Trioginal - instructions for use, analogs, testimonials and release forms (capsules or vaginal suppositories) for the treatment of atrophic vaginitis and postmenopausal disorders in menopausal women. Composition

In this article, you can read the instructions for using the drug Triojinal. There are reviews of visitors to the site - consumers of this medication, as well as opinions of doctors specialists on the use of Trioginal in their practice. A big request is to actively add their feedback on the drug: the medicine helped or did not help get rid of the disease, which were observed complications and side effects, possibly not declared by the manufacturer in the annotation. Analogues Trioginal with available structural analogues. Use for the treatment of atrophic vaginitis and postmenopausal disorders in menopausal women. Composition of the preparation.

Triojinal - a combined preparation for intravaginal application. The biocenosis of the vagina is determined by a number of factors, in particular, by the concentration of female sex hormones. The combination of Progesterone and estriol in low doses with the vaginal route of administration has a moderate trophic effect on the vaginal epithelium, promoting the accumulation of glycogen in it. The accumulation of glycogen contributes to the formation of an optimal acidic environment of the vagina (pH 3.8-4.2), which provides optimal conditions for the life of the Doderlein wand, which in turn prevents colonization of the vagina by pathogenic bacteria.

The composition of the drug as one of the active substances is estriol in an ultra low dose of 0.2 mg. Estriol is an estrogen that is synthesized in the human body. Getting into the bloodstream, it forms a complex with specific receptors (in the uterus, vagina, urethra, breast, liver, hypothalamus, pituitary), stimulates the synthesis of DNA and proteins. Has a selective effect, mainly on the cervix, vagina, vulva, causes an increase in the proliferation of the epithelium of the vagina and cervix, stimulates its blood supply,promotes the restoration of the epithelium during its atrophic changes during the periods of premenopause and menopause, normalizes the pH of the vaginal environment, the microflora of the vagina, increases the resistance of its epithelium to infectious and inflammatory processes, affects the quality and quantity of cervical mucus.

The composition of the drug as the next active substance is progesterone in a small dose of 2 mg. Progesterone is a hormone of the yellow body. By binding to receptors on the surface of the cells of target organs, it penetrates into the nucleus, where, by activating DNA, it stimulates the synthesis of RNA. After the preparation of the epithelium with estriol, progesterone in the preparation of Trioginal promotes the formation of intermediate layers of epithelium and the synthesis of glycogen - the substrate necessary for the Doderlein's stick to settle down.

Local saturation with hormones ensures colonization of the vagina with live Doderlein sticks - the third active component of Lactobacillus casei rhamnosus Doderleini, belonging to a strain that is known for its resistance to a number of antimicrobials. This creates a similar to the physiological environment in the vagina.

Composition

Lyophilized culture of lactobacilli Lactobacillus casei rhamnosus Doderleini + Estriol + Progesterone + auxiliary substances.

Pharmacokinetics

The absorption of estriol occurs rapidly. Excretion is carried out mainly by the kidneys in the form of metabolites (several hours after ingestion and lasts up to 18 hours), 2% is excreted through the intestine unchanged.

Progesterone is excreted in the urine in the form of metabolites, 95% of them are glucuron-conjugated metabolites, mainly 3-alpha, 5-beta-pregnanediol (pregnannione). These metabolites, which are determined in the blood plasma and in urine, are similar to substances formed during the physiological secretion of the yellow body.

Indications

• Atrophic vulvovaginitis due to estrogen deficiency;
• Preparation of postmenopausal patients for planned gynecological operations to prevent postoperative infectious complications (as part of complex therapy).

Forms of release

Capsules are vaginal (sometimes mistakenly called vaginal suppositories).

There are no other dosage forms, whether it's a pill or a solution.

Instructions for use and how to use them

Insert the capsule deep into the vagina, moistening it in a small amount of water to accelerate the dissolution of the drug.

