Antibiotics for inflammation of the appendages 5/5 (2)

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Antibiotics for inflammation of the appendages should be given to the patient immediately after an accurate diagnosis is established. At this time, studies can be carried out to determine the type of pathogen, but this is not reflected in the initial treatment. Antibacterial drugs are relevant if the inflammatory process proceeds in an acute form. In some cases, antibiotics are given to patients with an exacerbation of a chronic disease.

  • Types of antibiotics for inflammation of the appendages;
  • Indications for the use of antibiotics;
  • Pharmacodynamics of antibiotics;
  • Pharmacokinetics of antibiotics;
  • Treatment of inflammation of the appendages during pregnancy;
  • Contraindications to the use of antibiotics;
  • Side effects of antibiotics;
  • How to take antibiotics for inflammation of the appendages;
  • Overdose of antibiotics;
  • Interactions of antibiotics with other drugs.

For the treatment of inflammation of the appendages, drugs with a wide spectrum of action are relevant, that is, they kill a number of bacteria that usually lead to diseases of the genitourinary system. Doctors need to remember that the antibiotics chosen for the treatment of the patient must be active against ureaplasma, chlamydia and mycoplasma, because most often it is these organisms that cause the inflammatory process.

The treatment is adjusted after the result of the study, if it is found that another drug is better suited to destroy the identified pathogen. The drug and / or dosage should be changed if the patient’s condition has not improved in a few days, that is, there has been no progress in symptoms and laboratory data.

Types of antibiotics for inflammation of the appendages


In recent years, a number of pathogens have acquired resistance to popular antibacterial drugs of the tetracycline series. It is also worth considering that drugs in this group have a large number of side effects. Specialists in most cases treat inflammation of the appendages with doxycycline (which has minimal side effects and is excreted by the body in a short time).

Another group of effective drugs for the problems under consideration are macrolides. They are not destroyed in the stomach, have a long half-life, therefore they accumulate in the body and thus speed up recovery. The effectiveness of sumamed and klacid has been proven in practice today. Antibacterial drugs from the macrolide group destroy, among other things, organisms that settle inside cells, leading to inflammation.

Fluoroquinolines are the next group that is relevant in the treatment of inflammation of the appendages. The “addiction” of pathogens to these drugs is very, very slow, so there will be no need to change the drug often. If the patient has no contraindications to taking fluoroquinolines, one of these drugs is prescribed:

For the treatment of diseases of the genitourinary system, two or more drugs are used, monotherapy is not indicated. The reason is that the pathogens are often two or more microorganisms, both anaerobes and aerobes. For the destruction of the latter, drugs such as metronidazole and tinidazole are relevant.

Indications for the use of antibiotics

Infectious inflammation of the ovarian appendages is known as adnexitis. For therapy, the use of antibacterial drugs of various forms of release is mandatory. Injectable forms are mostly relevant (into a muscle, into a vein, as well as drugs are available in the form of powders for dilution or ready-made solutions). After a course of injections, the doctor prescribes tablet forms of drugs. Also, in some cases, suppositories or suspensions of antibacterial agents may be prescribed.

The main antibiotics that are prescribed for the inflammatory process in the appendages:

Effective drugs from the group of nitromidazoles:

The doctor prescribes aminoglycosides only if the disease is very severe, or if the infection has spread throughout the body, moving to other organs.

Pharmacodynamics of antibiotics

Antibiotics, which are classified as tetracyclines, kill the ability of the pathogen to multiply. They are effective against such flora:

  • gonococci;
  • streptococci;
  • staphylococci;
  • enterobacteria;
  • whooping cough;
  • salmonella;
  • klebsiella;
  • spirochetes;
  • mycoplasmas;
  • chlamydia;

Antibacterial drugs from the group of fluoroquinols inhibit DNA gyrase and topoisomerase, disrupt DNA synthesis, and through these mechanisms they help to cope with the disease. If the pathogen is resistant to 1st generation quinolines (which is detected during therapy), then the doctor prescribes one of the fluoroquinolones. Kill mycobacteria, mycoplasma and pneumococci drugs of this group, but the 3rd and 4th generation, and the 2nd generation is less effective. Some enterococci can also be destroyed by fluoroquinolones.

