if the effect is insufficient, a preparation dose gradually enlarge to 5-7 mg/day(frequency rate of reception 2-3 times/day). Treatment continue before normalisation of a menstrual cycle and-or ovulation restoration. If necessary, for preventive maintenance of relapses, treatment can be continued during several cycles.
At a premenstrual syndrome treatment begin for 14th day of a cycle about 1.25 mg (1/2 tablets.) a day. Gradually enlarge a dose by 1.25 mg/sut to 5 mg/day and prescribe before a menses.
At an acromegalia the initial dose makes on 1.25 mg (1/2 tablets.) 2-3 times/day, further, depending on clinical effect and side effects, gradually enlarge a preparation daily dose to 10-20 mg (4-8 tablets.).
For lactemia suppression in the first day prescribe on 1/2 tablet. 2 times (during meal at breakfast and a supper), then within 14 days - on 1 tablet. 2 times/days For prevention of the beginning of a lactemia should be begun preparation reception in some hours after sorts or abortion, however only after stabilisation of the vital functions. In 2 or 3 days after preparation cancellation sometimes there is an insignificant secretion of milk. It can be eliminated, having renewed preparation reception in the same dose within even 1 week.
At a beginning postnatal mastitis preparation dosage is carried out the same as and in case of lactemia suppression. If necessary to treatment add an antibiotic.
At good-quality diseases of mammary glands a preparation prescribe on 1.25 mg (1/2 tablet.) 2-3 times/days gradually enlarge the Daily dose to 5-7 mg (2-3 tablet.).
Parlodel dose should be enlarged slowly so that each patient to pick up the minimum effective dose. A preparation daily dose raise gradually, every week on 1.25 mg; a daily dose divide into 2-3 receptions. Adequate therapeutic result it is possible to reach within 6-8 weeks of treatment. If it does not occur, the daily dose can be raised further - every week on 2.5 mg/days
Average therapeutic doses of Bromocriptinum for mono-or the combined therapy make from 10 mg to 40 mg a day, however by some patient higher doses can be demanded.
If at dose selection there are by-effects, the daily dose should be reduced and supported at lower level within not less than 1 week. If by-effects disappear, the preparation dose can be raised again.
The patient with the impellent disturbances which are becoming perceptible against reception of Levodopum, it is recommended to lower Levodopum dose prior to the beginning of Parlodel application. After achievement of satisfactory effect from Parlodel application it is possible to undertake the further gradual reduction of a dose of Levodopum. At some patients full cancellation of Levodopum is possible.
Side effect
Throughout first several days of treatment at some patients can become perceptible a nausea; less often - giddiness, the general delicacy, vomiting, however these phenomena, as a rule, do not demand the treatment termination.
Parlodel can cause a hypotension, including an orthostatic hypotension which can sometimes lead to a collapse; therefore especially in the first days of treatment it is recommended to supervise a BP.
Besides, there are reports on development a constipation, drowsiness, headaches and, less often, confusion of consciousness, psychomotor excitation, hallucinations, dyskinesias, dryness in a mouth, cramps in muscles, allergic dermal reactions and abaissement of hair.
Application of Parlodel for suppression of a physiological lactemia in the postnatal period was accompanied by development in rare instances an arterial hypertensia, a myocardial infarction, cramps, a cerebral stroke or mental disturbances.
Contraindications
- An uncontrollable arterial hypertensia;
- An arterial hypertensia at pregnancy (including an eclampsia, a preeclampsia or the arterial hypertensia caused by pregnancy);
- An arterial hypertensia in the early and late postnatal period;
- An ischemic heart disease and other serious cardiovascular diseases;
- Serious mental diseases now and-or in the anamnesis;
- A hypersensibility to components of Parlodel or to other alkaloids of an ergot.
Pregnancy and lactemia
At the patients, planning to become pregnant, Parlodel, as well as all other medicinal preparations, after pregnancy acknowledgement it is necessary to cancel, unless there are medical indications for therapy continuation. Parlodel cancellation at pregnancy did not lead to augmentation of frequency of cases of its spontaneous discontinuing. Extensive experience shows, that Parlodel application at pregnancy does not render negative influence on its current or an outcome.
If pregnancy arises at presence at a sick adenoma of a pituitary body and treatment by Parlodel stop, attentive observation for sick throughout all duration of gestation is necessary.
