Progestogel Patient Information Leaflet - Besins Healthcare
Progestogel Patient Information Leaflet - Besins Healthcare
Progestogel Patient Information Leaflet - Besins Healthcare
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INSTRUCTION<br />
on medical use of medicinal product<br />
<strong>Progestogel</strong><br />
П N013765/01-091008<br />
Registration number:<br />
Trade name: <strong>Progestogel</strong><br />
International nonproprietary name: progesterone<br />
Pharmaceutical form: gel for cutaneous application<br />
COMPOSITION per 100 g<br />
Active ingredient:<br />
natural micronized progesterone - 1 g<br />
Excipients:<br />
octyldodecanol, carbomer 980, macrogol glyceryl hydroxystearate (polyoxyl<br />
hydrogenated castor oil), trolamine (triethanolamine), ethanol calculated with<br />
reference to absolute ethanol 96% (v/v), purified water.<br />
Appearance:<br />
a colorless, semitransparent, slightly opalescent gel with odor of alcohol without<br />
visible particles.<br />
PHARMACOTHERAPEUTIC GROUP:<br />
gestagen<br />
ATC code: G03DA04<br />
PHARMACOLOGICAL PROPERTIES<br />
Pharmacodynamics. The action of progesterone, on the one hand, is based on<br />
blockade of estrogen receptors resulting in an improvement of absorption of fluid<br />
from tissues, a decrease of compression of the milk ducts; on the other hand - on<br />
blockade of prolactin receptors in the breast tissue that leads to a reduction of<br />
lactopoesis. Thus, the local application of the product, by creating a high<br />
concentration of progesterone in the area of application does not exert the systemic<br />
action and makes it possible to avoid adverse side effects.<br />
The mechanism of action of <strong>Progestogel</strong> is based on an increase of<br />
progesterone concentration in the breast tissues. The active ingredient of the<br />
product is progesterone. Progesterone decreases expression of estrogen receptors in<br />
the breast tissues and also lowers the local level of active estrogens by stimulating<br />
production of enzymes (17-beta-hydroxysteroid dehydrogenase and estrone<br />
sulfotransferase) which oxidize estradiol into less active estrone and then by<br />
binding the latter transform it into inactive estrone sulfate. Thus, progesterone<br />
limits the proliferative action of estrogens on the breast tissues. Also, progesterone<br />
possesses the greatest natriuretic effect due to suppression of tubular reabsorption<br />
and increase of cellular filtration, thereby preventing retention of fluid at secretory<br />
transformations of the glandular component of the breasts and as a consequence,<br />
the development of pain syndrome (mastalgia or mastodynia). Along with that,<br />
Approved 09.20.2008 by RUS HA P. 1
transdermal method of gestagen administration allows also to provide an impact on<br />
the condition of the glandular epithelium and vascular network that results in a<br />
decrease of capillary permeability and consequently a reduction of severity of<br />
edema of the breast tissues and disappearance of symptoms of mastalgia.<br />
Pharmacokinetics. At transdermal administration <strong>Progestogel</strong> reaches tissues of the<br />
breasts without being destroyed in the liver and does not exert the systemic effects<br />
on the body. A study of serum concentration of prolactin, estradiol and<br />
progesterone during treatment with <strong>Progestogel</strong> has showed that one hour after the<br />
product application, when its maximum absorption in tissues of the breasts is<br />
observed, the level of hormones virtually does not change. Progesterone absorption<br />
at cutaneous application is about 10% of the dose. Cutaneous applications on the<br />
area of the breasts permit, on the one hand, to decrease the used dose of the<br />
product, and on the other hand, to create a high concentration in the area of action<br />