Pharmacokinetics of antibiotics

Approximately seventy percent of the taken drug from a number of tetracyclines, which are prescribed by physicians in the diagnosis of inflammation of the appendages, is absorbed in the gastrointestinal tract. The active substance “disperses” through tissues and fluids, and during pregnancy it enters both the placenta and the fetus. Tetracycline antibiotics are excreted unchanged from the body in the urine and feces.

Absorption can be greater or lesser, depending on the type of drug and its form, as well as whether it is taken before, during or after a meal. This point should be indicated by the attending physician when developing a treatment regimen. Especially carefully you need to calculate the time of eating and taking ezithromycin. Josamycin and clarithromycin can be taken without regard to lunch/dinner hours.

Macrolides are collected in large quantities in the blood serum and tissues of the body. During inflammation in the body, macrolides spread well in the air, getting inside the cells and concentrating there. These drugs do not cross the hematoophthalmic barrier. Macrolides break down into simpler elements in the human liver, and are excreted through the gallbladder. The half-life is different for all drugs in the group, but the period is at least 1 hour, maximum 55 hours. Renal failure when taking drugs from the macrolide group does not change the above half-life figures.

The absorption of drugs from the fluoroquinolone group occurs to a large extent in the gastrointestinal tract after the patient drinks the pill. 2 hours after ingestion, the highest concentration of the drug in the patient’s blood occurs. These antibiotics can also affect the fetus, so pregnancy is a contraindication for taking. These drugs are excreted mainly by the kidneys, the gallbladder also plays a small role.

Fluoroquinolones, with the exception of norfloxacin, accumulate in the organs and tissues of the human body. Different drugs from this group have different degrees of disintegration into smaller particles, pefloxacin disintegrates the most. Drugs are excreted by 50% in 3-14 hours, the maximum half-life in some cases is twenty hours. If the patient’s kidney function is impaired, then the drugs are excreted longer, this issue should be clarified with the attending physician and be sure to inform him of all diseases, in addition to inflammation of the appendages. When determining the desired therapeutic dose, one must take into account severe renal failure, if it is present in a patient with inflammation of the appendages.

Treatment of inflammation of the appendages during pregnancy


Pregnancy is a contraindication for the appointment of tetracycline drugs, because these drugs pass through the placenta into the fetus, can be collected in its organs and tissues. Because of this, the unborn child will develop the skeleton incorrectly. Some macrolides are also not used during pregnancy. Clarithromycin has been shown to be harmful to the fetus. And the action of roxithromycin and midecamycin has not been sufficiently studied today.

Relatively safe for the treatment of inflammation of the appendages of pregnant women are such drugs:

If no other treatment is possible, and inflammation of the appendages in a pregnant woman is severe, doctors may resort to prescribing azithromycin. Preparations from the group of fluoroquinolones during pregnancy are prohibited.

Contraindications to the use of antibiotics

Contraindications to the appointment of tetracyclines are:

  • kidney failure
  • hypersensitivity to this drug
  • diagnosis of leukopenia
  • if the patient is less than 8 years old
  • when breastfeeding
  • when carrying a child

Contraindications for treatment with macrolides:

  • pregnancy (only part of the drugs)
  • breastfeeding (clarithromycin and others)

Contraindications for fluoroquinolone therapy:

  • gestation
  • lactation
  • lack of glucose-6-phosphate dehydrogenase
  • the appearance of allergic manifestations in response to taking the drug
  • not suitable for children

Side effects of antibiotics

Tetracycline antibiotics can lead to an increase in pressure inside the skull, to dizziness. In the blood, the number of neutrophils, platelets, and hemoglobin changes. Other side effects of these drugs include:

  • nausea;
  • loss of appetite;
  • inflammation in the gastrointestinal tract;
  • diarrhea or constipation;
  • violation of the functioning of the kidneys;
  • allergic manifestations;
  • anaphylactic shock.

