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Trioginal - combined drug for intravaginal use. The biocenosis of the vagina is determined by a number of factors, in particular the concentration of female sex hormones. The combination of progesterone and estriol in low doses with a vaginal route of administration has a moderate trophic effect on the vaginal epithelium, contributing to the accumulation of glycogen in it. The accumulation of glycogen contributes to the formation of the optimal acidic environment of the vagina (pH 3.8-4.2), which provides optimal conditions for the life of the Doderlein stick, which in turn prevents the colonization of the vagina by pathogenic bacteria.
The composition of the drug as one of the active substances includes estriol in the ultralow dose of 0.2 mg. Estriol is an estrogen synthesized in the human body. Once in the bloodstream, it forms a complex with specific receptors (in the uterus, vagina, urethra, mammary gland, liver, hypothalamus, pituitary gland), stimulates the synthesis of DNA and proteins. It 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, helps to restore the epithelium during its atrophic changes during the premenopause and menopause, normalizes the pH of the vaginal environment, the vaginal flora, and the vaginal changes, and the vagina, and the menopause, normalizes the pH of the vaginal environment, the vaginal flora, and the microflora of the vagina and menopause epithelium to infectious and inflammatory processes, affects the quality and quantity of cervical mucus.
The composition of the drug as the following of the active substances include progesterone in a small dose of 2 mg. Progesterone is a yellow body hormone. By binding to receptors on the surface of target organ cells, it penetrates into the nucleus, where, by activating DNA, it stimulates RNA synthesis. After the preparation of the epithelium with estriol, progesterone in the composition of the Trioginal preparation promotes the formation of intermediate layers of the epithelium and the synthesis of glycogen, the substrate necessary for the Doderleini stick to take root.
Local saturation with hormones provides colonization of the vagina with Doderlein live chopsticks - the third active ingredient of the preparation Lactobacillus casei rhamnosus Doderleini, belonging to a strain that is known for its resistance to a number of antimicrobials. This creates a similar physiological environment in the vagina.
Absorption estriol happens quickly: time to reach Cmax in blood plasma with intravaginal use for 1-2 hours
The 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 in unchanged form.
Cmax in blood plasma progesterone in blood plasma is achieved 2-6 hours after administration.
Progesterone is excreted in the urine as metabolites, 95% of which are glucuron-conjugated metabolites, mainly 3-alpha, 5-beta-pregnandiol (pregnandion). These metabolites, which are determined in the blood plasma and urine, are similar to substances formed during the physiological secretion of the corpus luteum.
Atrophic vulvovaginitis due to estrogen deficiency; preparation of postmenopausal patients for planned gynecological operations for the prevention of postoperative infectious complications (as part of complex therapy).
1 vaginal capsule contains:
Active substances: freeze-dried culture of lactobacilli Lactobacillus casei rhamnosus Doderleini 341 mg, which corresponds to the content of viable lactobacteria 1 × 108 - 2 × 109 CFU, estriol 0.2 mg, progesterone 2.0 mg;
Excipients: potato starch (~ 41% by weight of the lyophilisate), lactose monohydrate (~ 20.6% by weight of the lyophilisate), sodium glutamate (~ 4.5% by weight of the lyophilisate), sodium thiosulfate (~ 26.8% by weight of the lyophilisate).
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Dosage and Administration
Introduce the Trioginal capsule deep into the vagina, wetting 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.
Preparing 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.
Allergic reactions: itching and irritation at the injection site.
From the reproductive system: bleeding from the vagina; extremely rarely - the tension of the mammary glands, mastodinia (pain in the mammary glands); increased vaginal discharge.
Othernausea; fluid retention.
Arterial hypertension, endometriosis, history of thromboembolic complications in first-degree relatives 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, history of endometrial hyperplasia, epilepsy, bronchial asthma, otosclerosis.
With simultaneous use with inducers of liver microsomal enzymes (phenobarbital, carbamazepine, phenytoin, rifampicin, rifabutin, nevirapine, zfavirenz), the metabolism of sex hormones increases, which can lead to a decrease in the effectiveness of the drug.
Inhibitors of liver microsomal enzymes (ritonavir, nelfinavir) significantly reduce the metabolism of liver microsomal enzymes, but when used simultaneously with sex hormones can act as inducers; Hypericum perforatum drugs can induce estrogen metabolism.
No clinically significant interaction reported.
Pregnancy and Lactation
Use of the drug during pregnancy and lactation is contraindicated.
It is not recommended to use the drug with spermicidal agents.
The drug can not be used for contraception.
It is recommended to carefully monitor patients who have heart failure, impaired renal function, arterial hypertension, epilepsy, migraine, severe liver disease, endometriosis, fibrocystic mastopathy, hyperlipoproteinemia, and the appearance of strong itch during pregnancy or when taking steroid drugs or cholestatic jaundice.
Influence on ability to drive motor transport and control mechanisms
Trioginal does not affect the ability to drive vehicles and mechanisms.
- Brand name: Triozhinal
- Active ingredient: Estriol, Progesterone, Eubiotic
- Dosage form: Vaginal Capsules
- Manufacturer: Bios Industry
- Country of Origin: France