Atrophic vulvovaginitis due to estrogen deficiency: 1 capsule in the morning and evening for 14 days. If necessary (the preservation of certain symptoms of the disease), therapy can be continued up to 21 days on the recommendation of a doctor.

The maximum duration of the course should not be more than 21 days.

Preparation of postmenopausal patients for planned gynecological operations to prevent postoperative complications (as part of complex therapy): 1 capsule in the morning and evening for 14 days.

Side effect

• itching and irritation at the injection site;
• bloody discharge (clotting) from the vagina;
• tension of mammary glands;
• mastodynia (pain in the mammary glands);
• increased vaginal discharge;
• nausea;
• fluid retention.

Contraindications

• established or suspected breast cancer;
• estrogen- or progesteroid-dependent malignant neoplasms or suspected of them (including endometrial cancer);
• bleeding from the vagina of an unclear etiology;
• untreated endometrial hyperplasia;
• acute and chronic liver disease (before the normalization of indicators of functional liver tests);
• porphyria;
• thromboses (arterial and venous) and thromboembolism at present and in the anamnesis (including thrombosis, deep vein thrombophlebitis);
• pulmonary embolism;
• myocardial infarction;
• ischemic or hemorrhagic cerebrovascular disorders;
• jaundice and / or impaired liver function;
• uncontrolled arterial hypertension;
• congenital or acquired predisposition to arterial thrombosis (eg, protein C deficiency, protein S deficiency, antithrombin 3 deficiency, antibodies to phospholipids (antibodies to cardiolipin, lupus anticoagulant);
• diabetes mellitus with diabetic angiopathy;
• benign and malignant neoplasms of the liver;
• expressed or multiple risk factors for the development of thromboembolic complications (transient ischemic attacks, angina pectoris, atrial fibrillation, complicated cardiac valve disease, extensive surgery accompanied by prolonged immobilization, extensive trauma, obesity with body mass index of more than 30 kg / m2);
• pregnancy;
• lactation period;
• children and adolescents under 18;
• hypersensitivity to the components of the drug.

Application in pregnancy and lactation

Contraindicated use of the drug during pregnancy and lactation.

Use in children

Trioginal contraindicated in children and adolescents under the age of 18 years.

special instructions

It is not recommended to use the drug together with spermicide.

The drug can not be used for contraception.

Use with caution in the following diseases and conditions: arterial hypertension, endometriosis, history of thromboembolic complications in relatives of the first degree of kinship at a relatively young age, risk factors for estrogen and progesterone-dependent tumors, liver disease (including adenoma), diabetes mellitus without diabetic angiopathy, cholelithiasis, migraine or severe headache, systemic lupus erythematosus, endometrial hyperplasia in the anamnesis, epilepsy, bronchial asthma, otosclerosis.

It is recommended to carefully monitor patients with heart failure,renal dysfunction, arterial hypertension, epilepsy, migraine, severe liver disease, endometriosis, fibrocystic mastopathy, hyperlipoproteinemia, as well as the appearance of severe itching or cholestatic jaundice during pregnancy or when taking steroid medications.

Impact on the ability to drive vehicles and manage mechanisms

The trioginal does not affect the ability to drive vehicles and mechanisms.

Drug Interactions

With the simultaneous use of microsomal liver enzymes (phenobarbital, carbamazepine, phenytoin, rifampicin, rifabutin, nevirapine, zfavirenz) with inductors, the metabolism of sex hormones increases, which may lead to a decrease in the effectiveness of the drug.

Inhibitors of microsomal liver enzymes (ritonavir, nelfinavir) significantly reduce metabolism with the participation of microsomal liver enzymes, but with simultaneous application to sex hormones can act as inducers; preparations of St. John's wort can lead to the metabolism of estrogens.

Clinically significant cases of interaction have not been reported.

Analogues of the drug Triojinal

Structural analogs for the active substance:

• Femaflor.

Analogues on the curative effect (agents for the treatment of postmenopausal atrophic vaginitis):

• Angelique;
• Atzilact;
• Balian;
• Estrokad.

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