Some of these antibiotics, prescribed for inflammation of the appendages, lead to candidiasis, the development of excessive susceptibility to ultraviolet rays. Tetracyclines in babies can disrupt the formation of bones, including teeth, the shade of enamel changes.

Macrolides can lead to such side effects:

  • allergic manifestations;
  • reinfection with pathogen resistance to erifomycin;
  • pain in the gastrointestinal tract;
  • nausea;
  • drooping of the upper eyelid;
  • vision problems;
  • a significant expansion of the pupil;
  • paralysis of the oculomotor muscles.

Fluoroquinolones also cause a number of side effects, one or some of which may be noted in the patient:

  • loss of appetite;
  • pain in the gastrointestinal tract;
  • diarrhea or constipation;
  • nausea;
  • poor sleep, or awakenings in the middle of the night;
  • headache;
  • convulsions;
  • trembling in the body;
  • decreased vision;
  • Allergy manifestations.

Rare side effects of taking fluoroquinolones include:

  • inflammation in the tendons, joints;
  • negative impact on the functioning of the kidneys;
  • tendon ruptures;
  • problems with heart rhythm;
  • diseases of the large intestine;
  • oral candidiasis;
  • thrush in female patients.

How to take antibiotics for inflammation of the appendages

Medicines classified as tetracyclines should be taken after meals or with meals. For adult patients, the doctor prescribes 100 mg of the drug, the dose is divided into three or four doses. If the child is over 8 years old, the dose for him is calculated according to the formula for a maximum of 25 mg / kg. The course of treatment with drugs of this group is 5-7 days, no more. But this should be indicated directly by your attending physician, self-medication with antibiotics is life threatening!

Treatment with tetracycline antibacterial drugs is canceled if a person develops such manifestations of allergies as burning, itching, redness of the skin. It is better not to take these drugs with milk or products based on it (kefir, fermented baked milk), otherwise the product will be absorbed much worse.

A number of macrolide antibiotics should be taken 2 hours after or 60 minutes before a meal. Erythromycin is recorded with water in an amount of more than two hundred milligrams. Suspensions for internal use must be diluted, before use, read the instructions, which indicate the features of administration and dosage. The doctor prescribes a specific treatment regimen that must be strictly followed. The medicine is taken at certain time intervals, and this plan cannot be deviated from, only in this way the desired concentration of the medicine in the blood and tissues is achieved.

Macrolides are not taken with antacids. The latter are prescribed in the presence of acid-dependent diseases of the gastrointestinal tract. Fluoroquinolones are also washed down with water in large quantities, taken 2 hours before meals. When treating with antibiotics, you need to drink one and a half liters of water or more per day.

Antibiotic overdose

If an overdose of tetracyclines occurs, the side effects of the drugs become stronger. Side effects are listed above. Treatment consists of taking medications to relieve symptoms. An overdose of antibiotics from a number of macrolides is not life-threatening. There are stool disorders, nausea, the heart rhythm changes.

Fluoroquinols in excessive dosage for the life of the patient do not pose a threat. The resulting symptoms are treated outside the hospital. Very rarely, epileptic seizures can occur. An overdose of these drugs affects the joints, liver, cardiovascular system and tendons.

Interactions of antibiotics with other drugs
Tetracyclines should not be combined with therapy with drugs containing such substances:

  • calcium;
  • magnesium;
  • iron;
  • zinc;
  • other metal ions.

The effect of tetracycline drugs is adversely affected by concurrent therapy with barbiturates and carbamazepine. It should be borne in mind that antibiotics from this series reduce the effectiveness of oral contraceptive pills. It is impossible to combine treatment with macrolides and aminoglycosides. Tetracyclines and chloramphenicol or lincomycin are not prescribed together. There are a number of other features of the interaction of antibiotics and other drugs that the attending physician should talk about, given the patient’s medical history and current diseases, in addition to inflammation of the appendages.

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Active Ingredient: Methotrexate.

Active Ingredient: Methotrexate 2.5 mg

Release form, composition and packaging
Coated tablets 1 tab.

Methotrexate is used for treating certain types of cancer, severe psoriasis, or rheumatoid arthritis in certain patients.

