

DIVINA - combined hormonal drug
Pharmacodynamics
Estradiol valerate is an ether of natural estrogen - estradiol. The pharmacological effects of estradiol are carried out through specific estrogen receptors in target tissues. By binding to specific receptors, estrogens, among other effects, stimulate endometrial growth and contribute to the development of secondary sexual characteristics.
Medroxyprogesterone acetate is a derivative of natural progesterone -17-alpha-hydroxy-6-methylprogesterone. Medroxyprogesterone acetate binds to progestin-specific receptors and acts on the endometrium, transferring it from the proliferative to the secretory phase.
Estradiol stimulates endometrial growth while increasing the risk of endometrial hyperplasia and cancer. Medroxyprogesterone acetate is added to treatment to counteract this effect.
Pharmacokinetics
After ingestion of estradiol, valerate is absorbed from the gastrointestinal tract (GIT) and undergoes hydrolysis to estradiol using esterases in the liver and the wall of the small intestine. The maximum concentration of estradiol in plasma is reached after 4-6 hours. Circulating estradiol binds to plasma proteins, mainly with sex hormone-binding globulin, and serum albumin.
Metabolites are excreted in the urine in the form of glucuronide and sulphate conjugates. A small portion of the dose is excreted in the feces.
After ingestion of one tablet of the drug Divisek, the maximum concentration of medroxyprogesterone acetate in the blood plasma is reached within 1-2 hours.
Medroxyprogesterone acetate binds to plasma proteins by more than 90% (mainly albumin). In oral administration, the half-life of medroxyprogesterone acetate is 24-48 hours. Medroxyprogesterone acetate is extensively metabolized in the liver by hydroxylation and conjugation.
Medroxyprogesterone acetate is excreted in the urine and bile.
Hormone replacement therapy (HRT) for the symptoms of estrogen deficiency and progesterone.
1 white tablet with:
Active substance: estradiol valerat2 mg;
Excipients: lactose monohydrate; corn starch; gelatin; magnesium stearate; talc; Kollidon K25; indigo carmine (E132), purified water.
1 blue tablet contains:
Active substances:estradiol valerat2 mg; medroxyprogesterone acetate 10 mg;
Excipients: lactose monohydrate; corn starch; gelatin; magnesium stearate; talc; Kollidon K25; indigo carmine (E132), purified water.
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Inside 1 tablet per day (preferably in the evening) for 21 days, followed by a 7-day break, during which menstrual-like bleeding occurs, after which they start again.
For the first 11 days, take white pills containing only estrogen, then for 10 days - blue pills containing a combination of estrogen with progesterone. The drug can be started at any time, if the normal menstrual cycle has stopped or if it is irregular, as well as on the 5th day after the start of menstruation.
Menstrual-like bleeding begins within a week, free from taking Divina. In menopause, there may be differences in the duration of the menstrual cycle. Bleeding can begin while taking blue pills (in this case, the admission should be immediately stopped, and after stopping the bleeding, white pills can be resumed).
If you miss the pill, it should be taken no later than 12 hours and then take the drug in the usual way.
The nervous system: headache; mood changes, including anxious and depressed mood; dizziness; migraine; sleep disorders
From the digestive system: nausea, abdominal pain, dyspepsia, vomiting, flatulence, cholecystitis, cholelithiasis, diarrhea or constipation.
Since the cardiovascular system: increased blood pressure, rarely - thrombosis, palpitations.
From the endocrine system: alopecia, hirsutism, engorgement of the mammary glands, an increase in myomatous nodes.
Allergic reactions: rash, pruritus, erythema multiforme exudative, nodular erythema.
Other: uterine bleeding, vaginal candidiasis, fluctuations in body weight, peripheral edema, changes in libido, cramps in the muscles of the lower extremities, visual disturbances, increased liver plasma transaminase activity (ALT and ACT), alkaline phosphatase, gamma glutamyltransferase, lupus syndrome.
Carefully: MS , estrogen-dependent tumors in history, cholelithiasis, marked obesity (including history), migraine, herpes infection in a Amnesia.
The estrogenic effect of Divina can be reduced while taking it with antihypertensive drugs, indirect anticoagulants, oral hypoglycemic agents; baobiturata, hydantoin, rifampicin, ampicillin, tetracycline, as well as with preparations of microsomal oxidation inducers (including phenytoin, antiepileptic drugs, griseofulvin).
The estrogenic effect of Divina can increase while taking it with drugs that inhibit microsomal oxidation (ketoconazole, cyclosporine).
Divina is contraindicated during pregnancy and lactation.
The drug Divina is not a contraceptive and does not protect against pregnancy. Taking Divin may reduce the effectiveness of high-pressure drugs and antidiabetic drugs. The effectiveness of the drug reduce rifampicin, carbamazepine