As Parlodel suppresses a lactemia, it should not be prescribed to mothers preferring thoracal feeding.
Treatment by Parlodel can restore ability to a child-bearing. Therefore to women of genital age who do not plan pregnancy offensive, it is necessary to recommend application of a reliable method of contraception.
Special indicatings
It is necessary to avoid reduction of concentration of Prolactinum in plasma below norm and development level in this connection disturbances of function of a yellow body.
There are reports on single instances of development of gastroenteric bleedings and a stomach ulcer. At development of such complications Parlodel should be excellent. During treatment by Parlodel careful observation over patients with a peptic ulcer or having this disease in the anamnesis is necessary.
Precautions at application in the postnatal period
It was informed on rare cases of development in the women accepting Parlodel in the postnatal period for suppression of a lactemia, serious by-effects, including an arterial hypertensia, a myocardial infarction, cramps, a cerebral stroke or mental disturbances. At some patients development of cramps or disturbances of a cerebral circulation was preceded by strong headaches and-or transient disturbances of sight. Though the causal relationship of these phenomena with Parlodel reception is not established, at the women accepting a preparation in the postnatal period for suppression of a lactemia, also as well as at the patients receiving Parlodel under any other indications, it is necessary to measure a BP periodically. When the arterial hypertensia or the expressed, progressing, not eliminated headache (accompanied and not accompanied by sight disturbances) develops or from party TSNS, Parlodel it is necessary to cancel signs of disturbances and immediately to survey the patient.
As at patients with pituitary body macroadenomas signs of a hypopituitarism owing to a prelum or destruction of a tissue of a pituitary body can become perceptible, at these patients before Parlodel appointment it is necessary to spend a full estimation of functions of a pituitary body and to prescribe corresponding replaceable therapy. At patients with secondary adrenal insufficiency the great value has carrying out of replaceable therapy by corticosteroids.
At patients with pituitary body macroadenomas it is necessary to estimate dynamics of the sizes of a tumour regularly. If the tumour augmentation becomes perceptible, it is necessary to survey possibility of application of surgical methods of treatment.
At such patients treatment by Parlodel often leads to reduction of the sizes of a tumour and fast positive dynamics from defects of fields of vision. In serious cases development of a compression visual or other craniocerebral nerves can form the basis for carrying out of an urgent surgical intervention on a pituitary body.
Reports on development in patients with illness Parkinson are known and is long receiving Parlodel in the big doses, a pleural exudate, and also a pulmonary and pleural fibrosis. Patients at whom changes of a pleura and lungs of an obscure genesis develop, it is necessary to survey carefully. It is necessary to consider the problem on Parlodel cancellation also.
Some cases of development of a retroperitoneal fibrosis at patients, within several years accepting Parlodel in daily doses more than 30 mg are described. At a similar category of patients for the purpose of diagnostics of a retroperitoneal fibrosis at early, reversible stages it is recommended to pay attention to its possible implications (for example, back pains, edemas of the bottom extremities, disturbances of function of kidneys). If the diagnosis of fibrous changes in retroperitoneal space is established or suspected, treatment by Parlodel should be stopped.
Influence on ability to driving of motor transport and to management of mechanisms
To the patients which activity is bound to driving of vehicles or work with mechanisms, it is necessary to observe extra care as sometimes, especially within the first days of treatment by Parlodel, the arterial hypotension leading to depression of rate of reactions can develop.
Overdosage
In all cases when the overdosage Parlodel accepted separately took place, lethal outcomes it is noted. The maximum unitary accepted dose of Parlodel known for today, makes 325 mg. At an overdosage such symptoms as a nausea, vomiting, giddiness, an orthostatic hypotension, drowsiness, hallucinations were observed.
Treatment: at an acute poisoning spend symptomatic therapy. For cupping of vomiting or hallucinations Metoclopramidum can be shown.
Medicinal interaction
Application of Parlodel for the patients receiving treatment by Levodopum, is especially expedient when weakening of medical effect of Levodopum is observed or when there are such complications as pathological consensual movements, efficiency depression to the extremity of action of a dose, an "including-deenergizing" phenomenon ("on-off").
Shipping of Parlodel can worsen at reception of ethanol (alcohol).
Conditions and periods of storage
The preparation should be stored at temperature not above 25 C. To protect from influence of direct rays of light. A period of validity - 3 years.
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