Pharmachologic effect
An antitumor agent from the group of antimetabolites – folic acid antagonists. Acts in the S-phase of mitosis. The mechanism of action is associated with the inhibition of the synthesis of purine nucleotides and thymidylate as a result of irreversible binding to dihydrofolate reductase, which prevents the restoration of dihydrofolate to active tetrahydrofolate. More active against rapidly growing cells. It has some immunosuppressive effect.

Pharmacokinetics
To a small extent penetrates the BBB (depending on the dose used). With intrathecal administration, a significant amount enters the systemic circulation. Binding to plasma proteins (mainly with albumin) of plasma is about 50%. Biotransformed in the liver. It is excreted by the kidneys (unchanged) and with bile (less than 10%). T1 / 2 depends on the dose used and has significant individual differences. With repeated administration, it accumulates in the tissues in the form of metabolites.

Indications
Acute lymphocytic leukemia, trophoblastic disease, skin cancer, cervical and vulvar cancer, esophageal cancer, squamous cell carcinoma of the head and neck, cancer of the renal pelvis and ureter, osteogenic and soft-cell sarcoma, Ewing’s sarcoma, lung cancer, breast cancer, germ cell tumors of the testis and testicles , liver cancer, kidney cancer, retinoblastoma, medulloblastoma, penile cancer, lymphogranulomatosis.

Severe forms of psoriasis (in case of failure of standard therapy).

Severe form of rheumatoid arthritis (in case of failure of standard therapy).

Dosage regimen
It is taken orally, administered iv, intramuscularly, intramuscularly. Installed individually, depending on the indications and stage of the disease, the state of the hematopoietic system, anti-tumor therapy regimen.
Side effect
From the digestive system: possible ulcerative stomatitis, anorexia, gingivitis, pharyngitis, nausea; rarely – diarrhea, melena, enteritis, pancreatitis; in some cases (with prolonged daily use) – liver necrosis, cirrhosis, fatty atrophy, periportal liver fibrosis.

From the hemopoietic system: leukopenia, anemia, thrombocytopenia.

From the side of the central nervous system: feeling tired, dizziness; rarely – headache, aphasia, drowsiness, cramps.

From the reproductive system: disorders of oogenesis and spermatogenesis, oligospermia, menstrual irregularities, decreased libido, impotence.

From the urinary system: hematuria, cystitis, severe renal dysfunction.

Allergic reactions: chills, decreased resistance to infection; rarely – urticaria, toxic epidermal necrolysis, Stevens-Johnson syndrome.

Dermatological reactions: skin rash, photosensitivity, pigmentation disorders, telangiectasia, acne, furunculosis.

Contraindications
Severe impaired liver and / or kidney function, leukopenia, thrombocytopenia, pregnancy. Methotrexate should not be used in immunodeficiency conditions.

Pregnancy and lactation
Methotrexate is contraindicated in pregnancy. If necessary, use during lactation should stop breastfeeding.

Women of childbearing age should use reliable methods of contraception while using methotrexate.

In experimental studies, the embryotoxic and teratogenic effects of methotrexate have been established.

Use for impaired liver function
Contraindicated in severely impaired liver function.
Use for impaired renal function
Contraindicated in severe renal impairment.
special instructions
Methotrexate should not be used for ascites, pleural effusion, gastric ulcer and duodenal ulcer, ulcerative colitis, gout or nephropathy (including a history).

It is not recommended for use in patients with chickenpox (including recently transferred or after contact with patients), herpes zoster, and other acute infectious diseases.

Before starting therapy and against the background of the treatment, the picture of peripheral blood, liver and kidney function, chest x-ray should be monitored.

In the treatment of rheumatoid arthritis or psoriasis, a comprehensive blood count should be done at least 1 time per month, and laboratory tests of liver or kidney function at least 1 time in 1-2 months.

When used for psoriasis, the local treatment of the disease should not be interrupted. In case of an overdose, the use of calcium folinate is recommended (but not later than 4 hours later).