(as much as 10 times of that in the systemic blood flow). The product undergoes<br />
secondary metabolization in the liver with formation of conjugates with glucuronic<br />
and sulphuric acid. Isoenzyme CYP2C19 is also involved in metabolism.<br />
Eliminated by kidneys - 50-60%, in the bile - more than 10%. The amount of<br />
metabolites eliminated by kidneys varies depending on the phase of corpus luteum.<br />
INDICATIONS<br />
Indications<br />
Mastodynia<br />
Difuse Fibrocystic Mastopathy<br />
CONTRAINDICATIONS<br />
Nodal forms of fibrocystic mastopathy<br />
Tumors (tumor-like formations) of the breasts of unclear etiology<br />
Individual intolerance of any of the components of the product<br />
Cancer of breast and genitals (as monotherapy)<br />
Pregnancy (trimesters II and III)<br />
WITH CAUTION<br />
Hepatic insufficiency; renal insufficiency; bronchial asthma; epilepsy; migraine;<br />
depression; hyperlipoproteinemia, extrauterine pregnancy; incipient abortion;<br />
predisposition to thromboses, acute forms of phlebitis or of thromboembolic<br />
diseases; bleeding from the vagina of unclear etiology; porphyria; arterial<br />
hypertension; diabetes mellitus.<br />
Approved 09.20.2008 by RUS HA P. 2
PREGNANCY AND BREAST FEEDING<br />
There is no sufficient experience of using <strong>Progestogel</strong> during pregnancy. The use<br />
of the product during pregnancy and in the period of lactation is possible only if<br />
the expected benefit for the mother overweighs the potential risk for the fetus and<br />
child.<br />
ADMINISTRATION AND DOSAGE<br />
1 application (2.5 g of gel) containing 0.025 g of progesterone is applied on the<br />
skin of the breasts with an applicator-dispenser until complete absorption 1-2 times<br />
daily or in the 2nd phase (from the 16th through the 25th day) of the menstrual<br />
cycle. The course of treatment - for up to 3 cycles.<br />
The repeated course of treatment may be prescribed only after a consultation with<br />
the doctor.<br />
SIDE EFFECTS<br />
Extremely rarely: tenderness of the breasts, hot flushes, metrorrhagia, decreased<br />
libido. In increased sensitivity to the product components - erythema at the site of<br />
gel application, edema of the lips and neck, fever, headache, nausea.<br />
OVERDOSE<br />
Overdose is unlikely due to a low systemic absorption.<br />
INTERACTION WITH OTHER DRUG PRODUCTS<br />
The action of <strong>Progestogel</strong> can increase against the background of contraception<br />
with combined hormone drugs.<br />
SPECIAL WARNINGS AND PRECAUTIONS<br />
<strong>Progestogel</strong> may be prescribed in mastodynia related to the use of oral<br />
contraceptives, pubertal period, premenopause, premenstrual syndrome.<br />
The product should be applied on the skin of the breast with an applicatordispenser<br />
without rubbing in it and massaging the breasts.<br />
Avoid exposure to direct sun rays after application of the cream.<br />
EFFECT OF THE PRODUCT ON THE ABILITY TO DRIVE A VEHICLE<br />
AND WORK WITH MECHANISMS<br />
There were no studies to reveal a possible effect of the product on the ability to<br />
drive a vehicle or to work with mechanisms.<br />
HOW SUPPLIED<br />
Gel for cutaneous application 1%.<br />
Approved 09.20.2008 by RUS HA P. 3
80 g of the product in AN aluminum tube closed with a screw cap. One tube in a<br />
carton together with a dosing applicator and the instruction on use<br />
Shelf life 3 years<br />
Do not use after the expiry date printed on the pack.<br />
STORAGE<br />
At a temperature not exceeding 25C<br />
Keep out of the reach of children!<br />
DISPENSING FROM PHARMACIES<br />
Prescription medicine.<br />
Name and address of the manufacturer:<br />
Laboratoires BESINS INTERNATIONAL<br />
13, rue Périer, 92120 Montrouge,<br />
France<br />
<strong>Besins</strong> Manufacturing Belgium<br />
128, Groot Bijgaardenstraat,<br />
1620 Drogenbos,<br />
Belgium<br />
Approved 09.20.2008 by RUS HA P. 4