When conducting combination antitumor therapy, special care should be taken while using methotrexate in high doses with drugs that have a nephrotoxic effect (for example, with cisplatin).

It is not recommended to vaccinate patients and their families.

Methotrexate (even at low doses) with acetylsalicylic acid should be combined with caution.

In experimental studies, the carcinogenic and mutagenic effects of methotrexate have been established.

Drug interaction
With simultaneous use with vitamin preparations containing folic acid or its derivatives, a decrease in the effectiveness of methotrexate is possible.

The simultaneous use of NSAIDs in high doses can lead to an increase in the concentration of methotrexate in plasma and to an increase in its T1 / 2, as well as to an increase in the concentration of methotrexate not associated with plasma albumin, which in turn enhances the toxic effects of methotrexate (primarily on the gastrointestinal tract and system hematopoiesis).

With the simultaneous use of methotrexate with penicillins (even at low doses), its toxic effects may increase.

With simultaneous use with sulfonamides, especially with co-trimoxazole, there is a risk of increased myelodepressive effect.

When nitrous oxide is used in patients receiving methotrexate, severe unpredictable myelodepression and stomatitis may develop.

With the simultaneous use of valproic acid with methotrexate, a decrease in its concentration in blood plasma is possible.

Colestyramine binds methotrexate, reduces its enterohepatic recirculation, which leads to a decrease in its concentration in blood plasma.

With simultaneous use with mercaptopurine, it is possible to increase its bioavailability due to metabolic disorders during the “first passage” through the liver.

Neomycin and paromomycin reduce the absorption of methotrexate from the gastrointestinal tract.

In patients receiving omeprazole, an increase in the concentration of methotrexate in blood plasma is possible.

With simultaneous use with probenecid, a 3-4-fold increase in the concentration of methotrexate in blood plasma is possible due to a decrease in its renal excretion.

With the simultaneous use of methotrexate with retinoids, an increased risk of hepatotoxic action is possible.

Salicylates potentiate the effect of methotrexate due to a decrease in its renal excretion.

After a course of treatment with tetracycline, methotrexate, used even in low doses, can have a toxic effect.

With the sequential administration of methotrexate and fluorouracil, a synergy of action is possible; fluorouracil introduced before methotrexate may reduce its toxicity.

Cisplatin has a nephrotoxic effect and therefore can reduce the renal excretion of methotrexate, which leads to an increase in its toxicity.

Possible increased toxicity with cyclosporine in patients receiving methotrexate.

A description of the active substances of the drug is provided. The scientific information provided is generalized and cannot be used to decide on the possibility of using a particular drug.

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Active Ingredient: Cabergoline.

Analogs of Cabgolin:Dostinex.

Chemical name
1 – [(6-Allylergolin-8beta-yl) carbonyl] -1- [3- (dimethylamino) propyl] -3-ethylurea.

Chemical properties
This substance is a fairly common dopaminomimetic, a derivative of ergot alkaloids. The tool is synthesized in the form of a white fine powder, which is highly soluble in ethanol, N, N-dimethylformamide and chloroform. The chemical compound is slightly soluble in 0.1 n hydrochloric acid, n-hexane. The product does not dissolve in water.

In medicine, drugs based on Cabergoline are used to treat hyperprolactinemia, and the substance is also used by athletes.

Cabergoline in bodybuilding
The medicine is used to reduce prolactin levels and eliminate unwanted side effects from taking progestin anabolics – trenbolone and nandrolone. During the treatment, athletes monitor the level of prolactin and continue taking the medicine, depending on the results of the tests. It is believed that the substance eliminates fluid retention in the tissues and accelerates the growth of lean muscle mass.

Pharmachologic effect
Hypoprolactinemic.

Pharmacodynamics and pharmacokinetics
Cabergoline is a long acting dopamine receptor antagonist. The drug acts mainly on D2-dopamine receptors, to a lesser extent – on D1-dopamine, serotonin, alpha2- and alpha1-adrenergic receptors.

Laboratory data show that the drug has a direct effect on the synthesis of prolactin by lactotrophs in rats, lactotrophs are located in the pituitary gland. Plasma prolactin levels are significantly reduced, especially in reserpine individuals.

The hypoprolactinemic effect of the drug was carefully studied in two independent, randomized, double trials involving a placebo-controlled and comparative group. The effect of the substance was studied on women suffering from hyperprolactinemia. The test results improved, and the normal menstrual cycle was restored in about 77% of women who took the drug 2 times in 7 days at a dosage of 0.5 mg. In 73% of the subjects, galactorrhea disappeared.

Pharmacokinetic parameters are directly proportional to the dosage of the drug. Eating does not affect the processes of assimilation, metabolism and excretion. After penetration into the digestive tract, the maximum concentration of a substance in the blood plasma was observed after 2-3 hours. With systematic administration of the drug, its equilibrium concentration is several times higher than the concentration with a single dose.

It is not completely known what bioavailability Cabergoline has, but it is unambiguously exposed to the effect of “first passage” through the liver tissue. The degree of binding of the agent to plasma proteins ranges from 40 to 42%, depending on the dose taken. The medicine and its metabolites are quickly and well distributed in tissues and organs, the highest concentration was found in the pituitary gland.

The substance is metabolized by hydrolysis reactions involving urea residues or an acylurea bond in the liver tissues. Cytochrome P450 takes part to a small extent in the biotransformation of the drug. The half-life of the drug is about 65 hours. The substance and its metabolites are completely eliminated from the body within 20 days, mainly through the intestines and urine.

Mild to moderate renal failure and mild to moderate hepatic failure do not require dosage adjustment. With serious violations in the liver, an increase in the concentration of the drug in the blood plasma and AUC is observed. For elderly patients, the drug can be prescribed in the same dosages as for young ones, however, special care must be taken, taking into account all the concomitant diseases and the state of the body as a whole.

The effect of taking the drug is observed after 3 hours, after taking the tablets, reaching its maximum within 48 hours. The duration of the drug is 14 days. Cabergoline does not affect the secretion of other hormones of the anterior pituitary gland or cortisol level. The substance does not have mutagenic activity, slightly reduces fertility.

Indications for use
The tool is prescribed:

  • for the treatment of idiopathic hyperprolactinemia;
    – with macro- and microadenoma of the pituitary gland;
    – patients with amenorrhea, anovulation, oligomenorrhea and
  • – galactorrhea according to indications;
    – to suppress or prevent lactation after childbirth;
    -as part of complex therapy or as a monotherapy for Parkinson’s disease.

  • Contraindications
    The medicine should not be taken:
  • in the presence of hypersensitivity reactions to the active component or – – derivatives of ergoalkaloids;
    – during lactation;
    – patients with uncontrolled hypertension;
    – pregnant women
    – with fibrotic changes in the heart muscle or respiratory system, which – caused disturbances in the functioning of the organs.

  • Caution is recommended to observe:

– with low blood pressure;
– if parallel therapy with dopamine receptor antagonists, antihypertensive – drugs;
– with eclampsia or preeclampsia;
– persons suffering from liver disease;
– with psychosis, including a history of;
– to children.


Side effects
Adverse reactions due to treatment with this substance are quite rare, and in mild or moderate severity.

During clinical trials, the following adverse reactions have been identified.

Most often occur: constipation, headache and dizziness, nausea, pericarditis, peripheral edema, pericardial effusion.

Often develop:

hallucinations, confusion, depression;
indigestion, gastritis, angina pectoris, vomiting;
heart palpitations, flushing and redness of the face;
a decrease in the level of hemoglobin, red blood cells or hematocrit in the blood;
shortness of breath, increased sexual activity, asthenia, pain in the chest and lower back;
weakness, drowsiness (sudden falling asleep in people with Parkinson’s disease).


Less commonly observed:

hyperkinesia, psychotic disorders, fainting, delirium;
malfunctioning of the liver, dyskinesia of the gallbladder and biliary tract, spasm of the vessels of the fingers and toes;
respiratory failure, nosebleeds;
allergic rashes, alopecia, increased levels of creatine kinase in the blood, cramps of the fingers and muscles on the calves;
pulmonary fibrosis, hemionopsia, erythromelalgia, pleurisy, edema (rarely).

Cabergoline, instructions for use (Method and dosage)
Inside.

In order to prevent lactation in the postpartum period, the medicine is taken once, on the first day after birth, at a dosage of 1 mg. To stop the existing lactation, 250 μg of the drug is used, every 12 hours, 4 times. The duration of treatment, therefore, is 2 days.

The treatment of hyperprolactinemia is carried out in accordance with the recommendations of the attending physician.

As a rule, the initial dosage is 500 mcg per week at a time or distributed over 2 applications. If necessary, the dosage can be increased by 0.5 mg per week, for a month. If the likelihood of developing unwanted adverse reactions is increased, then treatment can begin with 250 mg per week.

The standard therapeutic dose is 1 to 2 mg in 7 days. The maximum amount of a drug that can be prescribed per week is 4.5 mg.

Patients with Parkinson’s disease during monotherapy are prescribed from 500 μg to 3 mg of the substance, 1 time per day. The duration of treatment is determined by the doctor.

Overdose
In case of an overdose, the victim has nasal congestion, hallucinations, increased side effects, and fainting. As a treatment, supportive and symptomatic therapy is used.

Interaction
It is better to avoid co-administration of this substance and ergot alkaloids (their derivatives).

The drug is not recommended to be combined with macrolide antibiotics, they increase its bioavailability, more often and more side effects are manifested.

The drug cannot be combined with dopamine receptor antagonists (phenothiazines, thioxanthene, butyrophenone, metoclopramide), this leads to a decrease in the effectiveness of the drug.

Cabergoline is better not to use along with medicines that lower blood pressure.

Storage conditions
Tablets are stored in the original packaging in a cool place.

Shelf life
2 years.

Special instructions
Extra care must be taken in the treatment of patients with cardiovascular diseases, gastric and duodenal ulcers, Raynaud’s syndrome, gastrointestinal bleeding, severe liver diseases (dosage must be adjusted).

The first few days of drug therapy, it is recommended to control the patient’s blood pressure. The drug may cause it to decrease. Also, once a month you need to determine the level of prolactin in the blood. After discontinuation of the drug, prolactin levels can remain at a normal level from 2 weeks to several months.

Before starting treatment, the patient must undergo an examination to identify possible pathologies of the heart valves, liver or kidneys. It is also recommended to do an ECG about 1 time per six months or once a year, in accordance with the doctor’s recommendations. If valve regurgitation worsens, the valve wall thickens, and the lumen narrows, the drug must be replaced.

If during the course of therapy with the agent new clinical symptoms of the respiratory system have appeared, an X-ray of the lungs must be taken. If a patient develops pleural effusion or fibrosis (accompanied by shortness of breath, cough, chest pain and rapid breathing), blood ESR levels increase, additional studies are also needed.

Before starting treatment, it is necessary to accurately determine the cause of the development of hyperprolactinemia in order to exclude the presence of a pituitary tumor.

If you are taking drugs based on Cabergoline, then you can not drive a car and perform potentially dangerous activities, it should be remembered that drugs can lower blood pressure.

For children
This substance, as a rule, is not used in pediatric practice.
With antibiotics
The medicine cannot be combined with erythromycin and some macrolide antibiotics.

During pregnancy and lactation
During pregnancy, the drug is used with extreme caution. Pregnant women can start or continue treatment with the drug only after consulting a specialist.

The drug and its metabolites were found in the milk of experimental rats; it is not known whether the substance is excreted in milk in women. Since the drug can have a negative effect on the infant, it is recommended to stop breastfeeding or replace the medicine.

With antibiotics
The medicine cannot be combined with erythromycin and some macrolide antibiotics.

During pregnancy and lactation
During pregnancy, the drug is used with extreme caution. Pregnant women can start or continue treatment with the drug only after consulting a specialist.

The drug and its metabolites were found in the milk of experimental rats; it is not known whether the substance is excreted in milk in women. Since the drug can have a negative effect on the infant, it is recommended to stop breastfeeding or replace the medicine.

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